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Published in CenterView on April 09, 2012

UMMC employees can register end-of-life health-care decisions at ethics event

By Bruce Coleman

Mark Twain's two certainties of life will converge next week when the University of Mississippi Medical Center hosts its first National Health Care Decisions Day event in the University Hospital walkway.

From 10 a.m.-2 p.m. on Monday, April 16 – better known as Tax Day 2012 – UMMC faculty and staff will have the opportunity to officially register their personal end-of-life health-care decisions during a gathering cosponsored by UMMC's Center for Bioethics and Medical Humanities and the Ethics Advisory Committee.

The occasion is part of a national health-care decisions awareness event by the American Health Lawyers Association, the American Bar Association and the American Medical Association.    

Ethics committee members and social workers will be on hand to provide information about advanced directives – legal documents that allow patients to convey their decisions about their end-of-life care ahead of time – and assist Medical Center employees in completing the necessary forms. When UMMC's electronic health-care record system launches in June, the employees' advanced directive information will be recorded in EPIC.

"There's a large percentage of Medical Center employees and staff who use University Physicians," said Sue Ann Meng, social worker in coordinated care who suggested the event at UMMC. "This will become part of their medical record here, or they can take it to whoever their health-care provider is.

"All medical staff then will know what the patient's wishes are and who the power of attorney is – the person responsible if you are unable to make decisions."

In the aftermath of the Terri Schiavo case, a legal battle over who had the right to make the decision about prolonging life support, many states passed legislation to determine who the appropriate surrogate decision-maker should be for patients unable to make their own health-care decisions. Meng said having an advanced directive on file not only eliminates confusion over who can make end-of-life decisions for a patient, but also saves families the agony of having to make difficult decisions about their loved one.

"Families are so overwhelmed having to make horrible decisions, so if they can do that knowing what the person's wishes are, that makes decisions much easier on loved ones," she said. "Otherwise, the family is put in a position of having to guess or make a decision based on their emotions, not necessarily on what the patient wants done. 

"I've been a social worker long enough that I think everybody should have an advanced directive."

According to Dr. Ralph Didlake, professor of surgery and director of the Center for Bioethics and Medical Humanities, advanced directives can answer a wide range of ethical questions.

"The majority of ethics consultations are tied to some issue of surrogate decision-making or end-of-life decision-making, and it (an advanced directive) really simplifies the ethics consultation process," he said. "We're really strongly supportive of patient autonomy, the right of patients to decide what happens to them.

"The advanced directive is the best way to protect that autonomy."

Aside from the practical aspects of advanced directives, Didlake said end-of-life care also has an academic consideration.

"We want to explore the role of advanced directives in human-subject research," he said. "Should it be required of research participants to have an advanced directive? That's something we're interested in studying."

Advanced directives are included in meaningful-use criteria for electronic medical records under the Affordable Health Care Act of 2010, according to Susan Shands Jones, UMMC's associate general counsel.

"One proposed regulation encourages the institution to have a high percentage of patients 65 or older with an advanced directive," she said. "That's considered best practice because more expenditures are incurred during the last weeks of life, and the health-care providers need to know the patients' wishes."

Jones said the health department provided the form "pursuant to state law," but individuals who file an advanced directive maintain the right to change their decision at any time.

"It's important to note that it can be rewritten at any time, just like any power of attorney," she said. "Changes in life could be a factor in that decision. Having children might lead young couples to make a change."

Those interested in having end-of-life health-care decisions registered are invited to review information on the Center for Bioethics and Medical Humanities website before filling out an advanced directive at the event, or simply attend the event for more information. Either way, Meng said the event will be successful if it sparks conversations among the Medical Center community.    

"Even if no advanced directive is filed, if this leads people to have a conversation with their families so they will know what the patient would like to have done, it would take so much burden off the family in a crisis," Meng said. "Having these conversations with families is so important."