Young adults forget their own life-support decisions

May 30 2005

More than half of young adults soon unwittingly change their minds about decisions they make governing future life-saving medical treatment for themselves, a new study has found.

Asked if they would want to be resuscitated or given drugs in a hypothetical life-threatening event, most of the study subjects had forgotten their decisions only a few months later and gave different instructions.

The finding, to be presented at the American Psychological Society convention in Los Angeles, suggests that advance directives - or so-called living wills - made by young people should be reviewed regularly.

It comes in the aftermath of the recent controversy surrounding the death of a severely brain-damaged Florida woman, Ms Terri Schiavo.

Ms Schiavo had left no prior written instructions about the extent of medical care she wanted, prompting a much-publicised family legal battle and fierce political debate in the US about how long life-support systems should be used.

The new study was carried out by Dr Stefanie Sharman, UNSW psychology researcher and her colleagues, Maryanne Garry (Victoria University of Wellington), Peter Ditto and Elizabeth Loftus (University of California at Irvine). The team interviewed 31 young adults - aged 18 to 22 years - on two occasions, four months apart.

Respondents were asked whether or not they wanted each of four treatments (antibiotics, cardio-pulmonary resuscitation, gall-bladder surgery, and tube feeding) in nine hypothetical medical scenarios. The scenarios included Alzheimer's disease, emphysema, coma, paralysis and cancer.

In the second interview, respondents were asked whether they thought their decisions had changed. They were asked as well to give reasons for each treatment decision and their mood was measured during interviews.

"We found that 58 per cent of the people surveyed changed at least one of their decisions in the space of four months, without realising it," says Dr Sharman. Other key findings were that:

• On average, the respondents changed six of their 35 treatment decisions between interviews;
• One-third of them knowingly changed their minds about at least one treatment. On average, these people changed nearly eight of their decisions;
• Only seven per cent of respondents knowingly did not change their minds about any of the treatments;
• The decision changes were not systematic - respondents were just as likely to change their minds about wanting treatment as they were about not wanting treatment;
• The likelihood of them changing their treatment decisions was linked to changes in their mood or to giving different reasons for their decisions between the first and second interviews.

"These findings suggest that more than half of young adults who change their mind about advance treatments won't update their advance directives because they see no need to do so," says Dr Sharman.

"In a worst-case scenario, these people will not receive the medical treatment that will keep them alive. Our findings indicate that young people are poor at remembering advance decisions about their future medical treatment. If these findings are confirmed by other similar studies, clearly, these kinds of decisions need to be reviewed frequently."