__________________________________________________________________ Medical Ethics for Physicians
To this statement or its facsimile, this form does have a clause exempting any pregnant mother from having this advance directive honored while she remains in a pregnant state. Another clause may be added regarding the individual’s agreement or non-agreement to the discontinuance of artificial feeding and hydration through a feeding tube (adopted from the Nancy Cruzan case decision). The directive is signed by the individual and is honored only if the patient meets the criteria set forth in the advance directive. It is the clear and convincing evidence required by some states that the individual initiates and signs this form while competent, and his or her signature (usually required to be notarized or witnessed by two witnesses) affirms this. DURABLE POWER OF ATTORNEY FOR HEALTH CARE (DPAHC) The second type of form is known as a durable power of attorney for health care (DPAHC) and allows the individual to choose another person to act on his or her behalf should the individual become incapacitated and unable to do so, at any future time. This document offers more comprehensive choices for the individual by giving more scenarios and noting the patient’s wishes in those situations in the future. The DPAHC states the individual’s wishes in writing, as does the physician directive, but goes further into the circumstances under which future healthcare decisions may need to be made. It also allows another (a surrogate, also called an attorney-in- fact) to act on the patient’s behalf. The named person becomes equal to the patient in terms of his or her right to receive the same information required for decision making. This form also must be signed by the individual and notarized or witnessed. In both cases, the physician directive and the DPAHC are legal documents in all states and require all healthcare institutions to honor them if the patient meets the criteria. Healthcare agencies must have policies and procedures that allow the process for patient self-determination rights to be honored. The purpose of the Act is to communicate and protect patients’ rights to self-determination in health care. The underlying assumptions of the PSDA are that [8]: • Patients who are informed of their rights are more likely to take advantage of them. • If patients are more actively involved in decisions about their medical care, then that care will be more responsive to their needs. • Patients may choose care that is less costly.
• The patient’s record must be documented to indicate whether the patient has an advance directive. • Institutions may not discriminate against or refuse care to a patient based upon whether the patient has executed an advance directive. • Institutions have an affirmative obligation to comply with requirements of state law regarding advance directives. • Institutions must provide (individually or with others) education to staff and community regarding issues associated with advance directives. • State Medicaid laws must be amended to require participating healthcare institutions to furnish the written information mentioned above. • With the Department of Health and Human Services’ assistance, state Medicaid agencies must develop written descriptions of state laws on advance directives, and these materials are to be distributed by participating healthcare institutions. Finally, legislation was created to keep end-of-life medical decision-making issues out of the courts and in the appropriate arena, with the appropriate players: the patient/family and the healthcare professionals. The central focus of the law is the provision of patient education. The means or the tool for the individual to document his or her wishes for future healthcare decisions is called an advance directive. There are two types of advance directives available. Although both are not required to be completed together, most people are encouraged to do so.
The National Comprehensive Cancer Network recommends asking patients if they have a living will, medical power of attorney, health care proxy, or patient surrogate for health care. If not, patients should be encouraged to prepare one.
(https://www.nccn.org/professionals/physician_gls/ pdf/palliative.pdf. Last accessed January 13, 2023.) Level of Evidence : Expert Opinion/Consensus Statement
PHYSICIAN DIRECTIVE The first type of advance directive is called a physician directive, sometimes called directive to physician. The precedent form is the living will, an earlier, legally non-binding form. The living will allowed an individual to state his/her treatment choices should he or she be found in a terminal state, comatose, and/ or in another condition leading to imminent death for which the physician saw no cure. The patient stated that he/she be allowed to die naturally without medical intervention, with only comfort measures employed.
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MDTX1625
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