Advance Directives Are Important, But Are They Enough?

We all know the importance of advance directives in making clients’ healthcare wishes known.  Unfortunately, research tells us that creating such documents does not necessarily ensure that their wishes will be known when it counts.

Consider this: According to a study in the Journal of the American Medical Association, advance directives were not available in three out of four cases when a patient was admitted to the hospital.

Or this: In 67 to 74 percent of cases, physicians were not aware that their patients even had advance directives.

What explains the unavailability of these documents and the lack of knowledge about their existence by the medical professionals who need them?  For one thing, people tend to file away their directives, store them in a safe deposit box, give them to family Members, or even leave them in the estate plan binder you gave them. And why wouldn’t they? Who goes out in the morning thinking “What if I get into an accident or suffer a stroke today… better bring my advance directives with me just in case.” Thus, the documents are not readily available in emergencies, the very situations in which they may be most needed.

To address this problem, a number of electronic registries now provide instant access to advance directives. Utilizing the vast capacity offered by electronic storage and high-speed data transmission, these services permit advance directives to be obtained from just about anywhere, so that these documents can do their intended job at a moment’s notice.

Registries can also help protect clients’ advance directives from being unwittingly superseded — another benefit not widely recognized.  Here’s how: if a patient does not have his or her advance directive in hand when hospitalized, the hospital typically offers the patient the opportunity to complete a new directive, right there on the spot during the admissions process.  This directive is typically the state’s statutory form.  Patients often comply with the hospital’s offer (which is sometimes heard as a request) to complete a new directive –because they want to be cooperative.  But (as you well know), any new directive the client executes will negate the previous directive that you created.  Any non-statutory language that you may have carefully drafted to further clarify and protect the client’s wishes will be undone.

So how do registries work, and what should you look for in recommending one to your clients?  More on this in an upcoming post.

Randi J. Siegel, MBA, is the President of DocuBank, the largest advance directive registry in the U.S., which ensures that the healthcare directives of its 175,000 enrollees are immediately available 24/7/365. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.

Academy Guest Blogger
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