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Legal restrictions deter advanced directives
a.though all states and the District of Columbia have laws providing for the use of advanced directives, those same legal statutes might hinder the effective use of advanced directives, according to researchers at the University of California, San Francisco.1
In a review of 51 statutes addressing advanced directives as well as articles and legal proceedings, researchers discovered several unintended barriers to effective clinical use. Barriers included poor readability because all of the laws were written above a 12th-grade reading level. Another barrier was health care agent or surrogate restrictions. Forty states did not include same-sex or domestic partners as default surrogates. Execution requirements needed to make forms legally valid also can pose problems.Thirty-five states did not allow oral advance directives, and 48 states required witness signatures, a notary public, or both.
The researchers suggest doing away with mandatory legal language; relaxing health care agent and surrogate limitations, including non-medical professionals who might be close to unbefriended adults; promoting universal acceptance of oral advance directives; and eliminating witness and notary requirements.
They recommend that all states adopt nonrestrictive reciprocity laws for directives from other states, regardless of the location or type of advance care planning tool used, and urge that patients be allowed to document their religious, social, and cultural values and preferences for end-of-life care.
1. Castillo LS, Williams BA, Hooper SM, et al. Lost in translation: The unintended consequences of advance directive law on clinical care. Ann Intern Med 2011;154:121-128.