Advance health care directive
A living will, also called will to live, is one type of advance health directive, or advance health care directive. It is often accompanied by a specific type of power of attorney or health care proxy. These are legal instruments that are usually witnessed or notarized.
- A living will usually covers specific directives as to the course of treatment that is to be taken by caregivers, or, in particular, in some cases forbidding treatment and sometimes also food and water, should the principal be unable to give informed consent ("individual health care instruction") due to incapacity.
- A power of attorney for health care appoints an individual (a proxy) to direct health care decisions should the principal be unable to do so.
As the name suggests, the term "will to live", as opposed to the other terms, tends to emphasize the wish to live as long as possible rather than refusing treatment in the case of serious conditions.
Advance health care directive in specific countries
Australia
In Australia, when patients 80 years of age or older are hospitalized and presented options in a structured session by a trained non-medical facilitators, patients chose:[1] .
- Cardiopulmonary resuscitation
- 56% chose no
- 30% chose yes if the doctor anticipated a good outcome
- 14% deferred to doctor or surrogate
- Life prolonging treatment:
- 41% chose no
- 39% chose yes if the doctor anticipated a good outcome
- 20% deferred to doctor or surrogate
Netherlands
In the Netherlands, patients and potential patients can specify the circumstances under which they would want euthanasia for themselves. They do this by providing a written euthanasia directive. This helps establish the previously expressed wish of the patient even if the patient is no longer able to communicate. However, it is only one of the factors that is taken into account. Apart from the will in writing of the patients, at least two physicians, the second being totally unrelated to the first physician in a professional matter (e.g. working in another hospital, no prior knowledge of the medical case at hand), have to agree that the patient is terminally ill and that no hope for recovery exists.
Switzerland
In Switzerland, there are several organizations which take care of registering patient decrees, forms which are signed by the patients declaring that in case of permanent loss of judgment (e.g., inability to communicate or severe brain damage) all means of prolonging life shall be stopped. Family members and these organizations also keep proxies which entitle its holder to enforce such patient decrees. Establishing such decrees is relatively uncomplicated.
United States
In the United States:
- When individuals implement advanced care planning in their last two years of life, most individuals preferenced comfort care (96%) while 2% requested 'all care possible'. Advanced care planning increased terminal care matching the preferences of the individual[2].
- Only 17% of claims for patients 65 years of age or older submitted to Centers for Medicare & Medicaid Services indicated advanced care planning.[3]
- Most states recognize living wills or the designation of a health care proxy.[4] However, a "report card" issued by the Robert Wood Johnson Foundation in 2002 concluded that only seven states deserved an "A" for meeting the standards of the model Uniform Rights of the Terminally Ill Act.[5] Surveys show that one-third of Americans say they've had to make decisions about end-of-life care for a loved one.[6]
Benefit of advance care planning
In a randomized controlled trial the use of advance directives, including living will and power of attorney for health care, improved correlation between end of life choice and action.[1] In a randomized controlled trial, of the patients randomised to the intervention group which encouraged advance care planning, 81% received advance care planning[1]. Among the patients who died:
- Terminal care matching their wished occurred among:
- 86% of those in the intervention group
- 30% of those in the control group
- Significantly more satisfaction while less stress, anxiety, and depression occurred among family members in the intervention group.
Two cohort studies using Medicare’s Health and Retirement Study (HRS) found:
- Most individuals preferenced comfort care (96%) while 2% requested call care possible. Advanced care planning increased terminal care matching the preferences of the individual[2].
- Individuals with advanced care planning were likely to be enrolled in Hospice (adjusted relative risk = 1.68, 95% CI = 1.43-1.97) and to use Hospice for more than 3 days[7].
Surrogates who report knowing their loved once wishes seem to have less stress than those who made decisions without certainty of the preferences of their loves ones. This is according to a systematic review of observational studies that stated "knowing which treatment is consistent with the patient's preferences was frequently cited as reducing the negative effect on surrogates."[8].
Another cohort study demonstrated that reported depression and anxiety was lessened in families where end of life was discussed with families prior to end of life.[9]
Methods to promote advance care planning
Advance care planning can increased by using:
- 'Facilitated advance care planning' applied to hospitalized patients.[1]
- In person guidance for homeless individuals by a social workers from Hospice who used the SELPH AD.[10]
See also
- Health care proxy
- Uniform Rights of the Terminally Ill Act
- Do Not Resuscitate
- Patient refusal of nutrition and hydration
- Estate planning
- Ulysses pact
References
- ↑ 1.0 1.1 1.2 1.3 Detering KM, Hancock AD, Reade MC, Silvester W (2010). "The impact of advance care planning on end of life care in elderly patients: randomised controlled trial". BMJ. 340: c1345. doi:10.1136/bmj.c1345. PMC 2844949. PMID 20332506.
- ↑ 2.0 2.1 Silveira MJ, Kim SY, Langa KM (2010). "Advance directives and outcomes of surrogate decision making before death". N Engl J Med. 362 (13): 1211–8. doi:10.1056/NEJMsa0907901. PMC 2880881. PMID 20357283.
- ↑ National Quality Forum. NQF #0326 Advance Care Plan
- ↑ publicagenga.org
- ↑ rwjf.org
- ↑ publicagenda.org
- ↑ Bischoff KE, Sudore R, Miao Y, Boscardin WJ, Smith AK (2013). "Advance care planning and the quality of end-of-life care in older adults". J Am Geriatr Soc. 61 (2): 209–14. doi:10.1111/jgs.12105. PMC 3760679. PMID 23350921.
- ↑ Wendler D, Rid A (2011). "Systematic review: the effect on surrogates of making treatment decisions for others". Ann Intern Med. 154 (5): 336–46. doi:10.7326/0003-4819-154-5-201103010-00008. PMID 21357911.
- ↑ Garrido MM, Prigerson HG (2014). "The end-of-life experience: modifiable predictors of caregivers' bereavement adjustment". Cancer. 120 (6): 918–25. doi:10.1002/cncr.28495. PMC 3947659. PMID 24301644.
- ↑ Song J, Ratner ER, Wall MM, Bartels DM, Ulvestad N, Petroskas D; et al. (2010). "Effect of an End-of-Life Planning Intervention on the completion of advance directives in homeless persons: a randomized trial". Ann Intern Med. 153 (2): 76–84. doi:10.7326/0003-4819-153-2-201007200-00003. PMID 20643989.
External links
- Caring Connections Free state specific advance directives
- U.S. Living Will & Advance Directive Registry
- AssuringYourWishes.Org A non-profit resource for obtaining and storing advance directive forms and information.
- Issue Guide on the Right to Die from Public Agenda Online
- Means to a Better End, Robert Wood Johnson Foundation, 2002
- State Regulations for Advance Directives
- Write a UK Will online
- National Resource Center on Psychiatric Advance Directives
- What Are They and Do You Need One?
- Why You Need a Living Will - From Michele Baskin-Jones; About.com Guide to Death & Dying.
- Sample Wills and Trust Agreements