Goals of End-of-Life Care Should Drive Therapy

April 8, 2006

The goals of end-of-life care should drive a patient's therapy and not the other way around, said a panel on the subject at this year's American College of Physicians Annual Session.

The goals of end-of-life care should drive a patient's therapy and not the other way around, said a panel on the subject at this year's American College of Physicians Annual Session.

"Therapeutic tools such as mechanical ventilation and artificial nutrition should not drive decisions about care at the end of life. Therefore it is essential that individuals in some way articulate what their goals of care are," said Joseph Fins, MD, professor of medicine, Weill Medical College of Cornell University, New York City.

In order for individuals to express their "goals of care", they need to be prompted by their physician, said Neil Farber, MD, chief, general internal medicine, Wilmington (DE) Hospital. "I use the annual flu shot season to review proxy status. This allows you to have confidence that the patient's wishes are current," said Farber.

Along with a living will, a proxy (also known as durable power of attorney) is one of two methods that a person can use to have his or her interests advanced at the end of life.

Steven Levy, MD, associate clinical professor of medicine, Lake Erie College of Osteopathic Medicine, Erie, PA, made a point of distinguishing between a living will - a list of treatment preferences - and a durable power of attorney, which designates a proxy for a person if the individual can't make decisions.

The panel agreed that a proxy/durable power of attorney is preferable and superior to a living will. "A living will is a static document. Durable power of attorney allows families to act as they would in real life - with change and fluidity," said Dr. Farber.

Can a person have both? Yes, but it is problematic, said Dr. Levy. "Ideally, you should have only one because the two can conflict with each with other."