M09.03.009 Advance Directives

Advance directives are essential legal documents that outline a patient’s preferences for medical treatment in the event they become incapacitated and unable to make decisions for themselves. Understanding the types of advance directives and their implications is crucial for healthcare providers, patients, and their families.

Types of Advance Directives

Advance directives can take several forms, each serving a unique purpose:

1. Oral Advance Directive

• Definition: Statements made by a patient regarding their medical wishes before becoming incapacitated.
• Considerations:
  • Variability and Interpretation: Issues may arise regarding how the directive is interpreted.
    • Example: Was the patient fully informed about their condition before making the directive?
    • The specificity of the directive is crucial.
  • Validity: The more individuals who witnessed the oral directive, the stronger the validity.

2. Living Will

• Definition: A written document that specifies the medical treatments a patient wishes to receive or refuse if they lose decision-making capacity.
• Key Points:
  • Inviolability: A family member cannot override the wishes expressed in a living will.
    • Example: If a patient’s living will states a refusal of intubation but the family requests it, the physician must adhere to the living will.

3. Medical Power of Attorney (HCPOA)

• Definition: A legal document that designates an agent to make medical decisions on behalf of the patient if they lose capacity.
• Important Aspects:
  • Agent’s Role: The agent is expected to fully understand and represent the patient’s wishes.
  • Authority: The physician must follow the agent’s directives, regardless of other family opinions.

Do Not Resuscitate (DNR) Orders

DNR orders are specific instructions regarding resuscitation efforts:

• Definition: A DNR order indicates that the patient does not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
• Responsibility: DNR decisions may be made by the patient or their surrogate.
• Protocol:
  • Physicians may not be aware of existing DNR orders.
  • Upon becoming aware of a DNR order, all CPR measures must cease immediately.
  • Other treatment measures should continue as appropriate.

Points to Remember

• Importance of Clarity: Written advance directives are generally more clear than oral directives.
• Communication: Patients must communicate their wishes to family members and healthcare providers.
• Legal Framework: Understanding local laws regarding advance directives can aid in their proper implementation.

Bibliography

1. American Medical Association. (n.d.). Advance Directives: A Guide for Patients. Retrieved from AMA website.
2. National Hospice and Palliative Care Organization. (n.d.). Advance Care Planning. Retrieved from NHPCO website.
3. Center for Practical Bioethics. (n.d.). Understanding Advance Directives. Retrieved from Center for Practical Bioethics.