Best Practices, Enduring Challenges, and Opportunities for SED by AD

2021 ◽  
pp. 241-248
Author(s):  
Timothy E. Quill ◽  
Paul T. Menzel ◽  
Thaddeus M. Pope ◽  
Judith K. Schwarz
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Advance Directive ◽  
Family Members ◽  
Decision Making Capacity ◽  
Challenges And Opportunities

SED by AD begins with an advance directive specifying what eating and drinking limitations the person desires if decision-making capacity is lost and when to begin them. Both written and video instructions are recommended. SED by AD potentially prevents a preemptive choice to VSED by those still enjoying life but wanting to avoid a prolonged dementia death. Challenges to implementation include uncertainty about legality, and concerns about a patient’s possible ‘change of mind’ once capacity is lost. Family members and caregivers may become distressed about how to respond to subsequent requests for food or fluid. Should caregivers respond to the ‘then’ capacitated person who previously completed the directive or the ‘now’ incapacitated person who seems to want oral feedings? Ideally an AD for SED also articulates how caregivers should respond to apparent desires for fluids. Comfort feeding only (CFO) should be the ‘back up’ plan if SED by AD proves to be too difficult for the patient or caregivers.

Best Practices, Enduring Challenges, and Opportunities for VSED

2021 ◽  
pp. 126-130
Author(s):  
Timothy E. Quill ◽  
Paul T. Menzel ◽  
Thaddeus M. Pope ◽  
Judith K. Schwarz
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Best Practices ◽  
Advance Directives ◽  
Symptom Management ◽  
Early Phase ◽  
Terminal Illness ◽  
Care Providers ◽  
Decision Making Capacity ◽  
Challenges And Opportunities

VSED begins with excellent symptom management supported by experienced clinicians. VSED is largely patient controlled, but involvement of experienced palliative care providers and family is strongly recommended. Decision making capacity is frequently lost late in the process as death nears, so written advance directives to continue withholding food and fluids should be completed prior to initiating VSED to forestall any misunderstandings of the patient’s wishes. Challenges associated with VSED include its two week duration before death, the personal determination required, and the possibility of delirium in the latter stages that potentially compromises the commitment to forgo fluids. These challenges should be anticipated and planned for. The primary advantages of VSED include: 1) predictable two week duration from initiation to death; 2) alertness for the early phase, 3) no terminal illness requirement, 4) largely under the patient’s control, and 5) awareness of the possibility of VSED can provide comfort to those worried about unacceptable future suffering.

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

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

P02.186 Anxiety and depression in family members of ICU patients: Ethical considerations regarding decision-making capacity

2000 ◽  
Vol 15 (S2) ◽  
pp. 372s-372s
Author(s):  
F. Pochard ◽  
E. Azoulay ◽  
S. Chevret ◽  
I. Ferrand ◽  
J.F Dhainaut ◽  
...  
Keyword(s):  
Decision Making ◽  
Family Members ◽  
Anxiety And Depression ◽  
Ethical Considerations ◽  
Icu Patients ◽  
Decision Making Capacity

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

2016 ◽  
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

Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity

2001 ◽  
Vol 29 (10) ◽  
pp. 1893-1897 ◽  
Author(s):  
Frédéric Pochard ◽  
Elie Azoulay ◽  
Sylvie Chevret ◽  
François Lemaire ◽  
Philippe Hubert ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Family Members ◽  
Anxiety And Depression ◽  
Decision Making Capacity

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

2016 ◽  
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

Illustrative Cases

2021 ◽  
pp. 133-150
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Decision Makers ◽  
Decision Making Capacity ◽  
Challenges And Opportunities ◽  
Surrogate Decision Makers ◽  
Food And Drink ◽  
Surrogate Decision ◽  
Real Patients

Four stories of real patients considering VSED who would prefer to continue living until decision-making capacity is lost, and then have others start the stopping eating and drinking (SED) process on their behalf are described. Waiting until this stage potentially protects patients from having to initiate VSED before they really want to, but it also places considerable burdens on surrogate decision-makers who must activate the SED process based on the patient’s prior statements and formal advance directives (ADs). ADs for SED can help guide the timing, but a now-incapacitated patient who is very hungry and thirsty may not comprehend why he is not being provided food and drink. Patients and surrogates should consider in advance how to weigh statements of the “then-self” versus the “now-self” in subsequent decision-making. Four cases of SED by AD are explored, including some of the challenges and opportunities raised by allowing this possibility.

scholarly journals Personal transformation and advance directives: an experimental bioethics approach

2020 ◽  
Author(s):  
Brian D. Earp ◽  
Stephen R. Latham ◽  
Kevin Tobia
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Late Stage ◽  
Family Members ◽  
Personal Transformation ◽  
Dementia Patient ◽  
Ordinary People ◽  
Normative Model ◽  
People With Dementia

Some people with dementia are transformed by the disease, to the point that family members may describe them as a “different person.” These transformations may be negative or positive. What factors affect the judgements of ordinary people about whether an advance directive (AD) should be followed in such cases? We conducted three studies to test the influence of (1) positive versus negative transformation and (2) “treat” versus “withhold treatment” AD on the judgements of US participants (n = 1676) as to whether the AD should be followed and the extent to which the late-stage dementia patient had become a different person. We found that participants generally endorsed following the AD, irrespective of condition, but much less so when the patient had a positive transformation. Participants also favored “treat” over “withhold treatment” ADs. Unexpectedly, we found that AD type affected “different person” judgments: participants registered significantly weaker agreement with the proposition that the patient had become a different person when the AD instructed treatment. We discuss these results in the context of Walsh’s (2020) newly proposed normative model for AD decision-making.

scholarly journals Anxiety and depression in family members of ICU patients: ethical considerations regarding decision-making capacity

Critical Care ◽  
10.1186/cc952 ◽  
2000 ◽  
Vol 4 (Suppl 1) ◽  
pp. P233
Author(s):  
F Pochard ◽  
E Azoulay ◽  
S Chevret ◽  
F Lemaire ◽  
P Hubert ◽  
...  
Keyword(s):  
Decision Making ◽  
Family Members ◽  
Anxiety And Depression ◽  
Ethical Considerations ◽  
Icu Patients ◽  
Decision Making Capacity
Sign in / Sign up

Export Citation Format

Share Document