A advance a healthcare directive , also known as living will , personal directive , face directives , medical or advanced decisions , is a legal document in which a person determines what action should be taken for their health if they are no longer able to make decisions for themselves because of illness or disability. In the US it has its own legal status, whereas in some countries it is legally persuasive without legal documents.
The will of life is one form of face directives, leaving instructions for treatment. Another form is a special type of attorney's attorney or health care representative, in which the person authorizes an individual (agent) to make decisions on their behalf when they are unable. People are often encouraged to complete both documents to provide comprehensive guidance on their care, although they can be combined into a single form. Examples of combinations of documents include the Five Desires in the United States. The term living will is also a common language commonly known in many countries, especially the UK.
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Facial directives are made in response to the increasing sophistication and prevalence of medical technology. Numerous studies have documented an important deficit in dying medical care; has been found not to be overlong, painful, expensive, and emotionally burdensome for patients and their families.
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Living will
The will of life is the oldest form of facial direction. It was first proposed by an Illinois lawyer, Luis Kutner, in a legal journal in 1969. Kutner withdrew from existing real law, in which an individual can control property affairs after death (ie, when no longer available to speak for himself) and find ways for an individual to express his health care wishes when he can no longer express the wishes of current health care. Since this form of "will" is used while an individual still alive (but no longer capable of making decisions) it is dubbed "the will of life". In the US, the Pediatric Self-Determination Act (PSDA) came into force in December 1991, and requires healthcare providers (especially hospitals, nursing homes and home health institutions) to provide patients with information about their right to make advance directives based on state law.
A life will usually provide specific direction about the travel health care provider and caregiver to follow. In some cases, life will prohibit the use of various burdensome medical treatments. It may also be used to express a wish about use or on food and water, if provided through a tube or other medical device. Life will only be used if the individual has become unable to provide informed consent or refusal due to incompetence. A life will be very specific or very common. An example of a statement sometimes found in the life will be: "If I have an illness, illness, or condition that can not be cured and irreparable and my treating physician determines that my condition is terminal, I direct the steps to preserve life which will only serve to extend my dead arrested or terminated. "
More specific life preferences may include information about the individual's desire for services such as analgesia (pain relief), antibiotics, hydration, feeding, and the use of a ventilator or pulmonary heart resuscitation. However, research also suggests that adults are more likely to complete these documents if they are written in ordinary language and less focused on technical care.
However, in the late 1980s, public advocacy groups became aware that many people remained ignorant of advance directives and even fewer actually solved them. In part, this is seen as the failure of healthcare providers and medical organizations to promote and support the use of these documents. The public response is to suppress further legislative support. The latest results are the Patient Self-Determination Act of 1990, which seeks to address this awareness issue by requiring health care agencies to promote and support the use of face directives.
The will of life proved very popular, and in 2007, 41% of Americans had completed a living will. In response to public needs, the state legislature immediately passed legislation to support live wills in almost every state in the union.
However, as the will of life became more familiar, key deficits were soon discovered. Most life will tend to be limited in scope and often fail to fully address emerging problems and needs. Furthermore, many individuals write their desires in ways that may conflict with quality medical practice. Ultimately, it is determined that life alone may not be enough to address many important health care decisions. This leads to the development of what some might refer to as the "second generation" early guidance - "the appointment of a health care proxy" or "medical attorney of the lawyer".
The will of life also reflects a moment in time, and therefore needs regular renewal to ensure that the right course of action can be chosen.
The power of attorneys and long-lasting health services
Second generation faces
As before, future generational leads are drawn from existing laws - especially from business law. The power of attorney law has been in the United States since the days of "general law" (ie, laws brought from England to the United States during the colonial period). This initial power of attorney allows an individual to name someone to act in their place. Referring to this law, the "long-lasting power of attorney for health care" and the document "health care appointment agreement" are created and codified in law, allowing someone to appoint someone to make health care decisions on their behalf if they should be unable to make their desires are known. The designated health service proxy has, in essence, the same right to request or reject the treatment an individual will have if it is still able to make and communicate a health care decision. The main benefit of second generation advance directives is that the designated representative can make real-time decisions in actual circumstances, as opposed to forward decisions framed in hypothetical situations, as recorded in the life will. The new face-to-face instruction is sincerely supported by the American public, and support of the law is soon followed in almost all countries.
