The following materials explain the value of supplementing a written document advance directive with a video of the patient explaining her preferences, goals, andvalues.
Journal of Patient Safety (2023)
In this Journal of Patient Safetyarticle, Ferdinando Mirarchi and I explain the value of video advance diretives. Here is the abstract for "Widespread Misinterpretation of Advance Directives and Portable Orders for Life-Sustaining Treatments Threatens Patient Safety and Causes Undertreatment and Overtreatment."
Advance directives (ADs) and Portable Orders for Life-Sustaining Treatment (POLST) are powerful communication tools that help preserve an incapacitated patient’s wishes regarding life-sustaining treatment. They also help prevent conflicts, reduce moral distress, and control health care costs. Portable Orders for Life-Sustaining Treatments can even predict the location8 and possibly timing of death. However, despite all these benefits, ADs and POLSTs too frequently result in medical errors.
These medical errors manifest as both undertreatment and overtreatment. With undertreatment, a patient suffers harm or dies. For example, clinicians do not perform advance cardiac life support on a patient that should have been a full code patient. The patient fails to receive potentially beneficial life-sustaining treatment that they wanted.
In contrast, with overtreatment, a patient is harmed by receiving unwanted medical treatment. They are often forced to live against their predetermined wish to die naturally, often in the very circumstances that they wanted to avoid. For example, clinicians administer cardiopulmonary resuscitation on a patient with a do-not-resuscitate (DNR) order, or they aggressively treat a patient with orders for comfort measures only (CMO). Today, a growing number of malpractice lawsuits are settled or adjudicated in favor of families when patients receive treatment discordant with their AD or POLST.
In this article, we first describe the issue of discordance. Because clinicians frequently misinterpret POLSTs and ADs, patients regularly get treatment discordant with the orders and instructions in those documents. This discordance often results in wrongful prolongation of life or death. After describing this problem, we turn to solutions. Fortunately, we may already have better tools to mitigate discordance and improve patient safety. We specifically highlight the promise of video testimonials.
SMU Law Review (2020)
In this 2020 article in the SMU Law Review I make the case for video advance directives as a valuable, additional way for individuals to record their health care treatment preferences.
Supplementing a traditional advance directive with a video advance directive increases the likelihood that surrogates and clinicians will understand and follow the patient’s recorded wishes in the way the patient intended.
Perhas the most distinctive video advance care planning solution is MIDEO, which stands for My Informed Decision on vidEO. Unlike other AD videos, MIDEO is clinician directed. It is packaged in a usable format for medical providers and makes sure wishes are clear to the intended audience which is the clinician.
Dr. Stanley Terman helps his patients record video advance directives. Like MIDEO, he facilitates and guides these discussions. Here is one example of a discussion with patient Pan Haskins.
Canadian Virtual Hospice shares several videos where patients explain what would be a good death for them.
Videos on Importance of Advance Care Planning
These are some of my favorite videos on the importance of advance care planning and on the importance of careful, quality advance care planning.