advance directive

Advance directives

Contents of the post

  • Overview
  • Other names
  • Types of advance directives
  • The need for a living will
  • Important aspects related to a durable power of attorney for a health care
  • Living will vs durable power of attorney for a health care
  • Important aspects of advance directives
  • Frequently asked questions on advance directives
  • Some important medical terms to know before you prepare your advance directive

Overview

An advance directive is a legal document through which a person can give directions about the type of care which he wants before he needs it; when he or she has lost the capacity or competence to make any decisions regarding the required or best-suited treatment.

Other names

  • Advance healthcare directive
  • Personal directive
  • Medical directive
  • Advance decision
  • Directive to doctors ( referred only to living will)

Types of advance directives

  • There are 2 types of advance directives:
    • A living will
    • A durable power of attorney for healthcare or healthcare proxy
  • Both of the above-mentioned documents are legal written agreements which allow a person to establish values and treatment preferences to be honored in future when the person has lost his capacity to make decisions.
  • For example, if a person wishes that he or she should not be tube fed or resuscitated, that can be achieved by an advance directive.
  • A person’s preferences for medical care or treatment can be achieved by a living will.
  • If a person wishes that the other person should take decisions related to his or her healthcare and/or the preferences for medical care; it can be achieved by a durable power of attorney for healthcare.

Living will

  • This document is called a living will because it is in effect while the person is alive.
  • It expresses a person’s preferences for medical care.
  • In some states of the US, this document is also known as a directive to doctors.
  • A great variation can be observed in the laws of various states as far as the living will is concerned.
    • In some states, a legally effective living will can only be prepared by a terminally ill person.
    • In order to be a legally valid document, living will should be in compliance with the state laws.
    • Some states require that living wills should be written in a standardized format.
    • Others are more flexible, permitting the use of any language as long as the document is appropriately signed and witnessed.

Durable power of attorney for healthcare

  • This document facilitates the decision-making related to healthcare.
  • This is a document in which one person (the principal) names the other person (the agent or the attorney) to make decisions about healthcare and only healthcare.
  • A power is durable if it remains legally in force even when the principal becomes incapacitated.
  • Selecting an agent should be done with great care.
    • A person who strongly wishes to avoid aggressive medical treatment should not designate as an agent to anyone who believes, based on personal philosophy or religious doctrine, that every possible medical intervention should be used to prolong life.
    • Similarly, a spouse who is under enormous emotional stress may be unable to carry out the person’s preferences, especially if these include limiting or terminating the treatment or care.
    • A trusted business associate or a longtime friend is a better choice for a person who has strong preferences but who does not want the rigidity of a living will.
    • It is important to discuss the details of possible future medical choices with the person named as an agent since the agent should be guided by the person’s preferences.
  • The durable power of attorney for health care should name an alternate person or a successor in case the first named person is unable or unwilling to serve as agent.
  • There are 2 types of durable power of attorney for healthcare:
    • Jointly held power
      • In this case, 2 or more persons may be named to serve together or jointly.
      • This type of document requires that all the agents should agree and act together.
      • In this agreement, all the named agents must be contacted and must agree on every decision.
      • This type of arrangement may also lead to chaos and should probably be avoided unless there are special circumstances that warrant its use.
    • Severally held power.
      • This type of arrangement is usually preferable since it allows any named agent to act alone.

