Re-framing Advance Directives as Patient Safety Tools

(Many thanks to Emily Eliot Miller of Death Jewel for inspiring the thoughts in this post)

A woman I know was recently admitted to the hospital for observation after a concussion. She was shocked to find a DNR order pasted on her door.

I think the majority of conversations about Advance Directives focus on making sure your wishes are documented. I know in my experience they also always come along with a conversation about over-treatment: unwanted hospitalization, unwanted CPR, unwanted dependence on machines to sustain life.

But, as my good friend and colleague Emily Eliot Miller points out, there is a pressing reason to separate the two conversations. Because for many people, the fear is not over-treatment, but under-treatment.

As the national dialogue on racism in American institutions continues, one of the many important conversations is about how people with black and brown bodies are treated differently in our medical institutions. Another conversation is about how the white, American medical institutions have preyed on and discarded those with black and brown bodies, resulting in a deep-seated mistrust of these institutions that has yet to be properly addressed, let alone rectified.

And, there is an intersection between the implicit racism of our medical institutions and the treatment of those with bodies that are also “othered” – those with disabled bodies, bodies that don’t match their preferred gender, those with chronically ill bodies, those with fat bodies, also face the very real fear that their bodies will be treated differently. Or not at all.

So, yes, an Advance Directive is a way to document your wishes for medical treatment. But let’s also start talking about it as a way to ensure patient safety. To make sure every person gets the treatment they WANT.  Treatment many are afraid they will not get.

It sounds simple, but it won’t be easy. We have a long way to go to make sure every single person is treated as a whole human by our medical system. But an easy first step is to stop talking about Advance Directives as a way to prevent over-treatment and to start talking about Advance Directives as a way for patients to feel seen and heard as whole humans.

Let’s make Advance Directives into tools for patient safety.

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