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End of life issues A focus on advance directives. By Latashia Gilkes. Advance Directive. What is an advance directive? An advance directive is any type of statement made by an individual to determine the medical care they would like to receive.

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End of life issues a focus on advance directives

End of life issuesA focus on advance directives

By Latashia Gilkes

Advance directive
Advance Directive

What is an advance directive?

  • An advance directive is any type of statement made by an individual to determine the medical care they would like to receive.

  • You can decide to continue to live or end life if and emergency decision has to be made

Purposes for advance directive
Purposes for advance directive

  • To make decisions before the client becomes unable to make decisions for themselves

  • To be involved in and responsible for medical care

  • To ensure the proper care is taken

Purposes for advance directives
Purposes for advance directives

  • Preparation for a serious illness in the near future

  • To have someone provide a voice when incapacitated

  • Clarification of what the client wants

Topics to cover
Topics to cover

  • Advance directives

  • Living wills

  • Durable power of attorney

  • Benefits

  • Ethical issues

  • Things you can do

Types of advance directives
Types of advance directives

  • Living wills

  • Power of attorney

  • Do not resuscitate

  • Do not hospitalize

  • Organ donation

  • Feeding restrictions

  • Medical restrictions

  • Request for autopsy

General information
General Information

  • Advance directives are mostly used by the elderly and terminally ill individuals

  • Can have more than one advance directive (i.e. organ donation and do not resuscitate)

  • However, less than 25% of individuals have at least one advance directive.

General information1
General Information

  • Anyone over the age of 18 can have one or more types of advance directive.

  • Individuals with terminal Illnesses or in an vegetative state would be more likely to have AD’S

History of advance directives
History of Advance directives

  • Cruzan v Director of the Missouri Department of Health (1990)

    • Supreme Court case involving a client’s right to refuse treatment during incapacitated state

  • Patient Self- Determination Act (1990)

    • Gives individuals the right to obtain advance directives

    • All health care providers are required to inform their clients

    • can accept or refuse medical care or treatment

Living wills
Living Wills

  • Living wills are the statements made by the individual to determine what will happen to them in an emergency or temporary medical care.

    • They can be very specific in detail or simple

    • All parties need to be aware of the client’s wishes and comply with them

Types of living wills
Types of Living Wills

  • Living wills can be

    • Verbal (with family members, doctors)

    • Written up by an attorney (legal documents)

    • Discussed with a doctor or health care provider

Durable power of attorney poa
Durable Power of Attorney (POA)

  • Appointing someone to make decisions if the client becomes incapacitated

  • The person can be a family member (children, sibling, spouse)

  • A trusted friend

  • Lawyer or doctor

Responsibilities of poa
Responsibilities of POA

  • To serve as a mediator for the client and the doctor

  • Voice for client

  • Comprehend the decisions made

  • Understand the client’s health

  • Meet the needs of the client

Benefits of advance directives
Benefits of advance directives

  • A medical plan for the future

  • Legal regulations to inform and provide individuals with advance directives

  • Ability to be involved and direct their medical decision

  • Can accept or refuse medical treatment

  • Connection between the client and POA

Disadvantages of advance directives
Disadvantages of advance directives

  • Clients can change their mind about their decisions

  • Difficult to predict what health issues will occur

  • Not being specific enough

  • Client may not want to make any decisions


  • Misunderstanding the wishes of the client

  • Miscommunication between the client and POA

  • Disagreeing or ignoring the wishes of the client

Ethical issues
Ethical issues

  • Doctors not meeting the client’s needs

  • Not giving the client all options

  • Cultural differences of the client

  • Religious differences of the client

  • Health care providers going against the client’s/family’s wishes

Word to the wise
Word to the wise


  • Be responsible for your own health by any means necessary

  • You have the power to control of your medical care

  • Get all the information you can to make the choices necessary for your own medical circumstance

Things you can do
Things you can do

  • Obtain all the information about your health care to make the right decisions

  • Make clear and precise decisions of what you would want

  • Contact your doctor and/or attorney about advance directive options

Things you can do1
Things you can do

  • Talk to friends and family who have completed advance directives

  • Discuss your decisions with whom you want to have represent you

  • Trust that person to make choices when unable