The need for a living will

  • Many people believe that extreme heroic measures and technology should be used to extend life as long as possible, regardless of the degree of medical intervention required or the quality of life that results.
  • If you are one of the above types and if you want to indicate preferences for aggressive medical treatment, the document might state:
    • “I want my life to be prolonged to the greatest possible extent without any regard to my condition, the chances that I for recovery, the burdens of the treatment, or the cost of the procedures.”
  • A large number of people also feel that death is preferable to being perpetually dependent on medical equipment or having no hope of returning to a certain quality of life.
  • If you are one of the above types and if you want to prevent heroic attempts to extend life, this document, in your case might state that:
    • “I do not want my life to be prolonged and I do not want life-sustaining treatment including artificial feeding and hydration to be provided or continued if I can no longer recognize friends and loved ones and am not expected to resume an independent lifestyle.”
    • In this case, you can demand or specify that comfort measures should be taken.
  • If you want to express an intermediate preference, the document in your case might state that:
    • “I want my life to be prolonged and I want life sustaining treatment to be provided unless I am in a coma or in a persistent vegetative state that my doctors reasonably believe to be irreversible. After my doctors have reasonably concluded that I am in an irreversible condition, I do not want life sustaining treatment including artificial feeding and hydration to be provided or continued.”
  • A living will allows a person to express any of the above mentioned preferences.

Limitations of a living will

  • Living wills address only a narrow range of end-of-life decisions.
  • This is because it’s impossible to predict all the serious medical circumstances a person may face in future.
  • Also, the written document may not be available at the time and place where it’s needed.
  • Additionally, the preferences of a person who has prepared a living will, changes from time to time on the basis of illness and changes in priorities over time.
  • The biggest limitation of a living will is that it is prepared much before it’s need arises. Hence, highly specific directions or instructions are not included in this document for the new and unforeseen circumstances.

Important aspects related to a durable power of attorney for health care

  • A person who is competent can cancel a durable power of attorney at any time.
  • The choice of an agent does not have to be permanent.
  • If circumstances change, the person can create a new durable power of attorney naming a new agent.
  • Special circumstances may have to be addressed in drawing up a durable power of attorney for healthcare.
    • For example, family members have a priority as visitors in a hospital under most circumstances.
  • Unmarried partners and same-sex couples may need special protection to preserve such privileges.
  • A durable power of attorney for health care is critical if the patient wants special status and decision making power for a person who is legally unrelated.

Living will vs durable power of attorney for health care

  • A living will states a person’s preferences regarding medical treatment.
  • It provides guidance on what care should be provided under various circumstances.
  • A durable power of attorney differs from a living will.
  • This document designates an agent to make healthcare decisions.
  • The agent is granted the power to discuss medical alternatives with the doctors and make a decision if an accident or illness incapacitates the person.
  • The durable power of attorney for healthcare can include a living will provision or a description of health care preferences. But this should be done only to serve as guidance for the agent and not as a binding selection.

Important aspects of advance directives

  • Ideally, a person should give copies of his living will and durable power of attorney for health care to every doctor providing care for him and to the hospital upon admission.
  • Copies should also be placed in the person’s permanent medical record.
  • A copy of the durable power of attorney for health care should also be given to the person’s appointed agent and another copy placed with important papers.
  • The person’s lawyer should also hold a copy of all the documents.
  • Some advance directive documents are overly complicated or unfamiliar to doctors and hospitals. This may create confusion.
  • This is especially important if the person has both: a living will and a durable power of attorney to stipulate which should be followed if they appear to be in conflict.
  • In general, a durable power of attorney is preferable if the patient has a trusted person to appoint.
  • The appointed person can then act as an advocate, question the medical staff, and help decide what the patient would want or what is in the best interest of the patient.

Frequently asked questions on advance directives

  • Unlike most of the legal document which comes into effect from the date of the establishment of the document or the date mentioned in the document, an advance directive comes into effect only after a person’s incapacity has been determined.
  • If no advance directives have been prepared, someone has to take decisions related to his treatment and healthcare.
  • In this case, doctors and hospitals usually turn to the next of the kin.
  • In the rare event when the issue is presented to the court, the control is usually given to a family member.
  • If no appropriate family member can be found, the court appoints a guardian or a conservator who may be a friend or a stranger to oversee the treatment and care.

An advance directive eliminates almost any need for the courts to get involved and helps ensure that the person’s health care decisions will be respected.

