Importance of 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.

If I had to make the decision on what to do in Terri Schaivo’s case I would do what Michael Schiavo had done, I would fight to have the feeding tube removed. I believe that if a person has no quality of life and is in a PVS state, they have no feelings, they feel no pain, and they are not aware of their surroundings. According to the article Terri Schiavo and End-of-Life Decisions “Terri could not continue both to be alive and be free from invasive medical procedures” (Mathes, 2005) I feel keeping them alive is unfair to them and to their loved ones. I also believe that the surrogate decision maker should follow the “best interest” standard, which is, given the medical facts and prognosis, make decisions that would be in the best interests of the patient. (Hook & Mueller, 2005) There was a lot of evidence and proof from the doctors in regards to the fact that Terri was not going to get better, there were no medical interventions left that could help her. Prolonging treatment for Terri would not have changed her quality of life or made it better. In my opinion, Michael Schiavo acted properly as a surrogate decision maker because first of all, he followed her previously spoken wishes and views and, second of all, he acted in her

At the time of the Court’s ruling, eighteen states and Washington, D.C. had laws that allowed family members to withhold treatment from patients lacking the capacity to make medical decisions. The majority of these statutes required that the patient be terminally ill. As of June 1998, thirteen states require that the proxy have specific authorization and/or specific conditions be met in order to withhold artificial nutrition and hydration.

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.

Palliative care, somewhat similar to Hospice care, focuses on relieving or preventing suffering from a life altering illness. The goal for both Palliative and Hospice care is to provide the best possible quality of life to

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

On the same token, it’s recommended that adult children also have a living will, aka an advance care directive, which outlines a person’s wishes about life-extending medical treatment, as well as other intentions, such as organ donations. This document takes effect when the doctor declares that the patient lacks the capacity to make their own health care

Schiavo accepted the doctors diagnosis of persistent vegetative and decided he wanted to remove her from the ventilator (Quill, 2005). The article says he was recalling prior statements that his wife had made, such as “I don’t want to be kept alive on a machine” (Quill, 2005). This is the part where things get tricky. Terri’s parents (the Schindler family) disagreed and did not accept the diagnosis, they believed that Ms. Schiavo’s condition would improve if they continued to provide rehabilitative treatment (citation).

The ethical principles for nurses to practice with beneficence and no maleficence. This legal battle between Terri Schiavo’s husband and her family was an ethical debate between continuing artificial life or remove her feeding tube by the request of her husband. Using the theories of utilitarianism and deontology can be applied or considered in making the most ethically correct resolution. The cases are very complex and raise many moral and ethical issues. The cases have brought awareness to society of “the importance of discussing end-of-life issues with family members and underscores how an advance directive, a living will and/or durable power of attorney for health care, are a healthcare proxy clarifies and provides evidence of the wishes of an individual regarding end-of-life decisions. Terri Schiavo should impress upon laypersons and professionals alike the uncertainty of the context in which issues of continuation and termination are argued ethically. Nobody knows what Mrs. Schiavo would have wanted. She left no advance directive and in its absence her husband says one thing and her parents

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

Terri Schiavo was 26 years old when she collapsed in her home and suffered acute hypoxia for several minutes. Slightly shy of a year after her injury, it was clinically determined that she was in a persistent vegetative state (Perry, Churchill, & Kirshner, 2005). There were no legal documents, such as an advance directive or living will, specifying the wishes for care under such circumstances. Her husband, Michael Schiavo, was designated as her legal guardian. The Schiavo case caught the public’s attention when her husband elected to remove her feeding tube in the mid 1900’s. He understood that there has never been a case of recovery after a year of being in a persistent vegetative state. One of the moral issues surrounding the case centered on the appropriateness of removing the life-sustaining feeding tube or maintaining it. Throughout the case, there has

They were the subjects of public disputes with family members, court systems, medical professionals, the media, and society at large. Terri Schiavo, Nancy Cruzan and Karen Ann Quinlan; their names are synonymous with permanent vegetative state (PVS). The amazing technological advancements in modern medicine has been credited with keeping persons alive who in times past would have died, therefore this is remarkable for countless families. In the cases of the Quinlan’s, the Cruzan’s and many like them, families members find it unbearable to witness loved ones who linger indefinitely in PVS with little or no chance for recovery. There are many like Terri Schiavo’s parents, who value the lives of their love ones no matter how limited their

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

Ethical dilemma may also arise in cases where a patient may feel their right to DNR should be carried out when giving direct order. The DNR process, however, is required to be documented by a physician. Andrew Putnam (2003) presents a case where an eighty-eight year old patient’s code status was DNR; “However, the patient has never signed formal advance directive statement or assigned durable power of attorney for her health care to anyone.” (Putnam, 2003, 2025) Ethics can be simply stated as doing the right thing (Roberts, 2002, 242); but in this case ethics is questioned because the physician was faced with the decision to carry out the wishes of the patient or to make a decision based on legality. In this case, it may have been morally right to carry out the wishes of the patient who wanted DNR orders carried out, but it may have been the right choice to do the legal thing and not carried out due to lack of signed documentation.

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.