Central Virginia Coalition for
Quality End of Life Care

"Honoring Each Life's Path"

Who would benefit | The Patient Self-Determination Act | Leading reasons healthcare directives are not followed | Healthcare Declarations | Reasons to refuse treatment

Advance Directives
by Carol Hicks

Advance Directives are used when you are unable to communicate the kind of care you would like to receive, and if you have an illness or injury from which you are not likely to recover. Living wills, healthcare declarations, organ donation, selection of a healthcare proxy, and residence during illness are considered Advance Directives. Advance Directives are personal and can be complex.

"The most frequent reasons given for not having an AD were: 40% never thought about it, 24% preferred family to make the decision, and 23% were procrastinating."1. Most people are motivated to consider these choices only after seeing a loved one suffer from poor health care. Why wait until you enter the hospital or have an emergency?

Who would benefit from having an Advance Directive:

  • Patients with less than six months to live
  • People in emergency situations with injuries that may cause permanent disabilities
  • The mentally ill
  • Alzheimer's patients

The Patient Self-Determination Act

In 1991, Congress passed The Patient Self-Determination Act. This Act ensures your right to receive information that will enable you to make choices about healthcare. Doctors, nurses and other health care professionals are encouraged by this law to explain and help their patients with these difficult decisions

Information about Advance Directives will be provided by:

Health Maintenance Organizations- HMOs
Home Health Agencies -HHA
Hospitals - during admission
Nursing Facilities - during admission
Hospice - during admission
Relevant web sites e.g. www.seniornavigator.com

Many hospitals have a board of ethics, that make the difficult decisions about when to end life. But opinions may vary on quality of life issues, especially when it comes to emergency care situations. It's best to have your desires well documented.

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Important people to discuss your advance directives with:

  • The Doctor: This is the person who will be caring for you and will be more likely to carry out the requests if you have discussed them ahead of time. The doctor can help clarify issues and put your preferences into language that other medical staff can understand more clearly
  • Family members: Their understanding of your wishes can help when a legal agreement may not have covered every eventuality. It will also prevent family members from making decisions that are "for the best" but are against your wishes.
  • A Lawyer: Laws concerning Advance Directives are different in each state.
In all states some form of Advanced Directive is legal. Some states require evidence of your requests before medical action can be carried out. Communication is essential. The more people who know and understand your wishes the better.

The leading reasons healthcare directives are not followed:

  • The directives are against the ethics of the physicians involved.
  • Emergencies - it's hard to stop the process of saving a life.
  • Misunderstandings or confusion in the directives.
  • Unable to find in a timely manner.
Many resources are available to help you with this process. These documents can be updated or rewritten to fit changing health conditions. Again communication is a very important part of having your desires met.

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Healthcare Declarations

A Healthcare Declaration can define for doctors what healthcare treatment is right for you. One person may accept life with a feeding tube or respirator, while another may consider the same care intolerable. In medical emergencies several factors should be considered. One of these is the amount of time allowed to see if recovery is possible. The Healthcare Declaration can set a time limit. It can also state the types of treatment and whether or not you wish to have "extraordinary" care to stay alive or just "ordinary" care.

Reasons to refuse treatment:

  • The benefit of the treatment is not great enough to justify the risk or discomfort/pain.
  • Treatments that would prolong the life in intolerable conditions
  • The little likelihood of the treatment's long-term success.

Advance Directives are a difficult topic for most of us to consider, but they can provide you with peace of mind and the quality of life you choose. The science of healthcare is ever advancing to serve the needs of patients. Don't remain silent. Use your rights to choose the medical care that is best for you.

Links to web sites with more information:

American Bar Association website- ABA Commission on Law and Aging - Consumer's Tool Kit for Health Care Advance Planning

American Hospital Association web site-Put it in Writing

Family Doctor.org- Advance Directives and Do Not Resuscitate Orders

To receive Living-Will and Healthcare - Power of Attorney forms write:

Caring Connections
National Hospice & Palliative Care
1700 Diagonal Road, Suite 625
Alexandria, VA 22314

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1. Ingrid Llovera, MD, MPH ,Mary Frances Ward, RN, MS, CCRN, James G. Ryan, MD, Martin Lesser,PhD, Andrew E. Sama, MD, Daniel Crough,MD, Mary Mansfield,RN, MS and Lenard I. Lesser, Academic Emergency Medicine Volume 6, Number 10 1054-1060, (c) 1999 Society for Academic Emergency Medicine