Essay On Advance Directives

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.

The Federal Patient Self-Determination Act (PSDA) of 1991 first brought attention to the importance of advance directives (GAPNA, n.d.). Although regulatory bodies continue to promote advance directives, little has been done to encourage and enforce this initiative, highlighting the need for directed efforts to improve AD completion rates. The overall prevalence of completed advance directives in the United has been estimated that 5-15% (Tung & North, 2009). This indicates a need for programs to educate and empower patients and providers to ensure that dialogue about advanced care planning is initiated early on, and that advance directives are completed. Studies have shown that patients prefer that their primary care doctor initiate such planning while they are in good health and that such planning should occur earlier than it did in terms of age, natural history of disease, and patient-physician relationship. The barriers to advance care planning that have been identified include availability of trained staff, organizational commitment and policy to support advance care planning, and understanding/support of providers (Ramsaroop, Reid, & Adelman, 2007).

.“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).

A patient barrier might include having limited knowledge surrounding life-support systems and treatment options, thereby hindering their ability to fully comprehend or demand certain interventions. Good counseling is therefore essential to overcoming this barrier in implementing the patient’s true and best wishes (Kroning, 2014, p. 222). Another barrier in implementing advance directives concerns the role and influence of family members and the patient. There may be discordance between the desires of the patient and family, which can result in serious debate and tension if not addressed and taken into consideration. Physicians still may have reservations, as certain demands made by the patient may raise ethical concerns in the future, if the provider feels the interventions being done are no longer medically appropriate.

An example of this Act is the very popular Nancy Cruzan Case. Although Nancy was left in a vegetative state resulting from a car accident, her parents were able to make the decision to have her removed from feeding tubes because Nancy expressed before the accident that she never wanted to be kept alive from breathing or feeding tubes. This Act really promotes Advanced Directives and hospitals, clinics and other providers that receive Medicare or Medicaid funds to provide patients with written information about their right and the information must clearly state the institutions policies on withholding or withdrawing life-sustaining treatment.

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).

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

Every seriously ill patient and their family should have decided the following issues: proxy, resuscitation, hospitalization, and specific treatments. Every seriously ill person needs to have pointed out a person to speak on their behalf when they get too sick to do so. A “proxy” can be filled out at any hospital or nursing home granting “power of attorney” to a loved one to be able to make decisions. A person

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

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.

Therefore, acknowledgment of personal values needs to be understood and kept in check when having these discussions. Furthermore, these discussions are better received when one can intelligently speak to each question and apply the language to the discussions with patients and families. Moreover, reflecting on these questions can help the clinician be prepared for sensitive questions that may arise. All of these measures will help guide the advanced directive formulation process.

The case of Karen Ann Quinlan led to four basic approaches to this ethical problem; advance directives or other clear evidence of the patients wishes while competent, surrogate decision making (power of attorney), and action in the patients best interest. Each solution has deficiencies both in theory and practice, but there can be no debate that their application has changed the landscape of medical ethics.