  • Please note that the answer to the above question is applicable in every country.
  • An advance directive is valid and applicable throughout the country, but there’s a catch.
  • Every state has different laws and requirements as far as advance directives are concerned.
  • So if your advance directive is in compliance with the laws of the state in which you are receiving the treatment, it’s valid.
  • In the United States, advance directives are valid throughout the country.
  • An advance directive from one state may or may not work in the other.
  • This is because the laws and the requirements of the advance directive differ from state to state.
  • But if your directive is in compliance with the laws of both the states, it’s valid.
  • If you have prepared an advance directive which is in compliance with the laws of your state, check whether this directive is legally acceptable in the other state or not.
  • If it’s not, then prepare advance directives for all the states in which you spend a considerable amount of time.
  • An advance directive does not expire.
  • It remains in effect until the person who has prepared an advance directive changes it.
  • If you prepare a new directive, it automatically invalidates the previous one.
  • Your living will or durable power of attorney for health care will not be honored by an emergency medical technician.
  • In case of an emergency, medical personnel will do what he has to; to stabilize the patient for transfer to a hospital from the site of the accident or from his home or other facilities.
  • Advance directives can be implemented only after a physician:
    • Fully evaluates the patient’s condition.
    • Determines the underlying causes or conditions.
    • Confirms the incompetence of the patient to take any decision.
  • This depends on the country/state of your residence as well as the country or state in which you plan to move to in future.
  • In the United States, you don’t need a lawyer as long as you sign them in front of the required witnesses.
  • However, having a lawyer to guide you in preparing any legal document is always beneficial.
  • Once you have prepared an advance directive, you should keep reviewing it from time to time.
  • This should be done to ensure that it still reflects your wishes.
  • You cannot change an advance directive which you have already prepared.
  • If you want to make any changes, you will have to prepare the entire document once again.
  • Once this new directive is prepared, it automatically cancels the previous one.
  • If a person is incapacitated and no advance directive exists, some other person or persons must provide directions in decision making.
  • A surrogate can be a person designated by state law as a healthcare decision maker or an informally identified person such as a close family member or a close friend who happens to be available.
  • Most doctors and hospitals accept consent to provide care from spouse, sibling or an adult child or even from a distant or uninvolved relative who can be reached in crisis, although in many states none of these people has the legal right to consent on a person’s behalf without being appointed by a court.
  • Many hospitals and doctors will limit this selection to relatives and will ignore or exclude close friends.
  • It makes practical and ethical sense in accepting the judgment of a close relative or friend over that of a distant relative or total stranger.
  • People without family or close friends who are alone in the hospital are more likely to receive a court-appointed guardian.
  • The surrogate is just like the agent appointed in the durable power of attorney for health care.
  • Any decision taken by a surrogate is based on the three standards in the following order of importance:
    • The instructions expressed by the person such as in a living will or orally when the person was still capable of making decisions.
    • Inferences about what the person would likely want in a particular situation based on what is known about his prior behavior and his patterns of decision making.
    • What the surrogate and health care team believe is in the person’s best interest. This is resorted to when the person’s wishes and values are not known.

Please share this post if you think I have written something worth reading.

Some important medical terms to know before you prepare your advance directive

Code

The summoning of professionals trained in cardiopulmonary resuscitation to revive a person’ in cardiac or respiratory arrest.

No code

An order signed by a patient’s doctor stating that cardiopulmonary resuscitation should not be performed if a cardiac or pulmonary arrest occurs. This is also called a DNR (do-not-resuscitate).

Cardiopulmonary resuscitation (CPR)

An action taken to revive a person in cardiac or respiratory arrest.

Terminally ill

The medical state of being near death where there is no hope or cure.

Irreversibly ill

The state of debilitation like a coma or persistent vegetative state from which the patient will not recover.

Life-sustaining treatment

Any treatment given to postpone the death of a terminally ill person.

Palliative care

Measures taken to keep a terminally ill person as comfortable as possible.

