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...
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)
American Academy of Orthopaedic Surgeons. (2006) "Emergency Care and Transportation
of the Sick and Injured" Jones & Bartlett Publishers.
Billings, Diane M. (2008) "Lippincott's Content Review for NCLEX-RN." Lippincott
Williams & Wilkins.
Feldman, Mitchell D; Christensen, John F. (2007) "Behavioral Medicine." McGraw-Hill
Johnson, James. (2001) "Introduction to Fluid Power."
Johnstone, Megan-Jane. (2004) "Bioethics: A Nursing Perspective"
Lippincott Williams & Wilkins. (2004) "Pharmacology"
Lippincott Williams & Wilkins.
N.A. (n. d.) "Advance Directives." Retrieved 20 June, 2009 from http://www.alsmndalliance.org/uploads/pdfs/Advanced_directives.doc
N.A. (n. d.) "Advance Medical Directives." Retrieved 20 June, 2009 from http://www.cpt.org/files/PP%20-%20Advance%20Directives.pdf
N.A. (2007) "Patient Bill of Rights" Retrieved 20 June, 2009 from http://mhcc.maryland.gov/consumerinfo/hospitalguide/patients/consumer_help/bill_of_rights.htm
Sharpe, Charles C. (1999) "Medical records review and analysis."
Shewchuk, Tara Rayne. (1998) "Completing advance directives for health care decisions:
Getting to yes" Psychology, Public Policy, and Law, vol.…
Advanced directive may be one of the most important and underutilized tools in estate planning and health planning. This is partially due to the stigma that people have about advanced directives, as if, by planning how to deal with health issues, they are somehow going to cause health problems. However, the reality is that most people will encounter at least one medical emergency during their lifetime. In the event that
For example, Wissow and colleagues (2004) collected gender, age, ethnicity, and levels of clinic/ED use. This information may provide valuable insight into who is most likely to create an advanced directive in response to the intervention. The time frame for the study was not mentioned or how long after the intervention the survey instrument would be presented to intervention participants. This could be relevant because some individuals exposed to
According to this second view, contemporaneous autonomy trumps precedent autonomy because honoring precedent autonomy imposes preferences and values of a different person, the formerly competent self (Buccafumi, p. 14). The role that patient's families, doctors, health aides, pastors, chaplains and administrators, health educators and others play is crucial. Few people have executed an advanced directive, much less appointed a healthcare power of attorney by the time they enter a hospital
The DPAHC permits a person to name a successor to their proxy in the event that the proxy dies or otherwise not capable to assist in making choices at the time of need. It also permits a person to ascertain other constraint for boundaries of power. In most states it would also be legal to unite the two documents if a person wanted to (Cranston, n.d.). Discussions with relatives, legal
The overall incidence of the withdrawal of life sustaining measures in European ICUs is not known, although withholding and withdrawing life support is actively used by most European intensivists, shortening of the dying process remains rare. In the treatment of terminally ill patients in Japan, new surveys indicate that Japanese physicians tend to treat the patients more aggressively. An analysis showed that in Japan, patients wishes are often not
2006, p.1). In Anglo culture, extremities of grief may be reserved for close family members, while in cultures where extended family is important, intense grief may be acceptable and expected, even for distant family members There is also greater acceptance of death in the Latino culture as a whole, as manifest in the almost festive 'Day of the Dead' rituals in that nation, in which children often participate, and