Published ahead of print on September 11, 2002, doi:10.1164/rccm.200206-503OC Am. J. Respir. Crit. Care Med., Volume 166, Number 11, December 2002, 1430-1435 A more recent version of this article appeared on December 1, 2002
Submitted on June 3, 2002 Patient, Physician and Family Member Understanding of Living WillsAnupama Upadya1,1 Internal Medicine, Bridgeport Hospital, Bridgeport, CT, USA, 2 Internal Medicine, Bridgeport Hospital, Bridgeport, CT, USA; Internal Medicine, Yale University School of Medicine, New Haven, CT, USA * To whom correspondence should be addressed. E-mail: pcmant{at}bpthosp.org.
This study examines understanding of living wills by patients, family members and physicians. Questionnaires were used to examine whether each cohort understood patient's living wills regarding endotracheal intubation and cardiopulmonary rescuscitation (CPR). Of 4,800 patients admitted during the study period, 206 reported having living wills, all of which precluded intubation and CPR for terminal conditions. Of 140 admitted to the general hospital wards, 17 (12% of) wanted their living wills to preclude intubation/mechanical ventilation and 12 (8.6%) did not want resuscitation under any circumstances. Seven of 120 (6%) physicians and 5 of 108 family members would not intubate or perform CPR even if there was a chance of recovery. Of 88 patients with complete data (including physicians and family members), 29 (33%) wanted their living wills to block intubation/mechanical ventilation only if they were deemed terminal and 46 (52%) wanted the living will to block intubation even if there was a 10% chance of recovery. Thirteen (15%) wanted to block intubation even if the chance of recovery was Key words: living will, advance directive, death, mechanical ventilation, endotracheal intubation, cardiopulmonary resuscitation
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50. Results were similar for wishes regarding CPR. These data suggest substantial differences of patient, physician and family member understanding of living wills. Living wills did not reflect fully patient's expectations of receiving (or not receiving) life-sustaining modalities.