Do-not-resuscitate order (DNR)

  • The do-not-resuscitate order placed in a person’s medical record by his doctor informs the medical staff that cardiopulmonary resuscitation should not be performed.
  • This order has been particularly useful in preventing unnecessary and unwanted invasive treatment at the end of life.
  • A DNR order does not mean “do not treat”. It only means that CPR will not be performed. Other treatments may still be provided if needed.
    • Doctors discuss with patients the possibility of cardiopulmonary arrest, describe CPR procedures and ask the patient about treatment preferences.
    • If a person is incapable of making a decision about CPR, a surrogate may make the decision based on the person’s previously expressed preferences or if such preferences are unknown, then a decision has to be taken in accordance with the person’s best interests.

Persistent vegetative state

  • This is a state of permanent coma or unconsciousness caused by an injury or illness.
  • No reasonable expectation of recovery exists in this condition.

“Advance Health Care Directives: Towards a Coordinated European Policy?”. academia.edu.

“Aging With Dignity Five Wishes”. Agingwithdignity.org. Archived from the original on May 9, 2009. Retrieved 2010-06-23.

“Bioethics and Public Policy”. The Hastings Center. Archived from the original on 7 July 2010. Retrieved 2010-06-23.

“Biotestamento. Favorevole o contrario?”. ProVersi.it. 19 February 2018.

“BMA guidance” (PDF). bma.org.uk.

“Canadian Hospice Palliative Care Association”. CHPCA.net. 2014. Retrieved 2014-11-18.

“Common law | Define Common law at Dictionary.com”. Dictionary.reference.com. Retrieved 2010-06-23.

“Country reports on advance directives, 100 pages” (PDF). University of Zurich. Retrieved 2017-02-11.

“Death with dignity: on SC’s verdict on euthanasia and living wills”. 10 March 2018 – via www.thehindu.com.

“Do I Need a Will?”. State Bar of California. Retrieved 23 November 2017.

“Facts on Act 169 (Advance Directives) – Pennsylvania Medical Society”. Pamedsoc.org. Archived from the original on 2011-05-07. Retrieved 2010-06-23.

“Health Canada- Minister’s speeches”. Health Canada.ca. 2014-02-06. Archived from the original on 2014-11-29. Retrieved 2014-11-18.

“How to make a living will : Directgov – Government, citizens and rights”. Direct.gov.uk. Archived from the original on 2009-07-18. Retrieved 2010-06-23.

“Living Wills, Health Care Proxies, & Advance Health Care Directives”. ABA. American Bar Association. Retrieved 8 May 2017.

“Means to a Better End: A Report on Dying in America Today” (PDF). Robert Wood Johnson Foundation. November 2002. Archived from the original (PDF) on 9 July 2007. Retrieved 23 November 2017.

“National Framework for advance care planning”. SpeakUp. 2014. Archived from the original on 2014-11-28. Retrieved 2014-11-18.

“One-third of Americans say they’ve had to make a decision about whether to keep a loved one alive using extraordinary means”. Public Agenda. Archived from the original on 27 April 2009. Retrieved 17 June 2010.

“Pallium Canada”. Pallium.ca. 2014. Retrieved 2014-11-18.

“Rona Ambrose says Canada needs better palliative care”. CBC. 2014-09-15. Retrieved 2014-11-18.

“Site of the Swiss government on the intended new law”. Ejpd.admin.ch. Archived from the original on 2010-06-07. Retrieved 2010-06-23.

“The Accuracy of Surrogate Decision Makers: A Systematic Review”. Archives of Internal Medicine. 166: 493. doi:10.1001/archinte.166.5.493. Conclusions Patient-designated and next-of-kin surrogates incorrectly predict patients’ end-of-life treatment pREFERENCES in one third of cases.

“The CARENET”. The CARENET.ca. 2014. Retrieved 2014-11-18.

“The Robert Wood Johnson Foundation: Health and Health Care Improvement”. RWJF. Archived from the original on 22 June 2010. Retrieved 2010-06-23.

