ntroduction Any individual has a right to accept or refuse medical treatment which is protected by law. At times, serious illness, injury or mental incapacitation makes people incapable of talking and what medical treatments they want. Such situations pose hard questions to patients, friends, health care workers and even family members. An advance directive is a legal document that allows doctors, family and friends to know your desired health care. This paper discusses the legal and ethical basis of advance directives. A sample advance directive (a living will) is given at the end of the discussion. If doctors establish that a patient is incapable of making an informed decision, an advance directive will speak for the patient. If misunderstandings arise among those caring certain patients about different treatment options, an advance directive is used to resolve such misunderstandings. All health care organizations ought to tell their patients about these rights. A properly prepared advance directive permits any individual to plan ahead to make his/her wishes known and even identi...
Advance care planning allows a patient to identify health care preferences and surrogate decision making in the event the patient cannot make competent health decision. It promotes autonomy of patients who lack, but once possessed, the decision-making capacity. In general, there are two forms of Ads; the living will and the durable power of attorney. Nevertheless, most people, including elderly persons do not have Ads. One study of a random sample of all US deaths (N=13,883) found that only 9.8% of decedents had an AD. Patients with AD, however, were less likely to undergo cardiopulmonary resuscitation and more likely to use hospice care.
This ethical scenario presents an 86 year old female with numerous health issues and chronic illnesses. Mrs. Boswell’s advancing Alzheimer’s disease makes it extremely difficult to initiate dialysis, leading her physician to conclude a poor quality of life. The ethical dilemma portrayed in this case is between nonmaleficence and autonomy. Health care workers should focus on promoting the patient’s overall wellbeing and weigh the benefits and risks of the course of action, while also considering what the family declares they want done. Since the patient is deemed unable to make decisions, the goal is to collaborate with family, assess patient quality of life, address prognosis, and establish realistic care goals.
An effective advance care planning process follows a series of steps that incorporates the patient’s preferences, their values, and a dialog to help identify proxies. The educated person must first consider a proxy and determine the goals of their care. Ideally, the chosen proxy will then partake in the advance care planning process. It is important that the person completing the advance directive make the proxy aware of their authority, the goals of treatment, important personal factors, and the scope of discretion for that individual. It is also imperative that the advance care directive be available to both the proxy and healthcare providers.
In this context, new emphasis is being placed on the rights of patients. Recent federal legislation, for example, requires all health care facilities receiving Medicare or Medicaid monies to inform patients of their right to make medical treatment decisions. This includes the right to specify "advance directives," [1] which state what patients wish to be done in case they are no longer able to communicate adequately.
A living will is a type of advanced health care directive, which states an individual’s wishes for health care treatment when he/she is terminally ill. Living wills are often applied to end-of-life decision making when patients are no longer deemed competent to direct care for themselves. The form of living wills can vary widely. But, most address whether or not to use life-prolong medical treatment such as CPR, respirators, and artificial nutrition and hydration. These documents can also contain information about the importance of quality of life for patients and can name a healthcare proxy to make medical decisions in their place. Having a living will allows individuals to state their
Two examples of Advance Care Directives, which are living wills that allow a person to document end of life medical treatment, are the FiveWishes and MyDirectives in the United States. The FiveWishes directive is described as living with a heart and soul and follows five wishes. These wishes include: the person which will make decisions regarding the patient’s health when the patient is not able to, the kind of medical treatment wanted and not wanted, the level of comfortability of the patient, how the patient is treated, and the amount of information that the patient’s loved ones know. The MyDirec...
One of the greatest dangers facing chronic and terminally ill patients is the grey area regarding PAS. In the Netherlands, there are strict criteria for the practice of PAS. Despite such stringencies, the Council on Ethical and Judicial Affairs (1992) found 28% of the PAS cases in the Netherlands did not meet the criteria. The evidence suggests some of the patient’s lives may have ended prematurely or involuntarily. This problem can be addressed via advance directives. These directives would be written by competent individuals explaining their decision to be aided in dying when they are no longer capable of making medical decisions. These interpretations are largely defined by ones morals, understanding of ethics, individual attitudes, religious and cultural values.
Taking care of the individuals that are getting older takes many different needs. Most of these needs cannot be given from the help of a family. This causes the need of having to put your love one into a home and causing for the worry of how they will be treated. It is important for the family and also the soon to be client to feel at home in their new environment. This has been an issue with the care being provided for each individual, which has lead to the need of making sure individuals have their own health care plan.
The individual will need to be encouraged to make decisions about the care they receive and the type of life they want to live and also ensure that their families are part of the decision making process.
An advance health care directive or advance directive is a legal document that tells the doctor the wishes of a patient concerning health care. It provides a better chance of receiving the kinds of treatment a patient may or may not have when they are unable to voice those wishes to a doctor or family members. A patient may choose a living will, a medical directive, or a health care power of attorney or health care proxy, or a combination of the three.
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
Prior to discussing why Advanced Directives are so essential the definition of Advanced Directives is crucial. An Advanced Directive is made up of several legal components which ultimately online the patient’s wishes if one was to be incapacitated or unable to verbally make wishes know regarding healthcare. The understanding of what a living will and a durable power of attorney both need to be discussed before one is able to compare and contrast. A living will ensures that anyone reading this paper will understand how the patient wanted to continue their form of treatment. With a living will anyone ranging from patients to healthcare professions should be able to determine the specific actions the patients would want taken if they are unable to make said wishes known. A
Today, most states have some laws that allow patients to make informed decisions about how they wish to die. Almost every state allows one to have a living will. This simply states that if one is surviving via ...
Death is a personal experience and to ensure loved one’s wishes, there has to be the ‘what if’ conversation. It is natural to talk about the possible end with loved ones after marriage and having children. Living wills are obtained and do not resuscitate orders, thoughts of a possible guardian for the children, life insurance, appointing a health care agent, and any other loose ends that will ensure the well being of the family. A health care agent is someone who the patient designates to make medical decisions, if decisions cannot be made generally. The chosen agent should be a person who knows the wishes on the extent of medical care treatment wanted. The appointed health care agent should be someone who is not afraid to ask questions of the healthcare professionals to get information needed to make decisions and be assertive to ensure that wishes are respected. (Healthcare Agents, n.d.).
There will always be a need for healthcare as people are always sick in some way or they are out of balance with their health in some way. There are so many specialty areas in the healthcare field that it allows for a variety of specialists to be apart of a patient’s decision making process. It does pay to be knowledgable. Take the time to read each one of the patient’s rights and under-stand what it means to have a choice.