Exploring the Concept of the Ethical Will as a Way to Leave a Legacy of Values: A Scoping Review

Ethical wills communicate a legacy of values through non-legal emotional and supportive instruction to others and are distinct from legal or living wills. Employed for centuries, little is known about how and why ethical wills are used. We conducted the first scoping review on ethical wills to survey the breadth of published information and identify how they are defined and utilized. We followed the Joanna Briggs Institute methodology for scoping reviews employing an a priori protocol and PRISMA-ScR reporting guidelines . We searched 14 databases in November 2019 and January 2021 without filtering publication date or type. Our final extraction form included frequently used terms describing content, purpose, and outcomes. Two reviewers independently screened 1,568 results. Final extraction included 51 documents from 1997-2020, which were primarily published in lay or peer-reviewed journals within law, estate and financial planning, and religion; only 6 research articles were identified. Most frequently, descriptors characterized ethical wills as a non-material legacy of values, beliefs, wisdom, and life lessons learned written to family or future generations. Ethical wills were utilized most to be remembered, address mortality, clarify life’s meaning, and communicate what matters most. They provided opportunity to learn about self, were considered a gift to both writer and recipient and fostered intergenerational interaction and transcendence. Our findings highlight interdisciplinary utilization and dearth of research on ethical wills. Gerontological research is needed to explore ways ethical wills can be used to enhance generativity and intentional living as individuals age and prepare for the end of life.

Prevalence of advanced directives in the geriatric population with in long-term care facilities in the United States

Advanced directives, such as Living Wills and Do Not Resuscitate (DNR) orders, provide the ability to identify, respect, and implement an individual's wishes for medical care during serious illness or end-of-life care. The aim of this study was to evaluate the prevalence of advanced directives amongst the residents of long-term care facilities in the United States. A total of 527 cases were extracted from 2018 National Study of Long-Term Care Providers, which was collected by the National Center for Health Statistics through the surveys of residential care communities and adult day services centers. Advanced directive rates were higher in patients 90 years of age and above as compared to other age groups. Nursing home residents were more likely to have advanced directives than other long term care facilities. There was no significant difference among males and females in the rate of advanced directives. Nursing home and Hospice residents had more advanced directives compared to other facilities. The Black population had the highest rate of advanced directive preparedness. Overall, the finding of this study revealed that there was a significant difference in the preparedness of DNR orders and Living Wills by patient demographics and the type of long-term care facility. Offering advanced directive services at public health/social services facilities can enhance the rate of advanced directive preparedness. Advanced directives ease the stress and anxiety of patients, family, and friends during difficult times.

Advance Directives in Patients With Head and Neck Cancer - Status Quo and Factors Influencing Their Creation

Background: Advance Care Planning (ACP) including living wills (LWs) and durable powers of attorney for healthcare (DPAHCs) is a highly relevant topic aiming to increase patient autonomy and reduce medical overtreatment. Data from patients with head and neck cancer are not currently available. Methods: In this single center cross-sectional study, we evaluated patients during their regular follow-up consultations at Germany’s largest tertiary referral center for head and neck cancer, regarding the frequency, characteristics, and influencing factors for the creation of advance directives (ADs) using a validated questionnaire tailored to our cohort. The advance directives included living wills, durable powers of attorney for healthcare, and combined documents (CDs). Results: Four hundred and forty-six patients were surveyed from 07/01/2019 to 12/31/2019 (response rate=65.9%). The mean age was 62.4 years (SD 11.9), 26.9% were women (n=120). 46.4% of patients (n=207) reported having authored at least one advance directive. These documents included 16 durable powers of attorney for healthcare (3.6%), 75 living wills (16.8%), and 116 combined documents (26.0%). In multinominal regression analysis, older age (OR≤0.231, 95% CI 0.097-0.548; p<0.001), regular medication (OR=1.862, 95% CI 1.048-3.308; p=0.034), and the marital status (“married”: OR=2.395, 95% CI 1.074-5.337; p=0.033; and “permanent partnership”: OR=4.526, 95% CI 1.100-18.625; p=0.036) emerged as significant factors increasing the likelihood of having an advance directive. In contrast, the stage of disease, the therapeutic regimen, the ECOG status, and the time from initial diagnosis did not correlate with the presence of any type of advance directive. Conclusion: Less than half of head and neck cancer patients had created an advance directive. Older and comorbid patients who were married or in a permanent partnership had a higher likelihood of having an advance directive. This is the first study investigating the current situation in head and neck oncology and providing evidence to identify a patient population in need of appropriate support.

