Advance healthcare directive
Another form is a specific type of power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf when they are incapacitated.
People are often encouraged to complete both documents to provide comprehensive guidance regarding their care, although they may be combined into a single form.
[3][4] Numerous studies have documented critical deficits in the medical care of the dying; it has been found to be unnecessarily prolonged,[5] painful,[6] expensive,[7][8] and emotionally burdensome to both patients and their families.
It was first proposed by an Illinois attorney, Luis Kutner, in a speech to the Euthanasia Society of America in 1967[11] and published in a law journal in 1969.
More specific living wills may include information regarding an individual's desire for such services such as analgesia (pain relief), antibiotics, hydration, feeding, and the use of ventilators or cardiopulmonary resuscitation.
[16] However, by the late 1980s, public advocacy groups became aware that many people remained unaware of advance directives[17] and even fewer actually completed them.
The most recent result was the Patient Self-Determination Act of 1990,[21] which attempted to address this awareness problem by requiring health care institutions to better promote and support the use of advance directives.
This led to the development of what some have called "second generation" advance directives[25] – the "health care proxy appointment" or "medical power of attorney."
The appointed healthcare proxy has, in essence, the same rights to request or refuse treatment that the individual would have if still capable of making and communicating health care decisions.
[32][33] While a study comparing next-of-kin decisions on behalf of an incapacitated person, (who later recovered) found that these surrogates chose correctly 68% of the time overall.
[37] [38] Studies suggest that values regarding financial and psychological burden are strong motivators in not wanting a broad array of end-of-life therapies.
A study conducted to address concerns that a non-statutory advance directive might leave an incapacitated person with a document that may not be honored found that they are generally accepted.
[45] The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) requires behavioral health facilities to ask patients if they have PADs.
A NIH-funded study conducted by researchers at Duke University has shown that creating a PAD with a trained facilitator increases therapeutic alliance with clinicians, enhances involuntary patients' treatment satisfaction and perceived autonomy, and improves treatment decision-making capacity among people labeled with severe mental illness.
A PAD may help clinicians gain prompt access to relevant information about individual cases and thus improve the quality of clinical decision-making, and enhance patient safety and long-term autonomy.
A number of publicly funded initiatives exist to promote advance care planning and to encourage people to appoint "substitute decision makers" who make medical decisions and can give or withhold consent for medical procedures according to the patient's pre-expressed wishes when the patient becomes incapable of doing so themselves[53][54][55][56] In 2008, The Advance Care Planning in Canada: A National Framework and Implementation Project was founded.
[58] A 2014 Ipsos Reid Survey[59] reveals that only about a third of Canadian doctors and nurses working in primary care feel comfortable discussing end of life issues with their patients.
"[60] In England and Wales, people may make an advance directive or appoint a proxy under the Mental Capacity Act 2005.
On 14 December 2017, Italian Senate officially approved a law on advance healthcare directive that came into force on 31 January 2018.
[68][69] Controversy over end-of-life care emerged in Italy in 2006, when a terminally ill patient suffering from muscular dystrophy, Piergiorgio Welby, petitioned the courts for removal of his respirator.
Further debate ensued after the father of a 38-year-old woman, Eluana Englaro, petitioned the courts for permission to withdraw feeding tubes to allow her to die.
The new law permitted a judicially appointed guardian ("amministratore di sostegno") to make decisions for an individual.
Right to refuse care is only recognized if the patient is considered terminally ill and their life expectancy is less than six months.
Every adult with testamentary capacity can redact a legal binding document declaring a will in the event of loss of judgement.
They may also designate a natural person to discuss medical procedures with the attending doctor and make decisions on their behalf if they are longer capable of judgment.
A national study found that: "In 20% of cases, a family member had to quit work", 31% lost "all or most savings" (even though 96% had insurance), and "20% reported loss of [their] major source of income".
"[90] The announcement followed controversy surrounding proposed health care legislation that included language that would permit the payment of doctors under Medicare to counsel patients regarding living wills, sometimes referred to as the "infamous" page 425.
[92] Supreme Court of India on March 9, 2018, permitted living wills and withholding and withdrawing life sustaining treatments.
