1. ADVANCE CARE PLANNING DENISE MINTON, MD University of New Mexico Division of Geriatrics

2. OBJECTIVES Compare and contrast advance directives, living wills, health care proxies and instructional directives Compare and contrast decisional capacity and competence Identify resources available to patients for advance care planning

3. ADVANCE CARE PLANNING An ongoing discussion between the physician, the patient and the proxy decision-maker to plan for future medical care in the event a patient becomes unable to make his or her own decisions about health care. “Advance Care Planning: A Practical Guide for Physicians.” AMA 2001

4. PATIENT SELF DETERMINATION ACT OF 1990 Federal law requiring health care facilities that receive Medicaid and Medicare funds to inform patients of their rights to execute advance directives

5. UNIFORM HEALTH-CARE DECISIONS ACT OF 1993 Acknowledges the right of a competent individual to decide all aspects of his/her own health care in all circumstances Includes right to decline health-care or to discontinue treatment even if death ensues Authorizes health-care decisions to be made by an agent who is designated to decide when an individual cannot or does not wish to

6. UNIFORM HEALTH-CARE DECISIONS ACT OF 1993 A health-care directive may be written or oral Power of attorney for health-care must be in writing, but need not be witnessed Requires an agent/surrogate to make decisions in accordance with the instructions and other wishes of the individual to the extent known Prohibits a guardian from revoking a patient’s advance health-care directive without express court approval

7. UNIFORM HEALTH-CARE DECISIONS ACT OF 1993 Health-care providers/institutions must comply with an instruction of the patient and with reasonable interpretation of that instruction by the surrogate Instructions may be declined for reasons of conscience or if the instruction requires the provision of medically ineffective care or care contrary to health-care standards Authorizes the court to enjoin or direct a health-care decision or other equitable relief

8. ADVANCE CARE PLANNING Advance directive Living will Instructional directive Health care proxy ???

10. DECISONAL CAPACITY A health care professional’s opinion of a patient’s ability to make decisions for him- or her- self Principles of Geriatric Medicine & Gerontology, Hazzard, et al 2003

11. COMPETENCE A judge’s ruling as to whether an individual has been deemed capable of making his or her own decisions Principles of Geriatric Medicine & Gerontology, Hazzard, et al 2003

12. PATIENT RESOURCES Consumer’s Toolkit for Advance Care Planning www.abanet.org/aging FindLaw for the Public http://estate.findlaw.com/estate-planning/living-wills/ Advance Care Planning http://medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ6LW5 DZLC&sub_cat=386 Aging With Dignity – Five Wishes http://www.agingwithdignity.org/5wishes.html JAMA Patient Pages http://medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ71W3 H4AC&sub_cat=386 http://medem.com/medlb/article_detaillb.cfm?article_ID=ZZZJBYM 94GC&sub_cat=386