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The authority of advance directives 1
Published in Govert den Hartogh, What Kind of Death, 2023
As regards the authority of a positive advance directive there is an additional reason to focus primarily on the demented patient's interests. As I have argued in Section 9.5 the right to self-government doesn't provide a full justification for the doctor to grant a request for euthanasia in any case. For a full justification the doctor should also be reasonably convinced to act in the patient's best interests, as co-determined by her own basic values. Even if my advance directive should be seen as an authoritative representation of my interests, it doesn't follow that doctors are morally required, or even permitted to comply with it. Other relevant values may be at stake. I discuss this possibility in Section 15.8.
eMOLST
Published in Salvatore Volpe, Health Informatics, 2022
Advance directives (like New York’s health care proxy) are legal documents that identify a person who is entrusted by an individual to make medical decisions on their behalf, document the person’s values, beliefs, goals, and what matters most. An advance directive, like the living will, documents future care preferences but is difficult to interpret and cannot be followed in an emergency. The Patient Self-Determination Act ensures all adults 18 years of age and older have a right to complete advance directives. Public health law varies in each state, and as a result, there are different state-specific advance directives. Like wills and power of attorney documents, advance directives are legal documents that should be reviewed periodically and updated as needed.
Disability and Age Studies
Published in Joel Michael Reynolds, Christine Wieseler, The Disability Bioethics Reader, 2022
Another debate in bioethics in recent years has involved honoring advance directives that speak specifically to dementia, one of the most culturally feared intersections of old age and disability. For example, The Washington Post in 2020 featured a story on Susan Saran—a 64-year-old diagnosed seven years earlier with frontotemporal dementia who was told by her continuing care retirement community that they could not honor her wishes to withhold hand-feeding and fluids at the end of life (Aleccia 2020). An advance directive can allow an individual to set limits on the life-sustaining care received when they no longer have capacity to make their own medical decisions, including refusing treatments such as antibiotics and withholding nutrition and hydration at the end of life. In the case of dementia, determinations of both the end of life and capacity are complicated by the typically slow progression of dementia, which may span many years, and the accompanying uncertainties about the point at which an individual with dementia no longer has decision-making capacity. Saran, the article suggests, clearly demonstrates capacity seven years into her diagnosis (Aleccia 2020). Saran could choose to voluntarily stop eating and drinking now when she is still competent to make that choice but might lose out on several more good years of life.
Transferring nursing home residents to emergency departments by emergency physician-staffed emergency medical services: missed opportunities to avoid inappropriate care?
Published in Acta Clinica Belgica, 2023
Sabine E. E. Lemoyne, Peter Van Bogaert, Paul Calle, Kristien Wouters, Dennis Deblick, Hanne Herbots, Kg. Monsieurs
In Belgium, more than 75% of the NH residents are heavily dependent on care. More than half of them die within 24 months of NH stay [26]. Literature data show that DNR orders with written treatment restrictions often are not available, even for patients with severe life-limiting illness [27–29]. This increases the risk of futile resuscitation as discussed below [30–33]. The NH staff should make the DNR status available for every patient at the time of the EMS intervention [2]. When the NH staff pays more attention to the patient’s wishes regarding medical treatment, less avoidable transfers occur [34,35]. Conversations about advance directives are often perceived as difficult by health-care professionals and many GPs find it hard to identify the ‘right time’ to discuss directives [2]. It is, however, essential for this conversation between the patient and the GP or another treating physician to take place.
Take it to the resident: A model for engaging long-term stay residents in advance care planning
Published in Social Work in Health Care, 2021
Angelita Pritchett, Kelli E. Canada, Colleen Galambos, Laura Rollin, Marilyn Rantz
Understanding clients’ goals of care is an essential component of advance care planning for nursing home (NH) residents. Advance care planning involves having a meaningful conversation about a resident’s goals with the health-care team and documenting these wishes in advance directives (ADs; Momeyer & Mion, 2019). Advance directives include a living will, durable power of attorney for health care, and other documents for advance care planning (NIA, 2018). Unfortunately, conversations with residents about their wishes are not taking place early enough or with strategies that allow residents’ preferences to be meaningfully integrated into care plans (Bernacki & Block, 2014). In particular, knowing a person’s end of life (EOL) goals improves the quality of life and reduces the stress that families may experience when making health-care decisions on behalf of loved ones (Levy et al., 2008). Nursing home residents want more collaborative communication with family and staff yet collaborative conversations do not routinely take place (Munn et al., 2008).
Cognitive Transformation, Dementia, and the Moral Weight of Advance Directives
Published in The American Journal of Bioethics, 2020
In standard medical decision-making, patients are free to make their own choices regarding their treatment, so long as the patient in question is judged by medical professionals to have the requisite mental capacity to make an informed decision (Groll 2015).1 When capacity is compromised by a condition such as late-stage dementia, the patient is judged to no longer have the ability to know what is in their best interests.2 In such cases, the responsibility for the decision of how to act in the patient’s best interests is left in the hands of medical professionals or family members. Making this decision is particularly problematic, even harrowing, in cases in which the patient’s current preferences contradict their preferences as expressed in an advance directive. Advance directives are documents that allow individuals to set out directions and preferences for their future medical care, in the eventuality that they lose their decisional capacity (de Boer et al. 2010, 202).3 These documents have traditionally been conceived of as an effective means of extending an individual’s autonomy from their current self, as an individual who has decisional capacity, onto their future self, who lacks it.