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 ?
With a dementia-specific advance directive, the individual addresses a range of questions based on how cognitive decline typically progresses.
The 26-year-old had no advance directive when she had a massive heart attack leaving her comatose.
Westley and Briggs (2004) describe the use of the Stages of Change Theory to communicate about advance directives. Table 2 provides a summary of each stage.
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.
For the first time in Spanish legal system, the Convention on Human Rights and Biomedicine introduces the institution of advance directives [12].
While the focus with NM MOST and other efforts for ensuring that Advance Directives are properly completed is usually accomplished towards the end of life when patients are already in a health care facility, this may be too limiting an approach to increasing the overall proportion of individuals who have advance directives.
An advance directive is a way to tell both family and health care providers your wishes if you can't make decisions yourself.
Advance directives (often called "living wills") give people a way to express their wishes if they become severely ill and unable to make medical decisions for themselves.
Advance directives are given by hospitals to advanced cancer and terminally ill patients to sign, and are a checklist of medical procedures and medication that a patient might want to dispense with, because they are painful, prolong existence without improving the quality of life, or impose a heavy financial burden on the family.
This study was undertaken to uncover primary healthcare nurses' knowledge, experience and attitudes concerning their role in advance directives. In terms of terminology within the New Zealand context, an advance care plan may be considered an advance directive or may be aligned with other existing advance directives and be legally binding (MOH, 2011).

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