would benefit | The
Patient Self-Determination Act |
Leading reasons healthcare directives are not followed | Healthcare
Declarations | Reasons to refuse treatment
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?
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
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-
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
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Important people to
discuss your advance directives with:
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.
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
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.
Lawyer: Laws concerning Advance Directives are different
in each state.
The leading reasons
healthcare directives are not followed:
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.
- The directives
are against the ethics of the physicians involved.
- it's hard to stop the process of saving a life.
or confusion in the directives.
- Unable to
find in a timely manner.
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.
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
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:
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