Finally, however, shortcomings in the direction of "second generation" are also immediately noted. In particular, people are facing similar problems with those who live a crippled life wish - knowing what to say to a proxy decision maker about one's desires in a meaningful way. The study found most of what the proxy designated were told was too vague for meaningful interpretations. In the absence of meaningful information, family and doctors "guess" was found to be inaccurate as much as 76% of the time. While a study comparing the decision of the nearest relative on behalf of the disadvantaged, (who later recovered) found that this substitute chose 68% of the time overall. This ongoing problem leads to the development of what might be called third-generation advance directives.
Third generation advance
Third-generation advance directives are designed to contain enriched content to help individuals and agents, families and doctors designated to better understand and respect their desires. The first of the third-generation advance directives is the History of Values ​​by Doukas and McCullough, made at Georgetown University Medical Faculty, first published in 1988, and then more widely cited in the article in 1991. History of Values ​​is a "two-part directive directive which elicits the patient's value on terminal medical care and specific therapeutic directions. "The purpose of this follow-up instruction is to stay away from a focus on special care and medical procedures to focus on patient values ​​and personal goals. Another value-based project was then published by Lambert, Gibson, and Nathanson at the Institute of Public Law, the University of New Mexico School of Law in 1990. It continues to be available through the Hospice and Paliative Care Federation. One of the continuing challenges of the third generation document of value is to show the linkage between values ​​and objectives aroused with the expectation of medical care, although research has shown that the values ​​of financial and psychological burden are powerful motivators in not wanting wide-ranging end of life-therapy.
The next-generation face-to-face directive is the Medical Directive, created by Emanuel and Emanuel from Massachusetts General Hospital and Harvard Medical School. This is a six-page document that provides six scenarios of cases for prior medical decision-making. These scenarios are each associated with a list of commonly considered medical procedures and interventions, which allow the individual to decide in advance which treatment is desired or undesirable in the situation. Some of the criticisms of this advance directive have been expressed. In particular, it encourages individuals to make medical care decisions, which are usually not supplemented.
Probably the best known third-generation advance directive is the Five-Desire directive. This document was developed in collaboration with several experts with funding from the foundation of Robert Wood Johnson, and distributed by the Aging with Dignity organization. This document is supported by Mother Teresa of the Calcutta Sisters and by the Florida State Supreme Court Chief. This document meets the legal criteria in 42 states.
The latest third generation face-to-face guidance is the Lifecare Takeover Guidelines. In making this document, researchers reviewed more than 6,500 articles from medical, legal, sociological, and theological sources. The conclusion is that the initial directives need to be based more on the "health outcome" than on the list of names of medical care and legal jargon. Based on the insights gained from the literature review, advance guidance documents were created, tested in a study involving nearly 1,000 participants, and then compared with testing of other popular face-to-face forms. The results show greater patient proxies/proxies accuracy, and superior comprehensive content compared to other documents tested. The main criticism is that it is very long and tedious to be solved.
While some commentators state that every recording of a person's desires is problematic, more experts suggest completion of advance guidance documents - especially those that include both a survival wish and a proxy appointment. While most societies continue to rely on the standard format of their country directive, research shows that many of these documents are too jargon and unclear, confusing, and incomplete to adequately capture individual desires, and that they focus too much on the needs of medical practitioners and laws to rule out patient needs. Advanced manual documents are increasingly available online.
Some legal commentators have suggested that using non-legal advance instructions will leave users with documents that may not be respected. However, legal counsel for the Hastings Center for Bioethics denied this statement. To make the best choice, individuals should consider reviewing several document styles to ensure that they complete the documents that best meet their personal needs.
Legal situation by country
Note: Some of the countries listed below are in the European Union, where the legal system may vary from those in the US Country Report on advanced directives is a 2008 paper summarizing advanced health care legislation in the European Union with a summary which is shorter for the US; the 2009 paper also provides a European overview.
Australia
The law on face directives, power of attorney, and enduring protection varies from state to state. In Queensland, for example, the concept of advance health direction is defined in the Authority of Act of Attorney 1998 and Trusteeship and Administration of Action 2000 . Tasmania does not have specific laws on advance health care directives.
