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2.3.5: Advanced Directives

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    67568

    • Erin O'Hara-Leslie, Amdra C. Wade, Kimberly B. McLain, SUNY Broome
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    Advanced Directives are legal documents that allow a person to choose the type of medical care they wish to receive should they become unable to state their choices and make decisions in the future (Leahy, Fuzy & Grafe, 2013)

    An advanced directive is a legal document that tells a healthcare provider the type of treatments a patient wishes and does not wish to receive. They also allow a patient to select an individual(s) to make decisions for them should they be unable to do so. There are many types of advanced directives, which can be further explored by visiting MedlinePlus at http://www.nlm.nih.gov/medlineplus/advancedirectives.html

    Living Wills

    Living wills are a type of an advanced directive. They explain the type of medical care a patient wants and does not want to receive should they be unable in the future to make decisions for themselves.

    A living will is not the same as a last will and testament. A last will and testament is a legal document that delegates a person to be an executor of their estate and explains how a person wishes to have their property and possessions disposed of after their death. A living will is only about medical care and treatment.

    Laws about living wills vary from state to state. Examples of what a person may include in their living will might be decisions about:

    • Being artificially fed through a vein or stomach
    • Having a tube inserted down their throat for mechanical ventilation
    • CPR
    • Blood transfusions
    • Dialysis

    Durable Power of Attorney for Health Care (a.k.a. Health Care Proxy)

    A health care proxy is someone who the patient designates to make decisions for them in the future should they be unable to do so. A health care proxy is a type of advanced directive. A health care proxy is not the same as an executor of a will. A patient can have one person as the executor of their will and a completely different person designated as their health care proxy if they choose. A health care proxy can make decisions for a patient’s health care if the patient is unable to do so. A health care proxy is responsible for carrying out a patient’s wishes and for following a living will. If the patient has not made a living will, the health care proxy is responsible for making decisions on behalf of the patient according to what they believe is in the best interests of the patient.

    Laws about health care proxies and the decisions they can make vary from state to state (Health care agents, 2014). Most states do not allow a doctor or other health care provider to be a patient’s health care proxy. Home Health Aides/Personal Care Aides should not agree to be their patient’s health care proxy. This would be a boundary violation.

    Do-Not-Resuscitate (DNR) Order

    A Do–not–resuscitate (DNR) is another type of advanced directive. A patient who has a DNR has made a decision to not receive CPR (cardiopulmonary resuscitation). This means that should the patient’s heart stop, or if the patient stops breathing, that the health care providers are not allowed to perform CPR. A DNR order is an order that is written by a physician after the patient has discussed their wishes with their doctor (Do-not-resuscitate order, 2014). If a patient has a DNR order and a health care provider performs CPR knowing there is a DNR order, legal consequences can occur against the health care provider. It is important to know whether your patient has a DNR order in place.

    Having a DNR order does not affect any other treatments the patient receives. This means that a patient can continue to receive treatments such as medications, surgeries, physical therapy, and all other medical interventions. A DNR order only applies to whether or not your patient would like CPR performed should their heart stop or if they stop breathing.

    A health care proxy or family member cannot have a DNR order removed if it was already in place, based on the patient’s wishes and discussion with their doctor. This means that even a patient’s health care proxy cannot revoke (have removed) a DNR order if the patient had one in place before they became unable to make their own choices.

    Self Check Activity \(\PageIndex{1}\)

    Decide whether the statement is True or False

    Patients have a right to considerate and respectful care. _______

    Patients have a right to review their medical records and to control who can access their records and medical information. _______

    You can share medical information about your patient with any family member who wants to know how the patient is doing. ______

    Patients have a right to refuse medical treatment even if you think they should have the treatment. ______

    The patient has a responsibility to inform their healthcare team about who their health care proxy is and if there are any changes in their medical condition._______

    A patient who has a DNR order can still continue to receive home health services, medications, and treatments. _______

    A DNR order is a physician order based on the patient’s wishes, which states should the patient stop breathing, or their heart stop beating, CPR will not be performed.________

    If a patient has a DNR order, the patient’s family can get it removed. _________

    A health care proxy is someone the patient selects who can make decisions for the patient should the patient become unable to do so. _______

    A health care proxy can have a DNR order removed because they know what is best for the patient. ________

    Answer

    1. True

    2. True

    3. False

    4. True

    5. True

    6. True

    7. True

    8. False

    9. True

    10. False

    Feedback:

    1. According to the Patient Bill of Rights, patients have a right to considerate and respectful care.

    2. According to the Patient Bill of Rights, patients have a right to request and receive a copy of their medical record. This is also a federal law under HIPAA guidelines.

    3. You cannot share any information about the patient without the patient’s specific consent.

    4. According to the Patient Bill of Rights, patients have a right to refuse treatment.

    5. According to the American Hospital Association, 1992, Patient Responsibilities include informing their healthcare team about who their health care proxy is and if there are any changes in their medical condition.

    6. A patient who has a DNR order can still continue to receive home health services, medications, and treatments. A DNR order will only prohibit CPR and artificial respiration to occur should the patient choose to obtain this physician order.

    7. A DNR order is a physician order based on the patient’s wishes, which states should the patient stop breathing, or their heart stop beating, CPR will not be performed.

    8. It is a patient decision about whether or not to have a DNR order. If the patient is conscious and oriented, the family cannot have a DNR order removed.

    9. A health care proxy is someone the patient selects who can make decisions for the patient should the patient become unable to do so.

    10. If the patient is conscious and oriented, it is a patient decision and not up to the family about whether or not to have a DNR order.

    This page titled 2.3.5: Advanced Directives is shared under a CC BY 4.0 license and was authored, remixed, and/or curated by Erin O'Hara-Leslie, Amdra C. Wade, Kimberly B. McLain, SUNY Broome (OpenSUNY) via source content that was edited to the style and standards of the LibreTexts platform; a detailed edit history is available upon request.