ADVANCED DIRECTIVES

Advanced Directives

Advanced Directives

Introduction

In today's healthcare delivery system, attitudes toward end-of life care issues have taken on new dimensions due to advanced technological, economical, and societal factors. Very often, the advances in medical technology can simply neutralize the effects of certain diseases without healing. An individual can be placed into a human limbo kept from dying but deprived of a quality of living. Individuals facing death are concerned with losing autonomy, having medical decisions made by strangers, pain, becoming a burden, dependency on others, unwanted intrusion of futile treatment, the emotional and financial impact upon them and their families, and having their theological concerns denied or not honored (Croke & Daguro, 2005; Stanley, Blair & Beare, 2005).

Historical Perspectives on Advance Directive Laws

“The common-law concept of informed consent, buttressed by constitutional principles of privacy and liberty [has] formed the primary platform from which advance medical directives spring” (Sabatino, 2007). The doctrine of informed consent is based on the fundamental right of self-determination and the fiduciary nature of the patient-healthcare provider relationship.

The federal law underscored public concern regarding patients' rights and decisions regarding end-of-life care treatment. The PSDA requires all healthcare facilities and providers receiving Medicare or Medicaid funding to implement the following regulations:

Ask the patient, upon admission to the facility, about the existence of an advance directive

Provide a written information to all patients, upon admission to their facility, about the rights to accept or refuse medical or surgical treatments/procedure following state law

Give patients the right to complete an advance directive, although the law does not mandate that the patient execute an advance directive

Document advance directives in each of the patient's records

Provide education to staff, caregivers, patients, and the community on advance directives

Prevent discrimination in care for or against patients with an advance directive

Establish and communicate to staff, caregivers, and patients a policy about implementing advance directives

Include a clear and precise explanation of any conscious objection that a provider, facility, or provider's agent may have to following an individual's advance directive. Only the conscious objections permitted under state law may be included in the facility policy (Croke & Daguro, 2005; Painlaw, 2004).

Discussion

Types of Advance Directives

Advance directives inform healthcare providers, what type of care the individual would want to have or not have, if the individual becomes unable to make healthcare decisions. Types of advance directives include the living will, the durable power of attorney for healthcare (DPAHC), and a combined healthcare directive.

The living will

It is also known as “the five wishes.” This only comes into effect when the patient is terminally ill, which is generally defined as less than six months, to live. The living will be provides directives to healthcare providers, surrogates, and family members regarding the individual's wishes of future medical care he or she wishes to receive or not receive when he or she can no longer make the decision for him/herself.

The DPAHC

It allows an individual (patient) to appoint someone (agent, proxy, surrogate) to make healthcare decisions ...