Canada
Health Canada - Canada's federal healthcare agency - has recognized the need for greater investment in palliative care and care homes as it faces an aging population of elderly and severely ill populations.
Much of the current focus in Canada is on preliminary care planning that involves encouraging individuals to reflect on and express their desires for future care, including late-life care, before they become seriously ill or unable to make decisions for themselves. A number of publicly funded initiatives exist to promote advance care planning and to encourage people to designate "substitute decision-makers" who make medical decisions and may give or not consent to medical procedures in accordance with the wishes of the previously disclosed patient when the patient is not able to do it alone
In 2008, The Advance Care Planning in Canada: A National Framework and Project Implementation was established. The goal is to engage health care professionals and educate patients about the importance of up-front care planning and end-of-life care.
Polls show that 96% of Canadians think that having a conversation with a loved one about planning for the end of life is important. However, the same polls show that only about 13% actually do it, or have created a face care plan for themselves.
The Ipsos Reid 2014 survey revealed that only about one-third of Canadian doctors and nurses working in primary care feel comfortable discussing late-life issues with their patients. The final-life problem in Canada was recently highlighted due to the ongoing ongoing debate about Doctor-assisted deaths in Canada. Former Federal Health Minister Rona Ambrose (July 15, 2013 to November 4, 2015) has stated: "I think the starting point for me is that we still do not have the best aged care and palliative care... So let's talk about making sure we have a final treatment - the best life before we started talking about suicide and assisted euthanasia. "
England and Wales
In England and Wales, people can make referrals in advance or appoint a proxy under the 2005 Mental Capacity Act. This is only for initial rejection of treatment because when the person does not have mental capacity; to be legally binding, the decision must first be specific about the rejected treatment and the circumstances in which the denial will take effect. To be valid, the person must be competent and understand the decision when they sign the referral. If the patient's initial decision related to refusal of care extends life, this should be recorded in writing and witnessed. Any initial rejection is legally binding on condition that the patient is an adult, the patient is competent and properly informed when reaching a decision, it is clearly applicable to current circumstances and there is no reason to believe that the patient has changed his mind.. If the initial decision does not meet these criteria but seems to establish a clear indication of the patient's wishes, it will not be legally binding but should be considered in determining the patient's best interests. In June 2010, Defense Management Attorney, Moore Blatch, announced that research shows the demand for Life Wills has tripled in the previous two years, indicating an increasing rate of concerned people about the way in which their terminal illnesses will be managed. According to the British Government, any adult with a mental capacity has the right to approve or refuse medical treatment. To make their clear wishes clear, one can use the will of life, which can include general statements of desire, which are not legally binding, and the specific refusal of treatment called "forward decisions" or "face guidance".
German
On 18 June 2009 the Bundestag passed a law on face-to-face directives, effective from September 1, 2009. The law, based on the principle of self-determination, provides fiduciary and medical assistance.
Italy
On December 14, 2017, the Italian Senate formally approved a law on advance health care directives which came into force on 31 January 2018.
The controversy over life-end care appeared in Italy in 2006, when a patient suffering from severe pain from muscular dystrophy, Piergiorgio Welby, petitioned the court to remove his respirator. Debate in Parliament, no decision is reached. A doctor finally honors Welby's wish by releasing a respirator under a sedative. The doctor was initially charged for violating Italian law against euthanasia, but was later cleansed. A further debate came after the father of a 38-year-old woman, Eluana Englaro, petitioned the court to ask for permission to pull the food tube to allow her to die. Englaro has been in a coma for 17 years, after a car accident. After petitioning the court for 10 years, authorization was given and Englaro died in February 2009. In May 2008, apparently as a result of a recent trial in Englaro's case, the judge of the guardianship in Modena, Italy used a relatively new law to work around the lack of advance directives. The new law allows a legally appointed guardian ("amministratore di sostegno") to make decisions for an individual. Faced with a 70-year-old woman with late stage Lou Gehrig's disease who filed a petition (with her family's support) to prevent the use of a respirator at a later date, the judge appointed her husband as a guard with a special duty to deny the use of a tracheostomy and/or respirator if/when the patient can not refuse the treatment itself.