“The Way Forward- moving towards an integrated palliative approach to care: survey of GP/FPs and nurses in primary care” (PDF). Ipsos Reid. August 2014. Retrieved 2014-11-18.

“The Way Forward”. HPC integration.ca. 2014. Retrieved 2014-11-18.

“The Way Forward: an Integrated Approach to Palliative Care” (PDF). HPC integration. 2014. Retrieved 2014-11-18.

“Values History Form”. Hospicefed.org. Retrieved 2010-06-23.

“Values History”. Hospicefed.org. Archived from the original on 2012-12-13. Retrieved 2014-03-08.

“Washington state ends living will registry”. The Seattle Times. July 1, 2011. Archived from the original on September 27, 2013. Retrieved 2011-07-24.

Alexander G.J. (1991). “Time for a new law on health care advance directives”. Hastings Center Law Journal. 42 (3): 755–778.

American Academy of Neurology. Practice Parameters: Assessment and Management of Patients in the Persistent Vegetative State: Summary Statement. Neurology. 1995;45(5):1015-1018.

American Bar Association. Patient Self-Determination Act: State Law Guide. American Bar Association Commission on Legal Problems of The Elder. August 1991.

American Bar Association. Patient Self-Determination Act: State Law Guide. American Bar Association Commission on Legal Problems of the Elderly. August 1991.

American Medical Association. Guidelines for the Appropriate Use of Do-Not-Resuscitate Orders. Council on Ethical and Judicial Affairs. Journal of the American Medical Association. 1991;265(14):1868-1871.

Annas George J (1991). “The Health Care Proxy and the Living Will”. New England Journal of Medicine. 324 (17): 1210–1213. doi:10.1056/nejm199104253241711.

Annas GJ (1991). “The Health Care Proxy and the Living Will”. New England Journal of Medicine. 324 (17): 1210–1213. doi:10.1056/nejm199104253241711.

Anthony, J. Your aging parents: document their wishes. American Health. May 1995. pp. 58-61, 109.

Appel Jacob M. “When Any Answer is a Good Answer: A Mandated Choice Model for Advance Directives”. Cambridge Quarterly of Healthcare Ethics. 19 (3): 417–422. doi:10.1017/s0963180110000253.

Bok S (1976). “Personal directions for care at the end of life”. New England Journal of Medicine. 295: 367–369. doi:10.1056/nejm197608122950706.

Brett AS (1991). “Limitations of listing specific medical interventions in advance directives”. Journal of the American Medical Association. 266: 825–28. doi:10.1001/jama.266.6.825.

Callahan, D. Setting Limits Simon & Schuster. 1983

Campbell ML (1995). “Interpretation of an ambiguous advance directive”. Dimensions of Critical Care Nursing. 14 (5): 226–235. doi:10.1097/00003465-199509000-00001.

Charmaine Jones, With living wills gaining in popularity, push grows for more extensive directive, Crain’s Cleveland Business, August 20, 2007.

Childress, J. Dying Patients. Who’s in Control? Law, Medicine & Health Care. 1989;17(3):227-228.

Choice in Dying (now: Partnership in Caring). Choice in Dying: an historical perspective. CID 1035-30th Street, N.W. Washington, DC. 2007

Cohen-Mansfield J; et al. (1991). “The decision to execute a durable power of attorney for health care and preferences regarding the utilization of life-sustaining treatments in nursing home residents”. Archives of Internal Medicine. 151: 289–294. doi:10.1001/archinte.151.2.289.

Colin, BD. Living Choice. Health. November 1986. p. 72.

Colvin ER, Hammes BJ (1991). “If only I knew: a patient education program on advance directives”. American Nephrology Nurses Association Journal. 18 (6): 557–560.

Conolly, Ceci. “Obama takes personal approach in AARP speech,” The Washington Post, July 29, 2009.

Covinsky, KE; Goldman, L; Cook, EF; etal. The impact of serious illness on patient’s families. Journal of the American Medical Association. 1994;272(23):1839-1844.

