Advance Directives-research and discuss the legal and ethical basis for Advance Directives such as the Living Will and Durable Power of Attorney for healthcare.
Why are these documents so valuable in healthcare situations?
What legal authority do these documents provide for decision making by family and/or healthcare providers?
Briefly discuss a situation in which a Living Will might apply and would be of benefit to those involved.
Once you have researched and discussed Advance Directives, draft a sample Living Will, indicating the type of content that should be found in such a document. Some students take this opportunity to prepare their own actual Living Will, and that certainly is encouraged.
Grading Criteria: You will submit 2 Word Documents
Paper answering the questions highlighted above: 40 points (Word Document: 2-3 pages, APA format)
Living Will Sample Draft: 100 points (Use the book and your state requirements for content to be included
BOOK
This Paragraph is from this book page number : 320-321 page number
Medical Law and Ethics
Bonnie F. Fremgen
Advance Directives
The Federal Patient Self-Determination Act of 1991 mandates that adult patients admitted into any health care facility that receives funding from either Medicare or Medicaid must be asked if they have an advance directive or wish to have information about these self-determination directives. An advance directive is a document that directs a surrogate (a person who is replacing another person) to represent them. Ideally, people make decisions about advance directives before they are in a situation in which they are being admitted to a hospital or nursing home. If these documents—such as a living will, durable power of attorney for health care, Uniform Anatomical Gift Act, or do not resuscitate (DNR) order—have to be drawn up after a patient has entered a facility, then it should be done in a nonstressful manner.
Advance directives are popularly known as living wills. These documents became popular about 30 years ago when medical technology made it possible for people to be kept alive in unpleasant and fragile conditions for long periods of time. An advance directive is a statement or declaration by a patient that he or she does not want to be connected to life support equipment if the patient becomes terminally ill without hope of recovery. The document should be signed and witnessed and may serve as a “living will,” depending on the current law in the person’s state. Advance directives limit the type and amount of medical care and treatment that patients will receive if they should become incompetent and have a poor prognosis. It is important that directives are placed in writing; it is not sufficient for a person to just tell someone what his or her wishes for treatment are. The courts typically enforce written advance directives. For additional discussion about advance directives, see Chapter 5.
Med Tip
All health care professionals should be aware that it is also acceptable for a patient to write an advance directive asking to receive maximum care and treatment for as long as possible.
The substitute judgment rule is used when decisions must be made for people who cannot make their own decisions. Under this rule a person, committee, or institution will attempt to determine what the person would do if she or he were competent to make their own decisions. However, there is always speculation about what decision the patient would actually make if they were competent, even though they may have indicated their wishes to another person at an earlier time. Therefore, when there is a lack of an advance directive, most decision makers will rule in favor of using all interventions such as tube feedings. This is a case in which the principle of beneficence is followed because it operates in the interests of the patient. A subjective judgment of a committee or institution may or may not be what the patient would request if able to do so. Therefore, an advance directive is clearly the recommended document to advise the best course of treatment for the patient.
Without an advance directive from the individual patient, treatments that might be ordered for patients include CPR, mechanical breathing or respirator, tube feedings, kidney dialysis, chemotherapy, intravenous therapy, surgery, diagnostic tests, antibiotics, and transfusions.
Med Tip
It is recommended that all persons over the age of 18 place in writing their wishes about what type of treatment they should receive if they become incompetent. The advance directive should be specific about treatments such as CPR, tube feeding, and ventilators.
Health Care Proxy
In some cases, a person can sign a health care proxy appointing another person to act for them in making health care decisions on their behalf. Each state has passed laws to allow a health care proxy to be signed that authorizes the person appointed to make such health care decisions. Health care proxies may place specific limitations on the authority of the authorized person. Such proxies can be revoked either orally or in writing.
| Criteria | Ratings | Pts |
|---|---|---|
|
Written Paper Answering Questions: APA Format 5 points Spelling and Grammar 5 points Content 30 points |
40 pts Full Marks 0 pts No Marks |
/ 40 pts |
|
Living Will Sample Draft Professional 10 points Writing Mechanics (Grammar, Spelling, Syntax, Format) 25 points Content 65 points |
100 pts Full Marks 0 pts No Marks |
/ 100 pts |
| Total Points: 0 | ||