A RELEVANCIA DE LA VALUES HISTORY EN SU RELACIÓN CON LOS USUALMENTE DENOMINADOS “TESTAMENTOS VITALES”: OTRA CUESTIÓN DE RELEVANCIA QUE NOS PLANTEA LA BIOÉTICA JURÍDICA

This article, is focused from a legal bioethical point of view, its purpose is to study values history in its relationship with the so-called “living wills”, subjects that must include in their analysis the influence exerted by the corresponding axiological codes. In this way, once the genesis of these figures has been studied, we focus on their contents to finally refer to the Bill on Dignified Death and Palliative Care, a proposal which is currently under discussion in our National Congress. Thus, always from a legal bioethical approach, we deal with the relevance of the values which people are attached to, in relationship with significant topics such as illness, pain, medical treatments and death.

Ablehnungs- und Umsetzungsraten von Organtransplantationen – mögliche Ursachen und denkbare Auswege

The work deals intensively with the very complex topic of post-mortem organ donation and the question of why it is that not all organs of potential organ donors are considered in transplantation. It covers central questions of the legally and ethically required handling of dying and death. In addition to a presentation of the relevant legal situation, the statistical findings on organ transplants performed in Switzerland during the observation period, the relatively high rates of rejection and low rates of conversion of organ donations by means of retrospective analysis of the data of all in 2013 at their then place of work, the Cantonal Hospital of St. Gallen are made and their results compared with those of the national SwissPOD study. The "primary desirable goal" of the measures taken to promote organ donation appears to the author to be less the "increase in available organs, but rather reflection on dying and one's own death", which is why she would welcome an increase in the number of living wills and organ donation cards available, in order to thereby reduce the emotionally stressful proxy decisions - regardless of the will specified therein.

The Mediation Role of Socioeconomic Status on Racial and Ethnic Differences in Advance Care Planning

Background. Most research on EOL care planning has focused on racial/ethnic differences in completing advanced directives (AD) rather than the pathways of the disparities. Therefore, this study aims to examine the mediating role of education and income in racial/ethnic differences in EOL care planning. Methods. A secondary data analysis of Health and Retirements Study (HRS) 2004-2014 wave was used. The sample included 6,518 participants ((≥ 65 years old). The independent variable measured the respondents’ race and ethnicity and the dependent variable measured the completion rate of living wills or the Durable Power of Attorney of Health Care (DPAHC). Covariates included gender, age, marital status, religion, place f birth, educational attainment, income, cognitive function, limitations in physical functioning, geriatric syndromes, and the number of progressive chronic disease. Results. The hierarchical logistic regression analysis showed that race/ethnicity was a significant predictor of completing AD (p≤0.001). Mediation analysis, Karlson, Home, and Breen (KHB), revealed that both education and income explained 14.4% of racial/ethnic differences in completion of living wills for non-Hispanic Blacks and 17.6% for Hispanics. Similarly, education and income accounted for 17.6% of racial/ethnic disparities in completion of DPAHC for non-Hispanic Blacks and 20.9% for Hispanics. In particular, education had stronger mediating effect on the outcome variables than income. Discussion. The findings suggest the importance of targeted educational interventions for people of color with lower SES to raise their awareness of benefits of advance care planning and increase their access to higher quality of EOL care.

The Association Between Hearing Loss and Completion of Advance Care Planning Among Older Adults

Background: Ensuring access to quality end-of-life (EOL) care for all older adults is emerging public health concern. Hearing loss (HL) is the third most common chronic disease affecting older adults and a major impediment to access healthcare services. However, little is known about the impact of HL on advance care planning for older adults. Method: A sample of 1,862 older adults (≥65 years) was drawn from the National Health and Aging Trends Study (NHATS). HL was determined by self-report and advance care planning was measured by asking if an individual completed living wills or the Durable Power of Attorney for Health Care (DPAHC). Covariates included age, gender, race, marital status, education, religion, nativity, depression, region, facility status, regular doctor availability, Medicaid, hospitalization, cognition, perceived health status and a presence of chronic disease. Results: Descriptive statistics revealed that nearly 67% of older adults with HL completed the DPAHC, and the majority of them (71%) also had living wills. Multivariable logistic regression analyses showed that HL was significantly associated with completion of DPAHC and living wills, after controlling for a list of covariates (OR=0.50, p&lt;0.05). Conclusions: The findings show HL is a significant predictor of completion of any type of advance directives. Facilitating effective communication in advance care planning for older adults with HL is needed. Healthcare provider should make health information accessible to them to get quality EOL care.