In My Best Interest

2016 ◽  
Vol 34 (2) ◽  
pp. 160-165 ◽  
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.

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

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

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

Fiduciary Principles in Surrogate Decision-Making

2019 ◽  
pp. 248-263
Author(s):  
Nina A. Kohn
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Fiduciary Duty ◽  
Third Party ◽  
Duty Of Care ◽  
Surrogate Decision Making ◽  
Surrogate Decision Maker ◽  
Power Of Attorney ◽  
Surrogate Decision ◽  
The Individual

This chapter examines the fiduciary principles governing surrogate decision-making. Surrogate decision-making relationships arise when one person is appointed to make decisions for another, and are often used to make decisions for individuals with acute medical conditions or cognitive disabilities that make it difficult or impossible for the individuals to make decisions for themselves. A surrogate decision maker may be authorized by the individual for whom decisions are to be made or by a third party, including a court or a federal agency providing benefits to the individual. This chapter first considers how fiduciary duties are triggered in surrogate decision-making relationships and describes the requirements for appointment and acceptance by type of surrogate: guardians and conservators, agents acting under a power of attorney for finances or health care, and representative payees and other government fiduciaries. The discussion then turns to the surrogate decision maker’s duty of loyalty and duty of care, along with other fiduciary obligations. The chapter concludes with an overview of remedies available for a breach of fiduciary duty by a surrogate.

Who Decides?

2020 ◽  
pp. 41-48
Author(s):  
Kenneth V. Iserson
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Living Will ◽  
Care Physician ◽  
Power Of Attorney ◽  
Health Care Decisions ◽  
Decision Making Capacity ◽  
State Statutes ◽  
Hospital Policies ◽  
Life Sustaining Treatment

To make a health care decision, individuals (whether it be the patient or an adult surrogate) must have decision-making capacity. Based on the principle of patient autonomy (respect for persons), such adults can make their own health care decisions, even if they contradict what their health care provider recommends. However, if a patient lacks decision-making capacity, his or her previously completed health care directive(s) take effect. These can be a living will, durable power of attorney for health care, Physician Orders for Life-Sustaining Treatment (POLST) form, or a similar document. In a similar manner, if an adult patient wishes to orally designate another adult to make his or her health care decisions (as in the case in this chapter), they may do that. These surrogates’ decisions carry the same weight as and replace any previously named surrogate. When no surrogate has been named, most hospital policies and many state statutes list the general hierarchy of people to be the patient’s surrogates.

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

2015 ◽  
Author(s):  
Margaret L. Schwarze
Keyword(s):  
Health Care ◽  
Advance Directives ◽  
Living Will ◽  
Surgical Patients ◽  
Living Wills ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Do Not Resuscitate Orders ◽  
Surrogate Decision ◽  
Binding Mechanisms

Documentation of future wishes for life-supporting therapy includes living wills, do not resuscitate orders, and designations of a durable power of attorney for health care. All are legally binding mechanisms. Because surgeons may need to refer to these documents, this chapter discusses the use of advance directives and living wills in surgical patients, the use of do not resuscitate orders in the operating room, and the activation and use of power of attorney and subsequent surrogate decision-making. A figure shows a living will designating conditions for resuscitation. This review contains 42 references.

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

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.

A preliminary investigation of opinions and behaviors regarding advance directives for medical care

1993 ◽  
Vol 2 (2) ◽  
pp. 161-167 ◽  
Author(s):  
EH Elpern ◽  
SB Yellen ◽  
LA Burton
Keyword(s):  
Advance Directives ◽  
Advance Directive ◽  
Medical Center ◽  
Academic Medical Center ◽  
Preliminary Investigation ◽  
Tertiary Care ◽  
Living Will ◽  
Treatment Preferences ◽  
Convenience Sample ◽  
And Behaviors

BACKGROUND: Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives. METHODS: A questionnaire was administered by personal interview to a nonrandomized convenience sample of 46 inpatients and 50 outpatients at a large, tertiary care, urban academic medical center in the summer of 1991. RESULTS: Most respondents (77%) had heard of either the living will or durable power of attorney for healthcare, but only 52% correctly understood the purpose of these documents. Twenty-nine percent of the sample had executed an advance directive. Those who had advance directives were older and considered themselves less healthy than did those without advance directives. Unfamiliarity with advance directives and procrastination were cited most often as reasons for not having an advance directive. Most subjects (65%) had spoken with someone, usually a family member or close friend, about preferences for treatment during a critical illness. Although they had rarely discussed advance directives, 83% anticipated that they would be comfortable doing so with a physician or a nurse. CONCLUSIONS: Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.

Honoring Patient Care Preferences: Surrogates Speak

2012 ◽  
Vol 65 (4) ◽  
pp. 257-280 ◽  
Author(s):  
Julia W. Buckey ◽  
Olga Molina
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Living Will ◽  
Emotional Impact ◽  
Healthcare Team ◽  
Life Sustaining Treatment ◽  
Stressful Experience ◽  
Surrogate Decision ◽  
Interdisciplinary Healthcare ◽  
Interdisciplinary Healthcare Team

A growing body of evidence has pointed to the stressful experience surrounding surrogate decision-making on behalf of incapacitated patients. This study (N = 59) asked surrogates to speak about their experiences immediately after having made a life-sustaining treatment decision. Grounded theory analysis revealed four themes: (1) the emotional impact of the decision-making process on the surrogate; (2) the difficulty of watching a loved one's health deteriorate; (3) the importance of having a Living Will (LW) or other written/verbal instructions; and (4) the reliance on spirituality as a means of coping with the surrogate experience. Findings of this study suggest that engaging surrogates at the time of patient admission may be essential in order to clarify patient preferences and strengthen communication between surrogates and the interdisciplinary healthcare team.

scholarly journals The Ethics of Organ Donation in Patients Who Lack the Capacity for Decision Making

2018 ◽  
Vol 24 (3) ◽  
pp. 186-190 ◽  
Author(s):  
Lauren Lee
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Organ Donation ◽  
Health Care Providers ◽  
Consensus Statement ◽  
Organ Procurement ◽  
Well Being ◽  
Living Donors ◽  
Care Providers ◽  
Best Interest

Free and informed consent is the legal and ethical basis for organ donation from living donors, and is a requirement for making an autonomous health decision. In clinical practice, health-care providers are required to respect four bioethical principles: respect for autonomy, beneficence, non-maleficence, and justice (Beauchamp & Childress, 2012), with the best interest of their patients in mind. Yet there are bioethical concerns behind organ procurement from living donors who have never attained capacity, do not yet have the capacity, or have permanently lost the capacity for decision making. A consensus statement by the Live Organ Donor Consensus Group (Abecassis et al., 2000) protects these donors’ well-being and autonomy, but there still is a need to raise ethical awareness about the decision-making process regarding vulnerable potential donors. Health-care providers who are staff members in transplant clinics should be aware of the current consensus statement, commit to essential bioethical principles surrounding organ donation, and advocate for vulnerable living donors.

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