Cugliari A, Miller T, Sobal J (1995). “Factors promoting completion of advance directives in the hospital”. Archives of Internal Medicine. 155 (9): 1893–1898. doi:10.1001/archinte.155.17.1893.

Current TV: News Video Clips & Current News Articles “A Third of Americans Die in Hospitals, Study Finds” September 24, 2010.

Damato AN (1993). “Advance Directives for the Elderly: A Survey”. New Jersey Medicine. 90 (3): 215–220.

Decree of Dr. Guido Stanziani, Guardianship Judge of the Tribunal of Modena, 13 May 2008.

Diamond E; et al. (1989). “Decision-making ability and advance directive preferences in nursing home patients and proxies”. Gerontologist. 29: 622–26. doi:10.1093/geront/29.5.622.

Docker, C. Advance Directives/Living Wills in: McLean S.A.M., “Contemporary Issues in Law, Medicine and Ethics,” Dartmouth 1996

Docker, C. Advance Directives/Living Wills in: McLean S.A.M., Contemporary Issues in Law, Medicine and Ethics,” Dartmouth 1996:182.

Doukas DJ, McCullough LB (1991). “The values history: the evaluation of the patient’s values and advance directives”. Journal of Family Practice. 32: 145–53.

Doukas DJ, McCullough LB, “Assessing the Values History of the Aged Patient Regarding Critical and Chronic Care,” in The Handbook of Geriatric Assessment. Eds. Gallo JJ, Reichel W, Andersen LM, Rockville, MD: Aspen Press, 1988:111-124.

Eisendrath S, Jonsen A (1983). “The living will – help or hindrance?”. Journal of the American Medical Association. 249: 2054–58. doi:10.1001/jama.249.15.2054.

Emanuel LL, Emanuel E (1989). “The medical directive: A new comprehensive advance care document”. Journal of the American Medical Association. 261 (22): 3288–93. doi:10.1001/jama.261.22.3288.

Emanuel LL, Emanuel EJ (1993). “Advance directives: what have we learned so far?”. Journal of Clinical Ethics. 4: 8–16.

Emanuel LL, Emanuel EJ (1993). “Decisions at the end of life: guided by communities of patients”. Hastings Center Report. 23 (5): 6–14. doi:10.2307/3562059.

Ewer MS, Taubert JK (1995). “Advance directives in the intensive care unit of a tertiary cancer center”. Cancer. 76: 1268–74. doi:10.1002/1097-0142(19951001)76:7<1268::aid-cncr2820760726>3.0.co;2-u.

Fisher, Ian (21 December 2006). “Euthanasia Advocate in Italy Dies”. New York Times. Retrieved 23 November 2017.

For the official guidance to doctors, see: “Treatment and care towards the end of life: good practice in decision making”. General Medical Council, 2010. Although addressed to doctors, the guidance may also provide helpful information to patients and the public; see, [1]. Retrieved 2011-01-05.

Gamble ER; et al. (1991). “Knowledge, attitudes and behavior of elderly persons regarding living wills”. Archives of Internal Medicine. 151: 277–80. doi:10.1001/archinte.1991.00400020049011.

Hare J; et al. (1992). “Agreement between patients and their self-selected surrogates on difficult medical decisions”. Archives of Internal Medicine. 152 (5): 1049–54. doi:10.1001/archinte.1992.00400170123023.

Hashimoto DM (1983). “A structural analysis of the physician-patient relationship in no-code decision-making”. Yale Law Journal. 93: 361. doi:10.2307/796311.

Hastings Center. Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying: a report by the Hastings Center. Briarcliff Manor, NY: Indiana University Press. 1987.

Heap, MJ; etal. Elderly patients’ preferences concerning life support treatment. Anaesthesia. 1993;48:1027-1033.

High , Turner HB (1987). “Surrogate decision-making: the elderly’s familial expectations”. Theoretical Medicine. 8: 303–320. doi:10.1007/bf00489466.

