ADVANCE DIRECTIVES

1
ADVANCE DIRECTIVES

• ADVANTAGES
• AND
• DISADVANTAGES

2
WHY AN ADVANCE DIRECTIVE

• TO EXTEND THE AUTHORITY OF THE PATIENT BEYOND THE
  ONSET OF DECISIONAL INCAPACITY
• TO EXPRESS CLEARLY THE WISHES OF THE PATIENT SO
  THEY WILL BE HONORED BY CAREGIVERS, FAMILIES, AND
  OTHERS
• TO AVOID BECOMING A VICTIM OF ANOTHERS AGENDA
• ARBITRARY DECISIONS PATIENT WOULD NOT WANT
• DECISIONS MADE OUT OF GUILT OR FEAR
• PRESSURE FROM SPECIAL INTEREST GROUPS
• PROTRACTED OR UNDESIRABLE COURT DECISIONS
• TO AVOID THE NECESSITY OF GOING TO COURT ---
  OFTEN INAPPROPRIATE DECISIONS
• CONSERVE RESOURCES, PARTICULARLY WHEN FURTHER
  TREATMENT IS FUTILE

3
TYPES OF ADVANCE DIRECTIVESINFORMAL STATEMENTS

• ADVANTAGES
• INSURES COMMUNICATION HAS OCCURED

• DISADVANTAGES
• NO DOCUMENTATION IN CASE OF CONFLICT WHEN ADVANCE
  DIRECTIVE IS TO BE IMPLEMENTED
• OFTEN CASUAL COMMENT WITH LITTLE REFLECTION OR
  SPECIFICITY

4
TYPES OF ADVANCE DIRECTIVESDOCUMENTED STATEMENTS
TO PHYSICIANS

• ADVANTAGES
• NO NEED TO LABOR OVER A WRITTEN DOCUMENT
• NO NEED TO SECURE WITNESSES TO A SIGNED DOCUMENT
• CAN DISCUSS IMMEDIATELY TREATMENT DIRECTIONS WITH
  PHYSICIAN

• DISADVANTAGES
• PHYSICIANS RECORDS MAY BE INACCESSIBLE WHEN THEY
  ARE NEEDED, E.G., RETIREMENT
• STATEMENTS MADE TO SEVERAL PHYSICIANS MAY CONFLICT

5
TYPES OF ADVANCE DIRECTIVESLIVING WILL
DECLARATIONS

• ADVANTAGES
• DOCUMENTED PROTRAIT OF PATIENTS WISHES AND
  VALUES
• PROMOTES AUTONOMY BEYOND OF POINT OF INCAPACITY
• ENHANCES REFLECTIVE LIFE OF AUTHOR
• PROMOTES DIGNITY BY ALLOWING RISK-TAKING BY
  AUTHOR
• ACCEPTS CONTEXT OF NATURAL RHYTHMS OF LIFE

• DISADVANTAGES
• IMPOSSIBLE TO ANTICIPATE ALL CONTINGENCIES
• NO COMPETENT PERSON WITH AUTHORITY TO ASSESS
  PARTICULARS OF A CLINICAL SITUATION AND MAKE
  DECISIONS
• LACK OF SPECIFICITY IF GENERIC FORM IS USED
• LACK OF CREDIBILITY IF INTENTIONS AND VALUES OF
  AUTHOR ARE UNKNOWN

6
TYPES OF ADVANCE DIRECTIVESLIVING WILL
DECLARATIONS

• ADVANTAGES (CONT.)
• CAN GENERATE AVENUES OF COMMUNICATION
• AUTHOR AND SIGNIFICANT OTHER/CAREGIVERS
• PROTECTION FROM UNDESIRED INTERVENTIONS
• RELIEVES SECOND GUESSING
• RELIEVES GUILT AND FEAR
• PROMOTES CONTINUITY OF CARE
• MAY BE COST EFFECTIVE

• DISADVANTAGES (CONT.)
• FREQUENTLY LITTLE COMMUNICTION OCCURS WITH SIMPLY
  SIGNING A FORM

7
TYPES OF ADVANCE DIRECTIVESDURABLE POWER OF
ATTORNEY FOR HEALTHCARE

• ADVANTAGES
• DESIGNATES A PERSON THE PATIENT TRUSTS
• GIVES DECISIONAL AUTHORITY TO INDIVIDUAL WHO CAN
  ASSESS SPECIAL CIRCUMSTANCES IN THE CLINICAL
  SITUATION
• IDENTIFIES AN INDIVIDUAL WITH AUTHORITY WITH
  WHOM PHYSICIAN CAN COMMUNICATE

• DISADVANTAGES
• IF NO CLEAR COMMUNICATION BEFORE INCAPACITY,
  PATIENT COULD BECOME VICTIM OF ATTORNEY-IN-FACTS
  AGENDA
• WITHOUT DOCUMENTATION PHYSICANS CAN QUESTION IF
  ATTORNEY-IN-FACT IS TRULY REPRESENTING PATIENTS
  WISHES
• WITHOUT DOCUMENTATION OTHERS MAY OBSTRUCT
  ATTORNEY-IN-FACTS DECISIONS

8
TYPES OF ADVANCE DIRECTIVESDURABLE POWER OF
ATTORNEY FOR HEALTHCARE

• ADVANTAGES
• REQUIRES PHYSICIANS TO HONOR DECISIONS OF
  ATTORNEY-IN-FACT AS THEY WOULD IF THE PATIENT
  HIMSELF/HERSELF HAD MADE THE DECISIONS
• REDUCES FEAR OF LAWSUIT BECAUSE OF AUTHORITY OF
  DECISION-MAKER

• DISADVANTAGES
• WITHOUT PRIOR COMMUNICATION AND DOCUMENTATION
  ATTORNEY-IN-FACT MAY HESITATE TO MAKE NECESSARY
  DECISIONS BECAUSE OF GUILT
• WITHOUT DOCUMENTATION AUTHORITY OF
  ATTORNEY-IN-FACT MAY BE WEAKENED
• A WELL-DESIGNED LIVING WILL MAY NEUTRALIZE
  DISADVANTAGES