Regulations and Directives (2024)

FAQs

How do you explain in advance directives with a patient? ›

Talk about your values — what makes your life worth living and what you consider quality of life. Approach the conversation wanting to share your wishes before you ask someone else to share their own wishes. Be prepared to have more than one conversation or that the subject may cause an emotional reaction.

Even though advance directives are legally recognized documents, there are times that a health care provider may reject a medical decision made by you or your health care proxy based on your advance directive. For example: When the decision goes against the individual health care provider's conscience.

The law clearly bars doctors from giving unwanted treatments. Even when the written directive is unclear, if a physician ignores an agent's attempts to enforce the patient's preferences, there are grounds for a lawsuit.

This means that your health care provider and proxy will do their best to respect your advance directives, but there may be circ*mstances in which they cannot follow your wishes exactly. For example, you may be in a complex medical situation where it is unclear what you would want.

Living wills can be very specific or very general. A basic problem with creating a very specific living will is that hardly anyone can anticipate, years ahead of time, what treatments and interventions they will want or not want in circ*mstances they have never faced and have little experience of.

The most common types of advance directives are the living will and the durable power of attorney for health care (sometimes known as the medical power of attorney). There are many advance directive formats.

Your living will's authority overrides the authority of your medical POA. This means your healthcare agent and doctors must consider the instructions in your living will while making decisions about your healthcare, and reasonably follow those instructions to the best of their ability.

An oral designation of surrogate supersedes a previous written directive. A person may give an individual health care instruction orally to any person at any time.

Authority of the Surrogate A surrogate may make health care decisions on behalf of a patient if the patient has no available, previously appointed conservator or designated agent with authority to make such decisions, and the primary physician determines and documents that the patient lacks capacity for making health ...

They may require the withholding of treatment that will alleviate suffering, and have the potential to cause patients to lose abilities and live with unnecessary suffering or handicap.

What is the controversy with advance directives? ›

Although advance directives may stimulate discussions and reduce the stress of surrogate decision making (5–8), well-documented controversy exists over their clinical effectiveness, including their inability to affect clinicians' and families' understanding of patients' preferences and the type of care received (9).

Stated simply: A do-not resuscitate order says that if your heart stops beating, or if you stop breathing, you don't want to be resuscitated. An advance directive is more general. You can specify your wishes if you are incapacitated.

You have the right to make decisions about the health care you get now and in the future. An advance directive is a legal document, prepared by you, that expresses what kind of medical care you want, or who is authorized to make decisions for you should you be unable to make or communicate your wishes.

Starting the conversation

As you develop rapport with a patient, you can start the conversation. Guiding patients in advance care planning and assisting with the completion of advance directives falls under the scope of nursing practice.

An easy way to start the conversation is to ask if they have any documents already prepared, if they have talked to anyone else about advance directives, and if they would be comfortable sharing how they feel. You can also use resources like the Serious Illness Conversation Guide (see "Resources").