High DM (1988). “All in the family: extended autonomy and expectations in surrogate health care decision-making”. Gerontologist. 28 (Suppl): S46–S51. doi:10.1093/geront/28.suppl.46.

High DM (1988). “All in the family: extended autonomy and expectations in surrogate health care decision-making”. Gerontologist. 28 (suppl): S46–S51. doi:10.1093/geront/28.suppl.46.

Johnston SC; et al. (1995). “The discussion about advance directives: patient and physician opinions regarding when and how it should be conducted”. Archives of Internal Medicine. 155: 1025–1030. doi:10.1001/archinte.155.10.1025.

Johnston, Carolyn; Liddle, Jane (2007). “The Mental Capacity Act 2005: a new framework for healthcare decision making”. Journal Medical Ethics. 33 (2): 94–97. doi:10.1136/jme.2006.016972. PMC 2598235 Freely accessible. PMID 17264196.

Joos SK, Reuler JB, Powell JL, Hickam DH (1993). “Outpatients’ attitudes and understanding regarding living wills”. Journal of General Internal Medicine. 8: 259–63. doi:10.1007/bf02600093.

Ki Mae Heussner. “Easing the end of life: Startups that are helping people make the ultimate decision”. gigaom.com.

Kutner, Luis (1969). “Due Process of Euthanasia: The Living Will, a Proposal”. Indiana Law Journal. 44 (4): 534–554. Retrieved 22 March 2018.

Lambert P, Gibson, JM, Nathanson, P. The Values History: An Innovation in Surrogate Medical Decision-Making, Med. & Health Care, 202-212 (1990)

Larson, Aaron. “How a Power of Attorney Works”. ExpertLaw.com. ExpertLaw. Retrieved 4 May 2017.

Law No. 6 of January 9, 2004

LONDON (June 10, 2010) (2010-06-10). “Demand for Living Wills trebles in the last two years”. JLNS. Archived from the original on 17 July 2010. Retrieved 2010-06-23.

Lubitz, J; Riley, GF. Trends in Medicare payments in the last year of life. New England Journal of Medicine. 1993;328:1092-1096.

Lynn J (1991). “Why I don’t have a living will”. Law, Medicine & Health Care. 19 (1-2): 101–04. doi:10.1111/j.1748-720x.1991.tb01803.x.

McGrath, RB. In-house Cardiopulmonary resuscitation — after a quarter of a century. Annals of Emergency Medicine. 1987;16:1365-1368.

Omnibus Reconciliation Act of 1990 [including amendments commonly known as The Patient Self-Determination Act]. Sections 4206 and 4751, P.L. 101-508. Introduced as S. 1766 by Senators Danforth and Moynihan, and HR 5067 by Congressman Sander Levin. Signed by the President on November 5, 1990; effective beginning December 1, 1991.

Omnibus Reconciliation Act of 1990.

Ouslander, J et al. “Health care decisions made by frail elderly and their potential proxies. Gerontologist 1988; 28:103A-104A.

Owen, Richard (10 February 2009). “‘Right to die’ coma woman Eluana Englaro dies”. The Times. Retrieved 23 November 2017.

Patient Self-Determination Act U.S.C.A. 1395cc & 1396a, 4206-4207, 4751, Omnibus Budget Reconciliation Act of 1990, P.L:.b 101-508 (101ST Cong. 2nd Sess. Nov. 5, 1990) (West Supp., 1991).

Patrick, DL; etal. Measuring preferences for health states worse than death. Medical Decision-Making. 1994;14:9-19.

President Obama Holds a Tele-Townhall Meeting on Health Care with AARP Members, CQ Transcriptions, July 28, 2009.

Rothschild, Alan (5 Feb 2008). “Physician-Assisted Death. An Australian Perspective”. In Birnbacher, Dieter; Dahl, Edgar. Giving Death a Helping Hand: Physician-Assisted Suicide and Public Policy. An International Perspective. International Library of Ethics, Law, and the New Medicine. 38. Springer. p. 104. ISBN 9781402064951.

