ADVANCE DIRECTIVES ADVANTAGES AND DISADVANTAGES WHY AN ADVANCE

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ADVANCE DIRECTIVES ADVANTAGES AND DISADVANTAGES

ADVANCE DIRECTIVES ADVANTAGES AND DISADVANTAGES

WHY AN ADVANCE DIRECTIVE • • TO EXTEND THE AUTHORITY OF THE PATIENT BEYOND

WHY AN ADVANCE DIRECTIVE • • TO EXTEND THE AUTHORITY OF THE PATIENT BEYOND THE ONSET OF DECISIONAL INCAPACITY TO EXPRESS CLEARLY THE WISHES OF THE PATIENT SO THEY WILL BE HONORED BY CAREGIVERS, FAMILIES, AND OTHERS – TO AVOID BECOMING A VICTIM OF ANOTHER’S AGENDA • ARBITRARY DECISIONS PATIENT WOULD NOT WANT • DECISIONS MADE OUT OF GUILT OR FEAR • PRESSURE FROM SPECIAL INTEREST GROUPS • PROTRACTED OR UNDESIRABLE COURT DECISIONS TO AVOID THE NECESSITY OF GOING TO COURT --- OFTEN INAPPROPRIATE DECISIONS CONSERVE RESOURCES, PARTICULARLY WHEN FURTHER TREATMENT IS FUTILE

TYPES OF ADVANCE DIRECTIVES INFORMAL STATEMENTS • ADVANTAGES – INSURES COMMUNICATION HAS OCCURED •

TYPES OF ADVANCE DIRECTIVES INFORMAL STATEMENTS • ADVANTAGES – INSURES COMMUNICATION HAS OCCURED • DISADVANTAGES – NO DOCUMENTATION IN CASE OF CONFLICT WHEN ADVANCE DIRECTIVE IS TO BE IMPLEMENTED – OFTEN CASUAL COMMENT WITH LITTLE REFLECTION OR SPECIFICITY

TYPES OF ADVANCE DIRECTIVES DOCUMENTED STATEMENTS TO PHYSICIANS • ADVANTAGES – NO NEED TO

TYPES OF ADVANCE DIRECTIVES DOCUMENTED STATEMENTS TO PHYSICIANS • ADVANTAGES – NO NEED TO LABOR OVER A WRITTEN DOCUMENT – NO NEED TO SECURE WITNESSES TO A SIGNED DOCUMENT – CAN DISCUSS IMMEDIATELY TREATMENT DIRECTIONS WITH PHYSICIAN • DISADVANTAGES – PHYSICIAN’S RECORDS MAY BE INACCESSIBLE WHEN THEY ARE NEEDED, E. G. , RETIREMENT – STATEMENTS MADE TO SEVERAL PHYSICIANS MAY CONFLICT

TYPES OF ADVANCE DIRECTIVES LIVING WILL DECLARATIONS • ADVANTAGES – DOCUMENTED PROTRAIT OF PATIENT’S

TYPES OF ADVANCE DIRECTIVES LIVING WILL DECLARATIONS • ADVANTAGES – DOCUMENTED PROTRAIT OF PATIENT’S WISHES AND VALUES – PROMOTES AUTONOMY BEYOND OF POINT OF INCAPACITY – ENHANCES REFLECTIVE LIFE OF AUTHOR – PROMOTES DIGNITY BY ALLOWING RISK-TAKING BY AUTHOR – ACCEPTS CONTEXT OF NATURAL RHYTHMS OF LIFE • DISADVANTAGES – IMPOSSIBLE TO ANTICIPATE ALL CONTINGENCIES – NO COMPETENT PERSON WITH AUTHORITY TO ASSESS PARTICULARS OF A CLINICAL SITUATION AND MAKE DECISIONS – LACK OF SPECIFICITY IF “GENERIC” FORM IS USED – LACK OF CREDIBILITY IF INTENTIONS AND VALUES OF AUTHOR ARE UNKNOWN

TYPES OF ADVANCE DIRECTIVES LIVING WILL DECLARATIONS • ADVANTAGES (CONT. ) – CAN GENERATE

TYPES OF ADVANCE DIRECTIVES LIVING WILL DECLARATIONS • ADVANTAGES (CONT. ) – CAN GENERATE AVENUES OF COMMUNICATION • AUTHOR AND SIGNIFICANT OTHER/CAREGIVERS – PROTECTION FROM UNDESIRED INTERVENTIONS – RELIEVES SECOND GUESSING – RELIEVES GUILT AND FEAR – PROMOTES CONTINUITY OF CARE – MAY BE COST EFFECTIVE • DISADVANTAGES (CONT. ) – FREQUENTLY LITTLE COMMUNICTION OCCURS WITH SIMPLY SIGNING A FORM

TYPES OF ADVANCE DIRECTIVES DURABLE POWER OF ATTORNEY FOR HEALTHCARE • ADVANTAGES – DESIGNATES

TYPES OF ADVANCE DIRECTIVES DURABLE POWER OF ATTORNEY FOR HEALTHCARE • ADVANTAGES – DESIGNATES A PERSON THE PATIENT TRUSTS – GIVES DECISIONAL AUTHORITY TO INDIVIDUAL WHO CAN ASSESS SPECIAL CIRCUMSTANCES IN THE CLINICAL SITUATION – IDENTIFIES AN INDIVIDUAL WITH AUTHORITY WITH WHOM PHYSICIAN COMMUNICATE • DISADVANTAGES – IF NO CLEAR COMMUNICATION BEFORE INCAPACITY, PATIENT COULD BECOME VICTIM OF ATTORNEY-IN-FACT’S AGENDA – WITHOUT DOCUMENTATION PHYSICANS CAN QUESTION IF ATTORNEY-IN-FACT IS TRULY REPRESENTING PATIENT’S WISHES – WITHOUT DOCUMENTATION OTHERS MAY OBSTRUCT ATTORNEY-IN-FACT’S DECISIONS

TYPES OF ADVANCE DIRECTIVES DURABLE POWER OF ATTORNEY FOR HEALTHCARE • ADVANTAGES – REQUIRES

TYPES OF ADVANCE DIRECTIVES DURABLE POWER OF ATTORNEY FOR HEALTHCARE • ADVANTAGES – REQUIRES PHYSICIANS TO HONOR DECISIONS OF ATTORNEY-IN-FACT AS THEY WOULD IF THE PATIENT HIMSELF/HERSELF HAD MADE THE DECISIONS – REDUCES FEAR OF LAWSUIT BECAUSE OF AUTHORITY OF DECISIONMAKER • • DISADVANTAGES – WITHOUT PRIOR COMMUNICATION AND DOCUMENTATION ATTORNEY-IN-FACT MAY HESITATE TO MAKE NECESSARY DECISIONS BECAUSE OF GUILT – WITHOUT DOCUMENTATION AUTHORITY OF ATTORNEY -IN-FACT MAY BE WEAKENED A WELL-DESIGNED LIVING WILL MAY NEUTRALIZE DISADVANTAGES