However, it does mean that some things will be different from the normal line of treatment. ("Advance Medical Directives.," n. d.); (Feldman, Mitchell D; Christensen, John F. (2007)
The fact that resuscitation of a patient through CPR will not add significantly to the quantity and quality of life is an indication that death may not be very far off and that medicine does not have the power to turn around the dying process. CPR has not only proved to be ineffective for terminally ill patients but the harsh nature of its functioning make it a technological, cruel and expensive death process. The results of many studies have indicated that the "out-of-hospital survival" rate of patients suffering from multisystem disease like renal failure and advanced cancers have not increased as a result of CPR. Conflicts often crop up when the patient's family members, friends or relatives who have a vested interest in the welfare or estate of the patient can not comprehend the medical, ethical and legal implications of the advance directives specified by the patient. Doctors are likely to be threatened with charges of malpractices by the relatives of patients who insist on compliance, or even noncompliance with those specifications provided in the advance directive which are unacceptable to them. Therefore many state laws have provisions for extending immunity from liability to doctors who make decisions in good faith about life-saving medical procedures initiated in specific situations. ("Advance Medical Directives.," n. d.); (Feldman; Christensen, 2007); (Sharpe, Charles C. (1999)
Advance directives have considerable moral importance and provide a number of benefits. Firstly, it relieves the family members from the pressure of having to take important medical decisions regarding life and death and puts the entire responsibility on the patient. Secondly, it promotes self-determination and autonomy of the patients. Thirdly it promotes the well-being of the patients by protecting them from expensive, futile and intrusive medical treatments. It also serves altruism by giving health care providers and surrogate decision makers the authority to end any kind of treatment that would place a huge emotional and financial burden on family members. Advance directives help many terminally ill patients or otherwise healthy people to plan ahead for their eventual death. It also helps to strengthen relationships by increasing communication between near and dear ones and settles the issue of "unfinished business." (Johnstone, 2004); ("Advance Directives.," n. d.)
Despite such benefits there are certain limitations as well as risks that advance directives may pose. Even the earlier specified preferences of well-informed patients may get altered as prognosis and therapeutic options change. Moreover, people might not be able to judge their interests correctly. Initially made advance directives may change drastically in unforeseen future conditions including medical advances and would place people's interests at stake. Imprecise language used in advance directives can also make them vulnerable to controversial interpretations. It is also possible for designated proxies to disagree among themselves. In addition, there may be the problem of similarly specified advance directives being subjected to very dissimilar or contrasting degrees of judgment concerning the issue whether it is obligatory for the proxies to take such decisions. Some of the limitations that advance directives have include the fact that they cannot be employed as a request for euthanasia. In fact, they cannot be used to specify any kind of illegal action including inappropriate intervention or treatment. They also cannot be used to withhold basic healthcare, food and drink by mouth or hygiene. (Johnstone, 2004); ("Advance Directives.," n. d.)
Despite the fact that advance directives have been promoted by various state laws, condoned by the judiciary and carefully brought into operation by health care institutions, their execution rate still remains quite low. Doctors must inform and discuss with their patients about the benefits of advance directives and issues related to end-of-life when a patient's health is good enough for such discussions and not when they are in an acute medical problem. Patients must also be assisted in familiarizing themselves and becoming more comfortable with the reality of death and the need for advance care planning. Administrators of health care institutions must facilitate the education of both health care providers as well as of patients on the value of advance directives. Full acceptance and cooperation of patients, their families and care providers is essential for the full scale implementation of this very sensitive process. (Shewchuk, 1998)
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