ADVANCE DIRECTIVES ADVANTAGES AND DISADVANTAGES

WHY AN ADVANCE DIRECTIVE TO EXTEND THE AUTHORITY OF THE PATIENT BEYOND THE ONSET OF DECISIONAL INCAPACITY TO EXPRESS CLEARLY THE WISHES OF THE PATIENT SO THEY WILL BE HONORED BY CAREGIVERS, FAMILIES, AND OTHERS –TO AVOID BECOMING A VICTIM OF ANOTHER’S AGENDA ARBITRARY DECISIONS PATIENT WOULD NOT WANT DECISIONS MADE OUT OF GUILT OR FEAR PRESSURE FROM SPECIAL INTEREST GROUPS PROTRACTED OR UNDESIRABLE COURT DECISIONS TO AVOID THE NECESSITY OF GOING TO COURT --- OFTEN INAPPROPRIATE DECISIONS CONSERVE RESOURCES, PARTICULARLY WHEN FURTHER TREATMENT IS FUTILE

TYPES OF ADVANCE DIRECTIVES INFORMAL STATEMENTS ADVANTAGES –INSURES COMMUNICATION HAS OCCURED DISADVANTAGES –NO DOCUMENTATION IN CASE OF CONFLICT WHEN ADVANCE DIRECTIVE IS TO BE IMPLEMENTED –OFTEN CASUAL COMMENT WITH LITTLE REFLECTION OR SPECIFICITY

TYPES OF ADVANCE DIRECTIVES DOCUMENTED STATEMENTS TO PHYSICIANS ADVANTAGES –NO NEED TO LABOR OVER A WRITTEN DOCUMENT – NO NEED TO SECURE WITNESSES TO A SIGNED DOCUMENT –CAN DISCUSS IMMEDIATELY TREATMENT DIRECTIONS WITH PHYSICIAN DISADVANTAGES –PHYSICIAN’S RECORDS MAY BE INACCESSIBLE WHEN THEY ARE NEEDED, E.G., RETIREMENT –STATEMENTS MADE TO SEVERAL PHYSICIANS MAY CONFLICT

TYPES OF ADVANCE DIRECTIVES LIVING WILL DECLARATIONS ADVANTAGES –DOCUMENTED PROTRAIT OF PATIENT’S WISHES AND VALUES –PROMOTES AUTONOMY BEYOND OF POINT OF INCAPACITY –ENHANCES REFLECTIVE LIFE OF AUTHOR –PROMOTES DIGNITY BY ALLOWING RISK-TAKING BY AUTHOR –ACCEPTS CONTEXT OF NATURAL RHYTHMS OF LIFE DISADVANTAGES –IMPOSSIBLE TO ANTICIPATE ALL CONTINGENCIES –NO COMPETENT PERSON WITH AUTHORITY TO ASSESS PARTICULARS OF A CLINICAL SITUATION AND MAKE DECISIONS –LACK OF SPECIFICITY IF “GENERIC” FORM IS USED –LACK OF CREDIBILITY IF INTENTIONS AND VALUES OF AUTHOR ARE UNKNOWN

TYPES OF ADVANCE DIRECTIVES LIVING WILL DECLARATIONS ADVANTAGES (CONT.) –CAN GENERATE AVENUES OF COMMUNICATION AUTHOR AND SIGNIFICANT OTHER/CAREGIVERS –PROTECTION FROM UNDESIRED INTERVENTIONS –RELIEVES SECOND GUESSING –RELIEVES GUILT AND FEAR –PROMOTES CONTINUITY OF CARE –MAY BE COST EFFECTIVE DISADVANTAGES (CONT.) –FREQUENTLY LITTLE COMMUNICTION OCCURS WITH SIMPLY SIGNING A FORM

TYPES OF ADVANCE DIRECTIVES DURABLE POWER OF ATTORNEY FOR HEALTHCARE ADVANTAGES –DESIGNATES A PERSON THE PATIENT TRUSTS –GIVES DECISIONAL AUTHORITY TO INDIVIDUAL WHO CAN ASSESS SPECIAL CIRCUMSTANCES IN THE CLINICAL SITUATION –IDENTIFIES AN INDIVIDUAL WITH AUTHORITY WITH WHOM PHYSICIAN CAN COMMUNICATE DISADVANTAGES –IF NO CLEAR COMMUNICATION BEFORE INCAPACITY, PATIENT COULD BECOME VICTIM OF ATTORNEY-IN-FACT’S AGENDA –WITHOUT DOCUMENTATION PHYSICANS CAN QUESTION IF ATTORNEY-IN-FACT IS TRULY REPRESENTING PATIENT’S WISHES –WITHOUT DOCUMENTATION OTHERS MAY OBSTRUCT ATTORNEY-IN-FACT’S DECISIONS

TYPES OF ADVANCE DIRECTIVES DURABLE POWER OF ATTORNEY FOR HEALTHCARE ADVANTAGES –REQUIRES PHYSICIANS TO HONOR DECISIONS OF ATTORNEY-IN-FACT AS THEY WOULD IF THE PATIENT HIMSELF/HERSELF HAD MADE THE DECISIONS –REDUCES FEAR OF LAWSUIT BECAUSE OF AUTHORITY OF DECISION-MAKER DISADVANTAGES –WITHOUT PRIOR COMMUNICATION AND DOCUMENTATION ATTORNEY-IN-FACT MAY HESITATE TO MAKE NECESSARY DECISIONS BECAUSE OF GUILT –WITHOUT DOCUMENTATION AUTHORITY OF ATTORNEY-IN-FACT MAY BE WEAKENED A WELL-DESIGNED LIVING WILL MAY NEUTRALIZE DISADVANTAGES