Netherlands
In the Netherlands, potential patients and patients can determine the circumstances in which they want their own euthanasia. They do this by giving written euthanasia instructions. This helps establish the stated desires of the patient even if the patient is no longer able to communicate. However, that is just one factor to be reckoned with. Regardless of the written wish of the patient, at least two doctors, the latter has absolutely nothing to do with the first physician in a professional matter (eg working in another hospital, no prior knowledge of medical cases at hand), must agree that the patient is seriously ill and none hope to heal.
Switzerland
In Switzerland, there are several organizations that administer the patient's admission decree, a form signed by the patient stating that in case of permanent loss of judgment (eg, communication disability or severe brain damage) all means of prolonging life must be stopped. The family members and the organization also keep a proxy that gives the holder the right to enforce the patient's decision. Establishing such a decree is relatively uncomplicated.
However, in Switzerland, the patient's decision, in November 2008, there were no legally binding effects, both on civil and criminal aspects. Such a decision is now only seen as representing the will of the disenfranchised. However, the Swiss Criminal Code revision took place aimed at altering this situation (intended to be a 360 article of the Swiss Civil Code) by making patient decisions of legally binding documents.
United States
Aggressive medical intervention caused nearly two million Americans to be locked up in nursing homes, and over 1.4 million Americans remained very medically weak to survive only through the use of food tubes. US deaths, 25-55% occur in health care facilities. A total of 30,000 people remain alive in a coma and are vegetatively permanent.
The cost burden for individuals and families is quite large. A national study found that: "In 20% of cases, a family member should stop working;" 31% lost "all or most of the savings" (although 96% had insurance); and "20% reported losing their primary source of income." However, research shows that 70-95% of people prefer to reject aggressive medical treatment rather than their medically prolonged lives in other incompetent or incompetent prognostic countries.
As more and more Americans are experiencing the burden and diminished benefits of invasive and aggressive medical treatment in countries of poor prognosis - either directly (alone) or through loved ones - the pressure begins to increase to find ways to avoid the suffering and costs related to the treatment one does not want in a personal situation that can not be sustained. The first formal response is the will of life.
In the United States, all countries recognize some form of living will or appointment of health care representatives. The term life will is not officially recognized under California law, but advanced health care directives or long-lasting defense lawyers may be used for the same purpose as life will. A "report card" issued by Robert Wood Johnson Foundation in 2002 concluded that only seven countries deserved an "A" to meet the Uniform Rights model standard of the Terminally Ill Act. Surveys show that one-third of Americans say they have to make decisions about late-life care for loved ones.
In Pennsylvania on November 30, 2006, Governor Edward Rendell signed Act Act 169, which provides a comprehensive legal framework governing advance health care directives and health care decision making for incompetent patients. As a result, the health care organization provides a "Living Will & Power Care of Attorney Example Form from the Pennsylvania Act 169 of 2006."
Some countries offer live "registries" where residents can propose their lives so that they are easier and accessible to doctors and other healthcare providers. However, in recent years some of these lists, such as those run by the Washington State Department of Health, have been shut down by the state government due to low registration, underfunding, or both.
On July 28, 2009, Barack Obama became the first President of the United States to publicly announce that he has the will to live, and encourages others to do the same. He told an AARP town meeting, "So I really think it's a good idea to have the will of life.I'll encourage everyone to get it.I have one, Michelle has it, and we hope we do not need to use it for the time but I think that's something that makes sense. "The announcement follows the controversy surrounding proposed health care legislation that includes a language that would allow the payment of doctors under Medicare to advise patients on the will of life, sometimes referred to as" well-known "page 425. Shortly thereafter, bioethics Jacob Appel issued a call to make a compulsory life will.
India
India's Supreme Court on March 9, 2018 allowed live will and passive euthanasia. The country's top court stated that the right to a life of dignity extends to the point of dignity of death.
See also
- Unusual and extraordinary treatments
- Initial psychiatric instructions
- Do not resuscitate
References
External links
- The World Collaboration on Advanced Referrals. Andalusian Public Health School. Spanish.
- National Resource Center on the Psychiatric Instructions (USA)
- Portal for Advanced Referrals for Medical Care
- UK Medical Association's Guidance on Proxy decisions (UK) and simplified BMA decisions
- Macmillan/Cancerbackup patient's guide on face directives (U.K.)
- 9 South African factsheet about living wills
Source of the article : Wikipedia
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