Advance Directive Concept

The topic of end-of-life care may seem daunting and uncomfortable, and yet most individuals do have unique desires and concerns regarding their provision for the future. Providing the opportunity for that communication, the advance directive and POLST forms allow an individual to explicitly state their wishes before the future. Developed to lessen the apprehensions concerning patients undergoing any extensive and unwanted measures to preserve life at any cost, these medical directives lighten the decision-making burden for physicians and families alike and help comply with the patient’s utmost end-of-life wishes.

Advanced care directives are legal documents provided to physicians and health care workers with an outline containing preferences for the treatment at end of life. Patients often do not discuss their wishes regarding end-of-life care with family members or health care providers prior to the event of a serious illness or traumatic event. Educational interventions focus on raising awareness and providing patients with information on advance care planning.

There are two types of advance directives: a Living Will and the Durable Power of Attorney for Health Care. A Living Will requires a witness or be notarized and consists of a directive that instruct the acting physicians to not utilize medical interventions in an instance that the patient is unable to make their immediate medical decision. The Living Will is the oldest form of advanced directives, requires a patient be terminally ill and it states that its interpretation is only to be assumed by the patient and their physician, there is never to be any family influence or interpretation of a Living Will. Durable Power of Attorney for Health Care is also witnessed or notarized and identifies an ‘agent’ to make health care decisions if the signer is unable to make their own decision. An agent is an individual that the patient chooses with great care, due to the amount of power/authority that is assumed to making such decisions. The Durable Power of Attorney does not require that a patient be terminally ill and is interpreted by the identified ‘agent’. There have also been known to be hybrid documents that combine elements of a Living Will and Durable Power of Attorney for Health Care that acts as an Advanced Directive. (Advanced Directives.,

The Advance Directives form is somewhat different but its purpose is the same: to let an individual make end of life decisions. It is a longer form, with more involved questions.

In a world of advancing healthcare, it is important to keep the patient’s dignity and autonomy as the focus of practice. One way to further patient centered care is the implementation of advance directives. Advance directives are written wishes or instructions relating to an individual’s extent of care when they are unable to communicate themselves. (Galambos, 1998). This written document is recognized under State law and should be recognized and honored by healthcare providers while caring for the patients. Two of the most common forms of advance directives include a living will or durable power of attorney for healthcare. It is common during a hospital admission for a patient to be presented with a living will, or a checklist of medical interventions the individual is willing or unwilling to accept (Mahon, 2011).

This film explains the legal role of advance directives in end of life issues. An advance directive is “a written document directing how medical decisions are to be made in the future when the patient lacks decisional capacity and is unable to decide and choose” (Hanlon, End of Life Issues, Slide 28, Bullet 1). All three of the cases demonstrate the importance in filling out some form of directive. When there is nothing to go off of, it makes decisions extremely tough for families and medical providers. Having legal documentation of patient wishes helps understand what treatments they would or would not consent to. In cases like

If you have ever had to watch someone die in the hospital, then you understand how difficult it is to see them hooked up to machines, it is what is keeping them alive. Without proper preparation, it is eventually up to the family to decide your fate at the end of your life. Preparing an Advanced Directive is the only concrete way to make sure your needs and wants are actually met. It is your responsibility.

The purpose of an advance directive is a legal document that will tell your caregivers and doctors, in the case you can’t communicate, how to treat you in a medical situation. Sometimes people can become terminally ill and/or sick and they become unable to make medical decisions should they need to. Advanced directives can by in many different varieties depending on a person’s preference and comfortability using and making. Each state has their own rules and guidelines and everyone should be aware of what their states laws are.

The purpose of an advance directive is to have a written statement stating the type and amount of care a person wishes to receive during a terminal illness. (Medical Law and Ethics, 2008, pp. 102) An advance directive is a very important part of life once you have been diagnosed with a terminal illness, or even if you are getting older and doubt the degree to which you will be taken care of.

End of life decisions are very important because in some cases people lose the ability to provide informed consent for their medical treatment. If someone was unable to make his or her own health care decisions it becomes the responsibility of his or her designated surrogate. For example when someone is pronounced in a persistent vegetative state their health care surrogate would determine what kind of life prolonging procedures should be provided. During some point throughout a person’s lifetime it’s significant they make a Living Will that lists all of their intentions that will be respected by their family, friends and physicians. I chose to write about this topic because I recently created my own Living Will and had it signed by witnesses and documented incase I become incapacitated to express what treatment I want.

These directives are not always focused on life support, but can also include key decisions such as the types of treatments provided (surgical, nonsurgical, experimental, holistic) and set durations for treatment. Advanced directives can also establish proxies, transferring power of attorney over medical decisions to trusted family members or friends.

Advance Directives are extremely important because they allow others to express their wishes before they are too ill or incapable of doing so themselves, promoting one’s autonomy to make health care treatment choices. Advance Directives allow for individuals to have a plan set in case an unfortunate event happens. They intend to eliminate pain and suffering from family members by letting others know they followed the person’s wishes. Why is it that many people do not take the initiative to complete one? Some may argue that they are unaware of what an Advance Directive is. Others may claim that completing an Advance Directive is a waste of time because health care professionals may ignore it when it is necessary to consider it. Another perspective

Advance Directives are our wishes when we are at end of life stages of life that give specific direction of how, who, and when to treat us in our final days and hours. We can have documents drawn up to say what we want in the event we are in a state where we cannot voice our wishes aloud. These documents have legal and ethical basis, and they should be followed unless the legally or ethically unable to do so.

Living Wills, sometimes called Advanced Directives, are legal documents accepted in all 50 states. They clearly define a person’s wish to decline life-support or medical treatment in certain circumstances, usually when death is imminent. Generally, a living will takes effect when a person becomes terminally ill, permanently unconscious or conscious with irreversible brain damage.

The advance directive, or living will, is one way of circumventing the ethical dilemma of Quinlan, as it is essentially a set of choices by the competent patient if faced with different hypothetical circumstances. Patients can thus feel comfortable knowing that their competent wishes have been documented and can be easily interpreted in case of catastrophe. However, the authority of advance directives is a topic hotly debated amongst medical ethicists (see Advance Directive Authority). Arguments against directives state that not all factors are considered by the person creating the advance order. Also, in some cases of severe dementia, it is argued that the personal identity of the author is no longer intact and therefore has no authority over the treatment of the “new” person. The debate on this topic is extremely complex, but many of today’s cases are decided on an individual basis, with the directive often being upheld.