A Practical Method to Protect Patient Autonomy Using Conditional Medical Orders

Abstract

Throughout the world, patients have the right to determine what is done to their bodies, and to have their wishes recorded and honored when undergoing medical interventions. Unfortunately, many patients receive treatment that does not concur with their goals. Many patients are reluctant to discuss advance care planning because they are intimidated by the need to contemplate their own serious illness and/or death. Even if patient preferences are elicited, they may not be understood or clearly recorded, and if recorded, may not be accessible when needed. Conditional Medical Orders are one efficient way to concisely record patients’ preferred modes of treatment in a form that can be prominently placed in patients’ medical records and carried with them for use in outpatient medical care. It requires provider signatures because it combines an advance directive with treatment orders, providing assurance that the medical record accurately reflects patients’ preferences. Unlike most order sets that reveal little about patients and force them to make rigid binary choices, this order set identifies patients’ values and offers them more realistic options that stipulate the conditions under which each procedure is desired. Although only a single page, this order set is more complete than other forms. It is partly standardized and partly editable so it can be adapted to patient and provider preferences. The flexibility of this order set makes it more acceptable to many patients who have been averse to traditional approaches to advance care planning that they consider too rigid and insensitive to their evolving healthcare needs. Providers appreciate both the efficiency with which the orders can be completed and their specificity which facilitates delivering treatment that concurs with patients/ treatment goals.