Claudia Colon
Professor Wojtecki
8/25/2012
Advance Directives
We usually communicate our medical wishes to our doctors, but what happens when we can no longer communicate adequately? Fortunately, there are legal documents that help us for this type of circumstances. “Health care advance directives are documents that communicate a person's wishes about health care decisions in the event the person becomes incapable of making health care decisions. There are two basic kinds of advance directives: living wills and durable powers of attorney for health care.” A living will positions, in advance, a person's instructions or preferences about health care. A durable power of attorney for health care assigns a person (called an agent or proxy) to make decisions for the patient (the principal) in the occasion of incapacity. (Sabatino, 2007)
Advance directives are known in one form or another by legislative action in all 50 states. If the directive is created rendering to the outlines provided by valid state legislation, they can be considered legally mandatory. “In uncertain cases, the medical center's attorney or ethics advisory committee can provide guidance on how to proceed. However, advance directives take effect only in situations where a patient is unable to participate directly in medical decision making.” Pleas to living wills and proxy decision makers are ethically and legally unsuitable when individuals remain capable to guide their own care. “The assessment of decisional incapacity is often difficult and may involve a psychiatric evaluation and, at times, a legal determination.” Usually, we might encounter an ethical controversy dilemma of how the patient’s family or medical team interprets the patient’s living will. If a disagreement is present, difficult and subtle situations may arise, yet if the family does not agree with what the patient has requested, they do not have much ethical power to control the medical team, but if the disagreement is based on new information, substituted judgment, or recognition that the medical team has misinterpreted the living will, the family has the right to make changes. If no agreement is reached, the hospital's Ethics Committee should be consulted. (Tonelli, 2008)
For instance, a living will may be only used in the case of terminal illness, which means that the person has less than six months to live. In a living will, a person can only describe what he or she wants in certain situations. A living will does not allow a person to make their own decisions. A living will is written as a legal document, which specifically states the types of medical treatments and life sustaining measures a person wants, such as mechanical breathing (respiration and ventilation), tube feeding, or resuscitation. For example, a fatal car accident leaves a driver with no brain activity and his or her life is sustained by mechanical breathing and tube feeding. This incident is a case where a living will might apply. If the victim had a living will prior to the accident, the living will should have the following contents: life prolonging medical care, artificially administration of food and water and palliative care. In the majority of the states, living wills contain whether a person wants to receive life prolonging medical care at the end of life. These procedures normally include: transfusions of blood and blood products, cardiopulmonary resuscitation, diagnostic tests, dialysis, administration of drugs, use of a respirator, and