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Running Head: Advance Directives
Advance Directives Your Name: University: Instructor: Date:
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Advance Directives Advance care directives are specific instructions, written in ahead of the time they are needed, that are intended to give instructions regarding a person's medical care if he or she becomes unable to do so at some time. Doing this allows patients to state their wishes regarding health care they want to receive if they get so ill or sustain a life threatening injury that they are not able to state their wishes as to their own care. Advance care directives can also name someone to make such decisions if the patient is unable to do so. This is usually called naming a Power of Attorney for Health Care. The United States has a law that requires most medical facilities to provide information on advance care directives to every patient when they are admitted. There are a number of advantages of preparing care directives before they are needed. First of all is that it can take away the worry of what care would be administered. Family members are not burdened with wondering what their mother, grandmother, father or other relative desires or prefers as to treatments and care. Extra measures and interventions can be avoided when a patient actually prefers they not be employed which could alleve possible suffering, frustration and upset for the patient. Legal concerns can be avoided because nothing is done and nothing is withheld that the patient might want. Some examples of advance care directives are simply verbal instructions. This is often what must be relied upon when a person does not put anything in writing. People that are especially close, such as parents and children, spouses, or best friends, often know from discussions what the patient prefers.
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Another type of advanced care directive is organ donation. This is done again verbally by a family member who knows that the patient would want that to happen. Another way of donation is by an organ donation card or in some states, a driver’s license notation. Of course that information can also be put with the written instructions for other care. One of the most important advanced care directives is called a Living Will. It is a written document that spells out the wishes of a person in the event of a serious illness where the patient cannot communicate or cannot communicate rationally, such as being heavily sedated. A Living Will may give certain directions for treatment a person wants or does not want in in specific circumstances. There may be instructions for specific procedures, or the withholding of specific procedures. Many people, due to their age and health give instructions that they do not want to be resuscitation should they cease breathing. Some do not want nutrition delivered through feeding tubes if they are unable to eat. For religious reasons, a number of people refuse to have blood or other bodily fluids transfusions. Again, due to the age and/or health of the patient he or she may not want surgery, or to be maintained indefinitely on a respirator if there is no chance of regaining consciousness. Many people have a very different idea of what care they want than their family might. For instance, an adult child might want every medical procedure possible to be administered to his parent when the parent falls seriously ill, when that might not be the wishes of the parent at all. Sometimes artificial respiration is provided after an accident or a medical crisis and it becomes clear that the patient’s brain function has ceased. The respirator will
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A Living Will should not be confused with a person’s Last Will and Testament which is directing the distribution of assets after a person dies. State laws are different concerning advanced care directives. Sometimes a Living Will is a document which is used only if there is no hope of any quality of life, and a Power of Attorney for Health Care is another document spelling out the certain procedures a person wants or would refuse, such as transfusions. But this document gives the power to someone else that would be able to make such decisions or to pass along those decisions to the health care provider. This designated person is called an “attorney in fact” or a surrogate. Almost any adult could be named as the surrogate. It is best to select someone who can be made aware of the patient’s wishes and general value system, because every situation cannot be anticipated. It should be a trustworthy person and able to be calm in a crisis. This surrogate should not, and usually cannot be the doctor, nurse, or anyone on staff of the medical facility where a patient lives or receives treatment, because it might possibly create a conflict of interest. Only one person should be named as the surrogate who eliminates arguments or a difference of opinion. This would totally hamper the medical professionals and render the advance care directive useless. However, there can be an alternate should the first person named not be available at the time. An important thing is that the surrogate is only allowed to make health care decisions when the person is unable to do so. It could be temporary or a permanent condition. An example would be a person who has been in a car accident and is unconscious and certain decisions about the emergency care need to be made. This person is not in danger of dying, but is not able to
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make various decisions necessary right away. Or, a person could be undergoing a medical procedure when his heart stops, and that person has written instructions to the surrogate not to resuscitate. There are legal restrictions for these documents and them different slightly from state to state. For instance, in most states, a medical provider cannot be named as the “attorney in fact” or decision maker, on a Power of Attorney for Health Care. Some states require that these documents be notarized and others require one witness or two. A person executing these documents should be aware of the requirements so that there are no problems if and when the document is needed. Copies of these documents should be distributed to the medical providers, to family members and a copy should be carried at least in the vehicle. Some health care providers ask for the documents and some do not, but they can still be put in the file. Advance care directives promote the principles that each person has a right to decide upon his or her own medical treatment and also to be able to face death with dignity. They are a voice for a patient who no longer has a voice that can be heard, but yet wants her wishes to be respected. This is not to say that everyone who prepares a Living Will wants no medical care at all, but sometimes a treatment such as a feeding tube is abhorrent to the patient who does not want to live in such a way. Others do not want to be artificially kept alive because they do not know if they might be in pain and kept alive by some well meaning person who insists that the artificial means be kept going. People with an incurable condition often do not want to prolong the dying process while
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suffering great pain and putting their family and friends through a lot as well. These lifeprolonging procedures could be things such as ventilators, dialysis, CPR, and others. Ethically, it is important that a person’s wishes be honored. It might be “easier” on the patient’s family or other loved ones to try every treatment and procedure and to never give up trying to prolong the patient’s life. But, that is discounting, sometimes, that it is really not their decision. Legally, it is the best idea to have specific instructions written out so that the medical providers and all others know exactly who is to make these decisions when necessary and exactly what they are supposed to do.
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References Beck A, Brown J, Boles M, Barrett P. (2002) Completion of advance directives by older health maintenance organization members: the role of attitudes and beliefs regarding life-sustaining treatment. J Am Geriatr Soc. Feb 2002;50(2):300-6. Family Doctor, Advanced Directives and Do Not Resuscitate Orders; http://familydoctor.org/familydoctor/en/healthcare-management/end-of-life-issues/advancedirectives-and-do-not-resuscitate-orders.html Bioethics, Washington University School of Medicine; http://depts.washington.edu/bioethx/topics/advdir.html