Advanced Directive Essay

Each human being will reach a stage in life where death and separation are inevitable. Consequently, it is important for each individual to be able to foresee what the future will behold especially when death can occur unexpectedly or subsequently after chronic illnesses. The British Columbia Ministry of Health (2013) states that developing an advance directive ensures that families, and members of the interdisciplinary team acknowledge the individual’s own health care decisions, and carry their own wishes in an event where the individual may be deemed incapable (p. 3). Furthermore, it gives the individual the autonomy to make decisions in advance for themselves for situations such as an irreversible coma due to decrease oxygen perfusion to

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

Other barriers in implementation might include the legality of certain medical interventions, associated costs and limited resources for providing the best care possible (Mason, 2013, p.12). As nurses, a barrier in implementing advance directives might also arise when advocated end-of-life wishes are undervalued or poorly recognized by others who do not share the same comfort or high priority in the medical workplace. Finally, the patient, families, and healthcare professionals face barriers in misconceptions regarding advance directives, especially in regards to

Advance Directives by the patient designates no feeding tubes, artificial ventilation, or CPR. Concerns regarding alteration of mental status consequential to his illness provoke the physician to seek consultation from the designated Power of Attorney. Nursing responsibilities compel the nurse to consider if the proposed actions of Dr. G violate the patient’s rights of self determination and confidentiality and prompt the nurse to advocate for the patient’s desires regarding medical treatment. Health care providers have a responsibility to honor the patient’s autonomy and provide quality medical care (Badger, 2009 p122). Providing artificial nutrition and ventilation transgresses the patient’s directives and is unethical. The physician appears to be asserting a paternalistic approach in deciding what is best for this patient. Should the interventions be temporary and provide resolution of the condition, the physician can defend his actions as being healing and beneficial. However, there is a chance that the interventions may be permanent and futile; avoiding passive euthanasia and terminal dehydration, serving only to prolonging the illness. Violating the patient’s directives of care by performing invasive procedures can lead to legal incriminations of assault and battery.

Death is in a sense inevitable, we can’t escape from it. In today’s day in age, we are living longer than our parents and our grandparents due to medical technology. But there are so many ethical issues and complications that go hand and hand with death. There are two forms of death, cardiac and brain-oriented. Determining these two forms of death, along with the determined time of death is vital, simply because we don’t want to treat a living person as if they were dead. With so many issues concerning death, we have to protect those who are on the brink of death or terminally ill and can’t speak for themselves, but allowing them to make preparations for the future. Advanced directives makes this possible,

Under the Summary and Guidelines for the CALIFORNIA NATURAL DEATH ACT,” to use an advance directive you must be adult (18) and the declaration requires the conditions that the patient’s physician must see the declaration, that the patient specified must be diagnosed in a terminal condition, and the patient can’t make decisions about what health care should be administered. The hospital must: place the declaration is the patient’s records; or inform the patient that they cannot comply, and immediately transfer care to a physician or facility that can comply with the Act. Lastly, comfort and care must never be withdrawn, even if treatment is withdrawn under the Natural Death Act.”

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

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

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.

Residents of three skilled nursing facilities in the San Francisco Bay area were selected for the study. The study was completed at nursing facilities for two reasons, one, because with the passage of the PSDA hospitals and nursing homes were required on admission to inquire about advance directives in place for each patient and two, skilled nursing facility patients are admitted from hospitals and there are at least two opportunities, at the hospital admission and the nursing facility admission to inquire about advanced directives. (Van Leuven, 2010, p. 3128). During a six week period chart reviews and observations of admission interviews of the 272 residents, a full 44% entered the skilled nursing facility without an advanced directive and 11% remained without an advanced directive. This study concluded that the current law is ineffective and more conversation needs to take place about end-of-life decision

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.