After 25 years of public outcry over the right to die with dignity doctors are still ignoring patients' last wishes, according to a new study of terminally ill patients.
The study, reported in the current issue of The Journal of the American Medical Association, has found that doctors often misunderstand or ignore the patients' requests, with the result that large numbers of people still die alone, in pain and tethered to mechanical ventilators in intensive care units.Twenty-five years since the living will movement began, the study's authors say they have discovered that the wills, which are supposed to give terminally ill patients legal safeguards against unwanted medical treatment, offer vir-tually no protection.
The study also found that increasing communication between doctors and patients did not help. "People think advance directives are solving the problem," said Dr. William Knaus, one of the researchers who directed the study.
"We have very good information that they aren't, that nothing has changed - the amount of pain at the end of life, the number of people dying alone attached to machines."
The researchers found large gaps between what the patients wanted and what they got. Thirty-one percent of patients said they did not want cardiopulmonary resuscitation, but 80 percent of the doctors misunderstood or ignored their patients' wishes.
Forty-nine percent of the patients who wanted to avoid cardiopulmonary resuscitation by having their doctors write do-not-resuscitate orders did not get their wish. The patients who did had to wait a long time for the doctors' orders.