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 ?
Approximately one in three US adults completes any type of advance directive for end-of-life care.
Since 75% of West Virginians repeatedly say in surveys conducted over the past decade that at the end-of-life they would prefer to live a shorter period of time to avoid pain, suffering, and being kept alive on machines, the POST form more than advance directives allows West Virginians with such preferences to be treated according to their wishes and with the emphasis on comfort as opposed to treatments which might increase their suffering.
In Autonomous Communities the legislative development of advance directives ensued, setting out legal concepts and clinical situations in order to specify the scope of patient autonomy and advance care planning [14].
Having a designated agent and an alternate in case that person is unavailable is particularly helpful when unforeseen situations arise, like traumatic injuries, as the agent can be more dynamic than an Advance Directive.
Advance directives are the best way for parents and children to express their wishes for end-of-life care.
The mechanism for this is the living will or the advance directive.
Although end of life care is provided in a number of settings, some researchers suggest that advance directives in primary care settings be developed while the patient is well or in early disease (Conroy, Fade, Fraser, & Schiff, 2009; Putman-Casdorph, Drenning, Richards, & Messenger, 2009).
Because there is no record of an advance directive or a "Do Not Resuscitate" (DNR) order, the ER team jumps into full cardiopulmonary resuscitation (CPR) mode.
Purposive sample of registered nurses (n=14), attending physicians (n=7) and fellow physicians (n=3) with advanced training in critical care medicine, consenting to provide information about the use of advance directives in the care of their patients at high risk for death in this ICU.
The National Healthcare Decision Day will be recognized in Phoenix with an event designed to educate the public on the ease of obtaining and drafting Advance Directives and their specific uses.

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