advance directives


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Related to advance directives: Durable power of attorney

advance directives

 
instructions about a person's wishes, goals, and values regarding what will be done in case he or she becomes incapable of making decisions about medical care; called also living will, durable power of attorney for health care, and sometimes advance health care directives or health care advance directives.

A proxy directive designates another person to make decisions; an instruction directive provides instructions about the person's values and goals or treatment preferences; a combined directive can do both. An instruction directive should focus on goals and values more than on specific medical interventions; interventions can be good in some situations and undesirable in others.

Formal directives are signed and legally authorized written documents. Informal directives are oral communications with family, significant other, or health care provider. Advantages of formal directives are: (1) they are preferences and values more likely to have been carefully considered; (2) they reflect more accurately a person's preferences; (3) they invoke legal practice that commits health care providers to a course of action; and (4) they provide legal enforcement for a person's preferences. Disadvantages include: (1) relatively few people make them or leave explicit directions; (2) identified decision makers might not be available, might be incompetent to make good decisions, or might have a conflict of interest; (3) some people change their preferences regarding treatment but fail to change their directives (and a few, when legally incompetent, protest a surrogate's decision); (4) state laws often severely restrict the use of advance directives; (5) professionals have no basis to overturn instructions that are against the patient's best medical interests, even though the patient might have formulated the instructions without foreseeing a given situation; and (6) some patients do not have an adequate understanding of the decision making needed, or even with an adequate understanding, cannot foresee all clinical situations. Because of inadequate counseling or imprecise language, documents may reflect uninformed preferences.

People often have difficulty identifying decisions and questions delineating adequately the full range of situations that may occur. Because of this, designation of surrogates has become more prevalent. The document can be used for refusal of life sustaining treatment.
A statement made by an adult at a time when he/she has the capacity to decide for himself/herself about the treatments he/she wishes to accept or refuse, in circumstances in the future when he/she is no longer able to make decisions or communicate his/her preferences
References in periodicals archive ?
Nurses' own personal experience with advance directives was central to understanding their potential role in this area.
why advance directives are especially beneficial for same-sex partners
In recognition of Elder Law Month and Older American's Month, the Elder Law Section, along with Department of Elder Affairs Secretary Carole Green and the Statewide Public Guardianship Office, in May hosted advance directives workshops throughout the state.
As a result, few advance directives are made with the understanding that underlies genuine self-determination.
In the Oklahoma Advance Directive for Health Care form a health care proxy and alternate can be named.
In many parts of the country, nursing home social services departments have become primarily responsible for discussing advance directives during the admissions process (Happ et al.
Keep a copy of the resident's advance directives and related physician orders in the resident's chart, and be sure to flag resident charts and Kardexes accordingly.
But we believe that the Bill offers a new opportunity to clarify the law on advance directives, introduce new safeguards, and to help prevent euthanasia or physician-assisted suicide.
The Joint Commission on Accreditation of Healthcare Organizations is evaluating the possibility of requiring all acute general hospitals to create registries of advance directives, and the University of California, San Francisco, will require all medical students beginning in September 2004 to fill out a personal advance directive.
The Association of American Medical Colleges is investigating advance directives, and it is possible that their implementation may be added to the curricula of the 126 American medical schools.
Australia) explores the incorporation of mental health advance directives into law in relation to contemporary human rights debates and the human rights framework of the Convention on the Rights of Persons with Disabilities.
And the only way to ensure that outcome is through the completion of advance directives.

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