>     Hello,
>
>     I am also writing for the first time to the listserv although I have
>     been lurking for at least a year.  I find the discussion stimulating
>     and informative.  At present Alberta (my home) is preparing to
>     proclaim legislation pertaining to living wills, called the Personal
>     Directives Act.  I am looking for a validated survey questionaire
>     addressing the issue of quality of life for people who write or not
>     write a personal directive.  The intent of this legislation is to
>     allow autonomy and self-determination for control over future
>     decisionmaking.
>
>     The objective of the survey is to determine what influences people to
>     write or not write a personal directive and satisfaction  For my PhD
>     proposal I am considering researching the utilization of services in
>     the last year of life for people with and without an advance
>     directive.  A similar study was done in the U.S. that found no
>     difference in length of stay, treatments offered and decisions made
>     when comparing the two groups.  As there is a public perception that
>     advance directives "save money in Health care costs", I believe it
>     would be a good study.  Any thoughts on this type of research are
>     welcome.  Any insight to a survey questionaire would be most helpful.
>
>Thank you
>Deborah St.Arnaud
>EMAIL [log in to unmask]
>______________________________ Reply Separator
_________________________________

Hi Deborah,
Your comments made me think about the perception of saving money and whether
this would be the question I would pursue in this area.  I work in health
promotion, but I am thinking about your research question from a personal
perspective, having just come through a year of losing both parents in Ontario.

Both had advance directives - Living Wills - that dealt with no heroic
measures, and the administration of medication to provide comfort at a point
when they were close to the end, even if it would hasten their death.

If I understand the perception of saving money correctly, I assume that
means that, if people opt for a palliative philosophy of comfort measures
with the least invasive procedures throughout this period, however long that
might be, then the expense of tests, surgery, equipment and/or other forms
of treatment that are not adding to quality of life are avoided.  Is that
what you meant?  To me, that seems to be a given.  It was applicable in our
situation.

We followed their directives in the decisions we made, and I am sure we put
less 'stress' on the health care system as a result.

I wonder if you can pose a more open-ended question (you'll be able to tell
that I haven't had to do a thesis or dissertation proposal!) about what
difference does it make to the person who gave the directive and to their
caregivers, to have an advance directive in place?

For us, it meant peace of mind when it came to decisions about treatment,
about whether to introduce tube-feeding or IV fluids, about the type of
medications to use and their amounts, and about the desirability to preserve
and work hard for maximum quality of life, even when their capacities were
narrowing.

For my parents, I think it meant trust that the people around them knew what
they wanted, at a philosophical level, and knew that we would honour their
wishes.

I hope these thoughts hold some value for you.  I'd be interested to hear
more if you have time in the future to say more about your research.

Ann











>Subject: Re: Request info.
>Author:  Health Promotion on the Internet <[log in to unmask]> at Internet
>Date:    3/25/97 5:10 PM
>
>
>Dear Peter,
>
>I will relay your message to my husband, who directs a crisis-house
>program, and who has been doing more dual diagnosis work lately.
>
>He may have information or referrals.
>
>If you are preparing to study the issue, don't forget to include diet, a
>much neglected effect-modifier of physiological response.
>
>Best wishes,
>
>Jean Norris (spouse of Brad Hestir)
>
>
>>>Date: Tue, 25 Mar 1997 16:11:31
>>>To: CLICK [log in to unmask]
>>>From: Peter Bennett <[log in to unmask]>
>>>Subject: Request info.
>>>
>>>Good afternoon listmembers,
>>>This is the first time I've posted anything on this list, and it may be out
>>of the ordinary, if not out of line. Presently, at my place of employment,
>>we are changing some programs, and instituting new ones. One of these has to
>>do with dual disorders/dual diagnosis. We have a great deal of information
>>from Kathleen Sciacca, however we are looking for other sources as well. We
>>are particularly interested in areas regarding pharmacological effects on
>>those with chronic alcohol problems, i.e. side effects, contraindications,
>>etc.
>>>We are also seeking examples of different modalities for treatment, as at
>>present we have nothing on which to pattern our program.
>>>If anyone out there can help, we would be very gratefull. Please send your
>>replies to me by private e-mail.
>>>
>>>                              [log in to unmask]
>>>
>>>If this request is not in keeping with the purpose of this list, please let
>>me know, and I apologize.
>>>
>>>Thankyou.
>>>Peter Bennett
>>>
>
>
>Jean C. Norris, MS, RD, DrPH            phone (510) 642-4498
>Postdoctoral Researcher                 email [log in to unmask]
>School of Public Health
>590E University Hall
>Berkeley, CA  94720-7360
>
>