End of life issues

A focus on advance directives

By Latashia Gilkes

Advance Directive

What is an advance directive?

An advance directive is any type of statement made by an individual to determine the medical care they would like to receive.

You can decide to continue to live or end life if and emergency decision has to be made

Purposes for advance directive

To make decisions before the client becomes

unable to make decisions for themselves

To be involved in and responsible for medical care

To ensure the proper care is taken

Purposes for advance directives

Preparation for a serious illness in the near future

To have someone provide a voice when incapacitated

Clarification of what the client wants

Topics to cover

Advance directives

Living wills

Durable power of attorney

Benefits

Ethical issues

Things you can do

Types of advance directives

Living wills

Power of attorney

Do not resuscitate

Do not hospitalize

Organ donation

Feeding restrictions

Medical restrictions

Request for autopsy

General Information

Advance directives are mostly used by the elderly and terminally ill individuals

Can have more than one advance directive (i.e. organ donation and do not resuscitate)

However, less than 25% of individuals have at least one advance directive.

General Information

Anyone over the age of 18 can have one or more types of advance directive.

Individuals with terminal Illnesses or in an vegetative state would be more likely to have AD’S

History of Advance directives

Cruzan v Director of the Missouri Department of Health (1990)Supreme Court case involving a client’s right to refuse

treatment during incapacitated state

Patient Self- Determination Act (1990)Gives individuals the right to obtain advance directivesAll health care providers are required to inform their

clients can accept or refuse medical care or treatment

Living Wills

Living wills are the statements made by the individual to determine what will happen to them in an emergency or temporary medical care.

They can be very specific in detail or simple

All parties need to be aware of the client’s wishes and comply with them

Types of Living Wills

Living wills can be

– Verbal (with family members, doctors)

– Written up by an attorney (legal documents)

– Discussed with a doctor or health care provider

Durable Power of Attorney (POA)

Appointing someone to make decisions if the client becomes incapacitated

The person can be a family member (children, sibling, spouse)

A trusted friend

Lawyer or doctor

Responsibilities of POA

To serve as a mediator for the client and the doctor

Voice for client

Comprehend the decisions made

Understand the client’s health

Meet the needs of the client

Benefits of advance directives

A medical plan for the future

Legal regulations to inform and provide individuals with advance directives

Ability to be involved and direct their medical decision

Can accept or refuse medical treatment

Connection between the client and POA

Disadvantages of advance directives

Clients can change their mind about their decisions

Difficult to predict what health issues will occur

Not being specific enough

Client may not want to make any decisions

Disadvantages

Misunderstanding the wishes of the client

Miscommunication between the client and POA

Disagreeing or ignoring the wishes of the client

Ethical issues

Doctors not meeting the client’s needs

Not giving the client all options

Cultural differences of the client

Religious differences of the client

Health care providers going against the client’s/family’s wishes

Word to the wise

GET AN ADVANCE DIRECTIVE!

Be responsible for your own health by any means necessary

You have the power to control of your medical care

Get all the information you can to make the choices necessary for your own medical circumstance

Things you can do

Obtain all the information about your health care to

make the right decisions

Make clear and precise decisions of what you

would want

Contact your doctor and/or attorney about advance

directive options

Things you can do

Talk to friends and family who have completed

advance directives

Discuss your decisions with whom you want to

have represent you

Trust that person to make choices when unable