Advance Directives/ care planning : clear, simple and wrong

Abstract

I have been thinking a lot recently about the eerily prophetic words of the early 20th century journalist and satirist, H.L. Mencken, in the midst of New York’s COVID-19 pandemic. As I read Waller and colleagues article ‘‘Impact of Advance Directives on Outcomes
and Charges in Elderly Trauma Patients’’ in this issue of Journal of Palliative Medicine, I could not help but think of Mencken’s biting satire again—quoted at the top of my editorial. Yet again, 30 years after the Patient Self-Determination Act of 1991, we have a report that documents that the vast majority of adults (this time trauma patients 55 years and older) have not completed an advance directive, and for those who did, the advance directive had no discernable influence on the care received.