Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117026

Hana Osman, MSSW, PhD, Community and Family Health, University of South Florida College of Public Health, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL 33612, 8139740989, hosman@hsc.usf.edu and Marion A. Becker, PhD, Florida Mental Health Institute / Community Mental Health, University of South Florida, 13301 Bruce B. Downs Blvd, Tampa, FL 33612.

Since the Patient Self-Determination Act (PSDA) became law in 1991, nursing homes routinely address advance directives with all residents. In more recent years, scholars have suggested that advance directives are not useful in the practice of health care, and that it is time to abandon the PSDA. This study investigated the implementation of end-of-life care wishes of residents in one nursing home in Florida, as expressed in their advance directives. Data were collected from the medical records of residents who died in the facility (n=75) in one year. Two-thirds of the residents had either completed a living will, or designated a health care decision maker, and 90.7% of the residents had do-not-resuscitate orders. Findings suggest that in 94% of the cases advance directives were followed, and that professional social work activities contributed to the high rate of compliance. Case studies demonstrated the difficulties that families and health care providers experience in applying residents' end-of-life health care wishes. The difficulties include vagueness of the contents of the documents; residents' psychiatric condition; and family members' hesitance to make the final decisions responsible for patients' death.

Learning Objectives:

• Discuss the effectiveness of advance directives in end-of-life decision making
• Outline the ethical principles that underlie the formation of advance directives
• Develop arguments for and against the completion of advance directives

Keywords: End-of-Life Care, Ethics

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.