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People ought to be talking to their families about advance directives | READER COMMENTARY

In this April 1, 2020, photo, health care workers assist a COVID-19 patient at a library that was turned into an intensive care unit (ICU) at Germans Trias i Pujol hospital in Badalona, Barcelona province, Spain.
In this April 1, 2020, photo, health care workers assist a COVID-19 patient at a library that was turned into an intensive care unit (ICU) at Germans Trias i Pujol hospital in Badalona, Barcelona province, Spain. (Felipe Dana/AP)

Dr. Michael Rose’s plea for completion of an advance directive is important (“Help doctors fight COVID-19. Fill out an advance directive,” April 7). Unfortunately, the patient’s request is not always honored in the way they expected. Unless thoroughly discussed with their family prior to the document’s execution, a single relative’s objection can derail the process.

There are certainly other difficult issues (Read Ryan Lawrence’s 2009 commentary in the AMA Journal of Ethics, “Deciding for Others: Limitations of Advance Directives, Substituted Judgment, and Best Interest”). Regardless, COVID-19 is an exceptional crisis that can not be expected to routinely employ advance directives given the enormous flow of critical patients.

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Maryland, fortunately, has a formal protocol allowing the triage of these types of patients. This legal instrument includes not only medical, but also ethical decision factors as to whether a patient will die despite heroic measures (“Coronavirus: When there aren’t enough ventilators, who will live, who will die?” March 31).

Diane Hoffman and Anita Tarzian, Baltimore

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