Advance directives often ineffective

An American study has called into question the effectiveness of advance care directives, saying people often change their end-of-life preferences without realising.

The University of California Irvine paper published in the Health Psychology journal says ‘false memories’ can lead to a gap between an individual’s true desires and the instructions in their living will.

“Living wills are a noble idea and can often be very helpful in decisions that must be made near the end of life,” said Peter Ditto, Professor of Psychology and Social Behavior at UCI and co-author of the study.

“But the notion that you can just fill out a document and all your troubles will be solved, a notion that is frequently reinforced in the popular media, is seriously misguided.”

In the study Ditto and his colleagues interviewed a sample of 401 people over the age of 65 about the life-sustaining treatments they would want if they were seriously ill.

A year later they conducted the same interviews again and found that close to a third of participants had changed their views about treatments such as CPR and tube feeding.

Disturbingly, three quarters of the participants who changed their preferences thought they had not.

The interviewers also talked to the participants’ substitute decision makers and found that 86 per cent of them had “false memories”.

“On a policy level, these results suggest that living wills should have an ‘expiration date’,” said Ditto.

“People can’t be counted upon to update their directives as their wishes change because they often have no awareness that their wishes have changed.” 

“On a more personal level, our research stresses the importance of maintaining an ongoing dialogue among individuals, their families and their physicians about end-of-life treatment options.”