Advanced Directives : An Underutilized Means Of Communicating One's End Of Life Wishes

A person’s life can end at any age. They can depart quickly or slowly. End of life care, also known as palliative care, is the care of patients that are not only in their final hours or days but the patients with a terminal illness that has become incurable. End of life care takes into mind what the patient desires so it is recommended that they consider an advanced care plan also known as an advance directive and living will. These documents allow the patient to formulate decisions on the future of their care if, at any point, they cannot vocally express themselves.

The increased use of advanced directives, such as do-not-resuscitate orders, has made discussions on end-of-life care much easier for patients and professionals alike.

.“As medical technology continues to advance and health care choices become more complicated, the preservation of end-of-life autonomy is an increasingly important issue faced by various client populations.” (Galambos, 1998).

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.

Figure 1 displays each state within the United States and which form of advanced directive they have adopted into their individual state’s laws. Utah is one of twenty-eight states which have implemented an advanced health care directive with both a living will and a durable power of attorney for health care. In the state of Utah advanced health care directive is defined as “a designation of an agent to make health care decisions for an adult when the adult cannot make or communicate health care decisions; or an expression of preferences about health care decisions” (le.utah.gov). Agent is defined as “a person designated in an advance health care directive to make health care decisions for the declarant (le.utah.gov).” An individual has the right to not appoint and agent on Utah advanced health care directive forms as well (le.utah.gov).

It is very important that each individual, if possible has a say in his or her own dying and death. Facing death is hard for everyone and there are specific issues to be talked about in advance. A living will or a Physician Order for Life-Sustaining Treatment (POLST) is extremely useful. The POLST is designed for people with serious or life-threatening illnesses. “This is a standardized form that describes a patient’s wishes and is signed by his or her physician, providing both summary of an individual’s advance directive decision and the physician’s order. It can be used to inform emergency personnel about a patient’s wishes for life sustaining procedures, such as CPR. “

An advanced directive is a legal document in which a person can specify what measures should be taken, when considering their medical condition, in the event that they are incapable of making decisions for themselves.  Advanced directives are more often used by patients who have mental and terminal illnesses.  When given a scenario in which a dementia patient like David signed an advanced directive, there are many things to be considered before deciding whether or not to treat his pneumonia:  what is best for his health, what is considered ethical for the physician to do, and what effects would the physician’s decision have on the hospital. David should be treated for his pneumonia because, when considering the medical aspect of this case, it

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

would prolong their life in the case that they begin to deteriorate (Wilkinson 2007). Before an advanced directive can have any legal standing, there are two general guidelines that must be followed. Two physicians must sign off stating that the person in care is not able to make healthcare procedure elections themselves and the person must have a terminal illness or be permanently unconscious (CaringInfo). A terminally ill person can make advanced plans as to who they would like to appoint as their medical power of attorney as well which gives the appointee the right to make decisions on how aggressive the person wants to be treated and what form of care will be provided to the them. Advanced directives came to be in 1967 when a group called

With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient

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.

According to their research, some patients solidify their desire to use aggressive measures necessary while deciding on advanced directives. This translated to higher health care cost in those situations, and ultimately mixed results on health care costs. Tan and Jatoi (2011), evaluated the charges for cancer patients at Mayo Clinic in Rochester, MN., and concluded that the costs associated with end-of-life care with advance directives had no significant difference when compared to those without advanced directives. In addition to this finding, the authors also noted no significant difference in costs if the decedent was admitted through the emergency room or from

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

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.

End of life planning is of critical importance to everyone at an age that they typically care for themselves. Growing up, we have parents and/or caregivers that take care of us and make important decisions concerning medical intervention and healthcare. As we grow older and begin living independent lives, it is important to make sure that, given situations that we are unable to speak for ourselves, our personal wishes concerning these issues can, and will, be carried out. For me, being forty, it is important that planning is in place that will not only ensure the medical care I may want carried out during a health crisis, but also what financial plans, organ donation and funeral arrangements should be made upon my passing. This not only ensures my wishes, it also relieves any pressure and responsibility my family may feel dealing with the situation and makes it clear what I want done.