The Health Care Proxy and the Living Will

Discussions about advance directives should begin before a hospitalization occurs, yet are sometimes initiated at the time of imminent death or during a life-altering medical event. A lack of knowledge in the general public perpetuates this practice because most people do not think about end-of-life choices and do not want to discuss the topic. Yet, family members naturally undertake surrogacy but often find themselves ill equipped to handle the moral and ethical situations that arise. Hence, it is important that health care providers engage patients to consider the completion of health care proxy and living will documents. Provider awareness about general perceptions will facilitate the approaches to initiating conversations about advance directives. This case study highlights the ethical dilemma of an octogenarian whose poor prognosis and lack of an advance directive contributed to an uncertain medical course.

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The Health Care Proxy and the Living Will

New England Journal of Medicine ◽

10.1056/nejm199109193251218 ◽

1991 ◽

Vol 325 (12) ◽

pp. 893-894 ◽

Cited By ~ 2

Keyword(s):

Health Care ◽

Living Will ◽

Health Care Proxy

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In My Best Interest

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909115609576 ◽

2016 ◽

Vol 34 (2) ◽

pp. 160-165 ◽

Cited By ~ 2

Author(s):

Patricia A. Mayer ◽

Bryn Esplin ◽

Christopher J. Burant ◽

Brigid M. Wilson ◽

MaryAnn Lamont Krall ◽

...

Keyword(s):

Health Care ◽

Decision Making ◽

Medical Center ◽

Specific Treatment ◽

Living Will ◽

Treatment Preferences ◽

Power Of Attorney ◽

Best Interest ◽

Permanent Disability ◽

Surrogate Decision

Background: Advance directives (ADs) have traditionally been viewed as clear instructions for implementing patient wishes at times of compromised decision-making capacity (DMC). However, whether individuals prefer ADs to be strictly followed or to serve as general guidelines has not been studied. The Veterans Administration’s Advance Directive Durable Power of Attorney for Health Care and Living Will (VA AD) provides patients the opportunity to indicate specific treatment preferences and to indicate how strictly the directive is to be followed. Objective: To describe preferences for life-sustaining treatments (LSTs) in various illness conditions as well as instructions for the use of VA ADs. Design/Setting: A descriptive study was performed collecting data from all ADs entered into the medical record at 1 VA Medical Center between January and June 2014. Measurements: Responses to VA AD with emphasis on health care agents (HCAs) and LW responses. Results: Veterans were more likely to reject LST when death was imminent (74.6%), when in a coma (71.1%), if they had brain damage (70.6%), or were ventilator dependent (70.4%). A majority (67.4%) of veterans preferred the document to be followed generally rather than strictly. Veterans were more likely to want VA ADs to serve as a general guide when a spouse was named HCA. Conclusion: Most of the sampled veterans rejected LST except under conditions of permanent disability. A majority intend VA ADs to serve as general guidelines rather than strict, binding instructions. These findings have significant implications for surrogate decision making and the use of ADs more generally.

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Health-Care Provider Personal Religious Preferences and Their Perspectives on Advance Care Planning With Patients

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118785891 ◽

2018 ◽

Vol 35 (12) ◽

pp. 1565-1571

Author(s):

Marjorie Bowman ◽

Sarah St. Cyr ◽

Adrienne Stolf i

Keyword(s):

Health Care ◽

Health Care Providers ◽

Advance Care Planning ◽

Religious Affiliation ◽

Living Will ◽

Care Planning ◽

Care Providers ◽

Power Of Attorney ◽

Religious Preference ◽

Advance Care

Objective: To understand how health-care providers’ (HCPs) religious preferences influence their willingness to undertake advance care planning (ACP) with patients and their acceptance of other HCP’s involvement. Methods: Online anonymous survey distributed to HCPs in hospital, ambulatory offices, and hospice settings in Dayton, Ohio. We evaluated the associations of HCP religion with their personal ACP, willingness to facilitate ACP, and acceptance of other HCPs’ ACP participation. Results: 704 respondents: nurses (66.2%), physicians (18.8%), other HCPs (15.0%), white (88.9%), and primarily Catholic (23.3%) or Protestant (32.0%). “No religion” was marked by 13.9%. Respondents were favorable to ACP with patients. Religious respondents were more likely to have a living will ( P = .035) and health-care power of attorney ( P = .007) and more accepting of clergy as ACP decision coaches ( P = .030). HCP’s religion was not associated with willingness to facilitate ACP discussions. There were minor differences between Catholics and Protestants. Conclusions: Personal religious preference is associated with HCP’s own ACP but had little relationship with their willingness to facilitate ACP conversations with patients or acceptance of other professional types of HCPs involvement in ACP conversations. Regardless of religious affiliation, HCPs have interest in undertaking ACP and endorse other HCPs ACP involvement. As results of this study suggest that personal religious affiliation is not a barrier for HCPs engaging in ACP with patients, attempts to overcome barriers to increasing ACP should be directed to other factors.