Sachs GA, Cassell CK (1990). “The medical directive”. Journal of the American Medical Association. 267 (16): 2229–33. doi:10.1001/jama.267.16.2229.

Schneiderman LJ; et al. (1992). “Relationship of general advance directive instructions to specific life-sustaining treatment preferences in patients with serious illness”. Archives of Internal Medicine. 152 (10): 2114–22. doi:10.1001/archinte.152.10.2114.

Scitovsky, A.A. The High Cost of Dying, Revisited. Milbank Quarterly. 1994;72(4):561-591.

Seckler AB, Meier DE, Mulvihill M, Cammer Paris BE (1991). “Substituted judgment: how accurate are proxy predictions?”. Annals of Internal Medicine. 115: 92–98. doi:10.7326/0003-4819-115-2-92.

Silverman H, Vinicky J, Gasner M (1992). “Advance directives: implications for critical care”. Critical Care Medicine. 20 (7): 1027–1031. doi:10.1097/00003246-199207000-00021.

Strengthening Advance Directives: Overcoming Past Limitations Through Enhanced Theory, Design, and Application. Lifecare Publications. 2008

SUPPORT Investigators. A controlled trial to improve care for seriously ill hospitalized patients: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). Journal of the American Medical Association. 1995;274(20):1591-1598.

Tokar, Steve. “Patients Prefer Simplified Advance Directive over Standard Form – UCSF Today”. Pub.ucsf.edu. Archived from the original on 2009-02-07. Retrieved 2010-06-23.

Tomlinson T, Howe K, Notman M, Rossmiller D (1990). “An empirical study of proxy consent for elderly persons”. Gerontologist. 30: 54–61. doi:10.1093/geront/30.1.54.

Tyminski MO (2005). “The current state of advance directive law in Ohio: more protective of provider liability than patient rights”. Journal of Law and Health. 19 (2): 411–49.

Uhlmann R, Pearlman R, Cain K (1989). “Understanding elderly patients’ resuscitation preferences by physicians and nurses”. Western Journal of Medicine. 150: 705–44.

US Congress, Office of Technology Assessment. Life-Sustaining Technologies and the Elderly. OTA-BA-306. Washington, DC: US Gov’t Printing Office. July, 1987.

Wilkkes, JL. Nursing Home Nightmares. USAToday. August 20, 1996. 11A.

Wolf SM (1991). “Honoring broader directives”. Hastings Center Report. 21 (5): S8–S9. doi:10.2307/3562902.

Zweibel NR, Cassel CK (1989). “Treatment choices at the end of life: a comparison of decisions by older patients and their physician-selected proxies”. Gerontologist. 29: 615–21. doi:10.1093/geront/29.5.615.

advance care planning

By |2018-09-05T14:13:27+00:00September 5th, 2018|Uncategorized|0 Comments

About the Author:

B. Pharm (K.L.E. society's S.V.V. Patil College of Pharmacy, Bengaluru) M. Pharm (Maharishi Arvind Institute of Pharmacy, Jaipur)

Leave A Comment

WE NEED YOUR HELP IN CREATING AWARENESS ABOUT DISEASES AND MEDICINES

In today's fast paced life, we often come across minor health issues that we often neglect due to lack of time for paying a visit to a doctor, which usually takes away 2-3 hours of a person's time and are expensive too. Further more, such minor conditions may grow big at any time if neglected. Our aim in setting up this platform is that any person can search for any health condition or medicines and can get all the needed information within hardly 10-15 minutes, which saves a lot of time and money. After going through every information, if the person has any questions, he/she can go to our forums section and raise a topic. This will help him/her decide better whether he/she needs to pay an immediate visit to a doctor or can it wait for a day or two? Help us in bringing awareness about diseases and medicines by spreading the word to at least 5 of your friends and relatives.
Select your currency