Advanced healthcare directives

An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity.

Another form is a specific type of power of attorney or health care proxy, in which the person authorizes someone to make decisions on their behalf when they are incapacitated.

Goals of ADs is the increase the likelihood that a patient will receive the medical care he or she wishes at the end of life, enhancing quality of life, and providing input and support to one’s family members.

Patients are encouraged to complete both documents to provide comprehensive guidance regarding their care.

Advance directives were created in response to the increasing sophistication and prevalence of medical technology.

Of U.S. deaths, 25–55% occur in health care facilities.

Deficits in the medical care of the dying, found to be unnecessarily prolonged,painful, expensive, and emotionally burdensome to both patients and their families.

Aggressive medical intervention leaves nearly two million Americans confined to nursing homes, and over 1.4 million Americans remain so medically frail as to survive only through the use of feeding tubes.

As many as 30,000 persons are kept alive in comatose and permanently vegetative states.

70-95% of people would rather refuse aggressive medical treatment than have their lives medically prolonged in incompetent or other poor prognosis states.

The living will is the oldest form of advance directive.

The living will is a way for an individual to express his or her health care desires when no longer able to express current healthcare wishes.

It requires healthcare providers to give patients information about their rights to make advance directives under state law.

They usually provides specific directives about the course of treatment healthcare providers and caregivers are to follow.

It may forbid burdensome medical treatments.

Utilized only if the individual has become unable to give informed consent or refusal due to incapacity.

Specifics of living wills may include: individual’s desire for analgesia, antibiotics, hydration, feeding, and use of ventilators or cardiopulmonary resuscitation.

Most living wills tend to be limited in scope, and often fail to fully address presenting problems and needs, and patient wishes might conflict with quality medical practice.

Living wills also reflect a moment in time, and may need regular updating to ensure that the correct course of action can be chosen.

Durable powers of attorney for health care and healthcare proxy documents allow an individual to appoint someone to make healthcare decisions in their behalf if they should be incapable of making their wishes known.

Second-generation advance directives allow the representative to make real-time decisions in actual circumstances, as opposed to hypothetical situations, as recorded in a living will.

Third generation advanced directives were designed to assist individuals and their appointed agents, families, and physicians to better understand and honor their wishes.

It is to focus on specific treatments and medical procedures of patient values and personal goals.

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