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Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

10.2310/obg.2187 ◽

2018 ◽

Author(s):

Laura Stafman ◽

Sushanth Reddy

Keyword(s):

Health Care ◽

Decision Making ◽

Advance Directives ◽

Advance Directive ◽

Persistent Vegetative State ◽

Living Will ◽

Do Not Resuscitate ◽

Power Of Attorney ◽

Decision Making Capacity ◽

Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

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How to plan for the progression of dementia

10.1093/oso/9780190098124.003.0018 ◽

2021 ◽

pp. 263-280

Author(s):

Andrew E. Budson ◽

Maureen K. O’Connor

Keyword(s):

Health Care ◽

Daily Living ◽

Power Of Attorney ◽

Future Planning ◽

Health Care Proxy ◽

Loved One ◽

Legal Documents ◽

The Future ◽

Will Power ◽

To Receive

As your loved one begins to experience more problems with thinking and memory, they will need help managing their health care, finances, and other aspects of daily living. They may need to leave their home in order to receive the amount or type of care they require. Preparing legal documents such as a will, power of attorney, and health care proxy is an important step in planning for the future. Having conversations with your loved one early after a diagnosis ensures that they can participate in future planning as much as possible, easing your burden as increased care is required. Even if they don’t want to participate, you can still explore options so you will be ready when a crisis occurs.

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Case of Conflicting Emotions Tests What a Health Care Proxy Can Decide

Caring for the Ages ◽

10.1016/s1526-4114(08)60036-0 ◽

2008 ◽

Vol 9 (2) ◽

pp. 8

Author(s):

Jeffrey Nichols

Keyword(s):

Health Care ◽

Health Care Proxy

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The role of oncologic health care providers in end of life discussions for women with recurrent gynecologic or breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20543 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20543-e20543

Author(s):

Ashley Stuckey ◽

Katina Robison ◽

Don S. Dizon ◽

Michelle Rogers ◽

Miles Ott ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

End Of Life ◽

Health Care Providers ◽

Institutional Review Boards ◽

Care Providers ◽

Provider Type ◽

Health Care Proxy ◽

Recurrent Cancer ◽

And Gender

e20543 Background: Advance care planning (ACP) is an important topic for women with metastatic or recurrent cancer. Unfortunately, data suggest ACP is often not discussed at health care visits. Because patients with metastatic or recurrent cancer are incurable, the issue of end of life (EOL) is one faced by patients and providers. This study evaluates how often oncologic health care providers initiate EOL conversations with their patients. Methods: Eligible patients included women with metastatic or recurrent gynecologic or breast cancer of ≥3 month’s duration in an academic women’s oncology program. Interviews were conducted by research staff. Clinical characteristics and documentation of EOL decisions were obtained through chart reviews. Data were analyzed using SAS v.9.3. Multivariate logistic regression was used to model the association of EOL discussions with ACP. The study was approved by the hospital and university Institutional Review Boards. Results: 200 women were enrolled; 64% had stage III-IV cancer at diagnosis. The majority was white (91%) with a mean age of 60 (range 35-82). A total of 638 providers were identified (mean: 3.2 providers per patient; 57% female). Health care provider type and gender were not associated with EOL discussions. Only 49 women (25%) recalled an EOL conversation with at least one provider which appeared to correspond to the low proportion of people with documented ACP. Only 42 (22%) had an advanced directive (AD) and 29 (15%) a health care proxy (HCP) in the chart. Having an EOL conversation with at least one provider was not associated with a chart-documented AD (OR=1.6, 95% CI=0.7-3.6) or HCP (OR=1.8, 95% CI=0.7-4.5). The time since recurrence was shorter for those reporting EOL conversations (1.7 vs. 3.1 years, p=.0274). Conclusions: In this study, oncologic health care providers infrequently initiated EOL discussions with their patients with metastatic or recurrent cancer. More concerning, patient recollection of an EOL discussion with a provider was not associated with chart-documented ACP. Further studies evaluating the factors limiting EOL discussions as well as studies testing interventions to improve provider documentation of the ACP are warranted.

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