Advance Directives

Advanced care planning is critical element in the therapeutic alliance between healthcare team and patient in providing adequate patient-centered care, with the patient a more willing collaborator. This process provides patient, family, and caregiver with realistic expectations about result of treatment and prudent preparation for possible outcomes. Effective advance care planning has been shown to increase satisfaction with care, lower moral distress, lead to healthier bereavement after death, provide timely

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.

I recognize that modern medical technology has made possible the artificial prolongation of my life beyond natural limits. I do not wish to artificially prolong the process of my dying if continued health care will not improve my prognosis for recovery and my death is likely to occur within several months, or if I require life support as the result of an irreversible condition, even if that life support might prolong my life for a sustained period. Therefore, I do not want efforts

When you are able, you should put thought into the physical process you will go through. All of us love you and want to make sure that when the time comes, we know and can follow your wishes regarding the care you wish to receive. Having your decisions thoroughly and clearly stated in an advance directive will make this possible. (Berger, 2014, p. 590). Your advance directive document may contain a living will, a signed consent for Do Not Resuscitate (DNR), and information identifying your healthcare proxy. Understanding these things now, will help you make clear choices. A living will clarifies what care, or lack of care, you wish to have (Berger, 2014, p. 590). This is helpful for reference if you are ever unconscious or in any way incapable

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.,

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

In the older patient that has planned for end-stage diagnosis, an advance directive provides a means to articulate patient requests. However, in the patient who has sustained

It’s never easy for a family to say they want someone taken off life support. We want our family member to live; therefore, leaving this decision to them in their time of fear and grief is not fair. According to an article I found not many have made this choice, the article states, “but if we mirror the larger US population, only 25% to 30% of us have completed an advance directive” (Alspach, J. G., 2016). It’s often thought that just telling your family what you want will be enough, but without written proof, at that time, it’s no longer your

If I should be in an incurable or irreversible mental or physical condition with no reasonable expectation of recovery, I direct my attending physician to withhold or withdraw treatment that merely prolongs my dying.

In a living will you include in written form the kind of medical treatment you would want or not want if you become ill and were unable to make the decision yourself (Friends of Hospice, 2014). I expect to be treated with respect and to maintain my dignity in the event that I become seriously ill. I would want the following wishes and any other directions that I may have relied to my Heath Care Proxy to be acknowledged and respected. I would want my caregiver to keep in mind that I do not want to be in any pain and I would like to be kept clean and warm. If I am close to death and show no sign recovery I do not wish to receive life-support. If I have signs of permanent and severe brain damage and not expected to recover, I do not wish to receive life-support. If I am expected to recover and I show no signs of brain damage, then I do wish to receive life-support. In case of an emergency, I do wish to be resuscitated only if I have high hopes of recovering. For example, if I am sick and expected to die already, I do not wish to be resuscitated.

If at any time I should have an incurable or irreversible injury or disease, which is examined to be a terminal condition as stated by my physician, I ask that procedures and medications that extend the dying process be withheld or withdrawn.

Upon reflection of the Five Wishes, several thoughts came to mind. First and foremost, having a designated advanced directive is critical. There are countless examples of clinical experiences in with which families were overwhelmed with unexpected end-of-life decisions. As an educated caregiver, we should personally take the necessary steps to assure these tough decisions are known to someone who can facilitate the level of care desired. Such consideration of these elements of care in advance can help to support our loved ones during this emotional time. After review of the five wishes, I recognized that I would not want life-support measures if faced with irreversible deleterious outcomes that resulted from

Extra time can be great if the human body’s aging process could be spread out over 120 years like it is over 80. If aging were spread out, then quality of life might not be so bad. Martien Pjinenburg and Carlo Leget made the statement that, “Quality of time outweighs quantity of time. The argument of quality over quantity can be brought up into many issues, but the most prominent being about life. As insinuated in the beginning, if the quality of a long life is poor, then the subject may be more apt to contemplate suicide as a means to escape constant worldly torture. If quality of life is positive, the subject would be more apt to take the longer life given as a blessing instead of a curse. The extension of human life is an ethical issue that depends on the person. The issue of poor life quality such as physical decrepitude will be brought out more in the older generations. Selfish family members that want to prolong a possible family member’s life through this method is really just inhibiting the family member if their current condition is poor. Good intentions can be misguided in instances where one person doesn’t want another dying so they preserve them just so they don’t have to go through the pain and heartache. In “Listening to Public Concerns About Human Life Extension,” it is stated by the authors that the most commonly worried concept is quality of

However, there is sometimes circumstance when a living will, advance directive, nor a power of attorney is established, and the individual is unable to express their wishes regarding the way their medical care is facilitated. In this case, another individual makes the decision. The other individual’s decision can be contrary to your