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Advance Directives. Ethics Champion Program Carol Bayley, PhD VP Ethics and Justice Education Catholic Healthcare West. (add poll) How many of you have an advance directive?. Living will Durable Power of Attorney for Health Care I don’t have an advance directive.

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advance directives

Advance Directives

Ethics Champion Program

Carol Bayley, PhD

VP Ethics and Justice Education

Catholic Healthcare West

add poll how many of you have an advance directive
(add poll) How many of you have an advance directive?
  • Living will
  • Durable Power of Attorney for Health Care
  • I don’t have an advance directive
which federal law authorizes advance directives
Which federal law authorizes advance directives?
  • 1976 Quinlan (U.S. Supreme Court)
  • 1989 EMTALA
  • 1991 Patient Self-Determination Act
  • No federal law; advance directives are regulated by the states
which does the law not require
Which does the law NOT require:
  • Hospital patients must be advised that they can refuse treatment
  • Patients must be advised that they can make an advance directive
  • Nursing home patients must make an advance directive witnessed by an ombudsperson.
who can create an advance directive
Who can create an advance directive?
  • Only the patient’s physician
  • Any person
  • Any person with capacity to make medical decisions
advance directives 101
Advance Directives 101
  • Written document of person’s wishes for treatment or non-treatment
  • Two forms
    • Living Will
    • Durable Power of Attorney for Health Care
  • Only a competent person may create AD.
  • Only takes effect when the patient does not have capacity to make a medical decision.
  • One of the conditions of participation in Medicare/Medicaid for hospitals and nursing homes
what about witnesses
What about witnesses?
  • Two witness; at least one of them must not be related to the person (by blood, marriage, or adoption—it’s about the estate…)
  • Witnesses only attest identity of person creating AD; can be total strangers
  • In nursing home, ombudsperson must also sign
what problems can an advance directive solve
What problems can an Advance Directive solve?
  • Family does not know how long to continue treatment
  • Family feels guilty about terminating treatment
  • Patient wished to avoid specific types of treatment
what problems ads cannot solve
What problems ADs cannot solve
  • Appointed agent who cannot follow patient’s wishes
  • Dysfunctional families (!)
  • Doctors who only stop when they think further treatment is useless
  • Doctors who believe ADs are only for dying patients
more things ads won t solve
More things ADs won’t solve
  • The difficulty of value -laden decisions under conditions of uncertainty
  • Loss of meaning; loss in general
  • Grief
advance directives are not a substitute for
Advance Directives are not a substitute for
  • Care plans to carry forward a patient’s goals for treatment
  • DNR orders
  • Family conversation about end of life care