1. End of life issuesA focus on advance directives By Latashia Gilkes

2. Advance Directive What is an advance directive? • An advance directive is any type of statement made by an individual to determine the medical care they would like to receive. • You can decide to continue to live or end life if and emergency decision has to be made

3. Purposes for advance directive • To make decisions before the client becomes unable to make decisions for themselves • To be involved in and responsible for medical care • To ensure the proper care is taken

4. Purposes for advance directives • Preparation for a serious illness in the near future • To have someone provide a voice when incapacitated • Clarification of what the client wants

5. Topics to cover • Advance directives • Living wills • Durable power of attorney • Benefits • Ethical issues • Things you can do

6. Types of advance directives • Living wills • Power of attorney • Do not resuscitate • Do not hospitalize • Organ donation • Feeding restrictions • Medical restrictions • Request for autopsy

7. General Information • Advance directives are mostly used by the elderly and terminally ill individuals • Can have more than one advance directive (i.e. organ donation and do not resuscitate) • However, less than 25% of individuals have at least one advance directive.

8. General Information • Anyone over the age of 18 can have one or more types of advance directive. • Individuals with terminal Illnesses or in an vegetative state would be more likely to have AD’S

9. History of Advance directives • Cruzan v Director of the Missouri Department of Health (1990) • Supreme Court case involving a client’s right to refuse treatment during incapacitated state • Patient Self- Determination Act (1990) • Gives individuals the right to obtain advance directives • All health care providers are required to inform their clients • can accept or refuse medical care or treatment

10. Living Wills • Living wills are the statements made by the individual to determine what will happen to them in an emergency or temporary medical care. • They can be very specific in detail or simple • All parties need to be aware of the client’s wishes and comply with them

11. Types of Living Wills • Living wills can be • Verbal (with family members, doctors) • Written up by an attorney (legal documents) • Discussed with a doctor or health care provider

12. Durable Power of Attorney (POA) • Appointing someone to make decisions if the client becomes incapacitated • The person can be a family member (children, sibling, spouse) • A trusted friend • Lawyer or doctor

13. Responsibilities of POA • To serve as a mediator for the client and the doctor • Voice for client • Comprehend the decisions made • Understand the client’s health • Meet the needs of the client

14. Benefits of advance directives • A medical plan for the future • Legal regulations to inform and provide individuals with advance directives • Ability to be involved and direct their medical decision • Can accept or refuse medical treatment • Connection between the client and POA

15. Disadvantages of advance directives • Clients can change their mind about their decisions • Difficult to predict what health issues will occur • Not being specific enough • Client may not want to make any decisions

16. Disadvantages • Misunderstanding the wishes of the client • Miscommunication between the client and POA • Disagreeing or ignoring the wishes of the client

17. Ethical issues • Doctors not meeting the client’s needs • Not giving the client all options • Cultural differences of the client • Religious differences of the client • Health care providers going against the client’s/family’s wishes

18. Word to the wise GET AN ADVANCE DIRECTIVE! • Be responsible for your own health by any means necessary • You have the power to control of your medical care • Get all the information you can to make the choices necessary for your own medical circumstance

19. Things you can do • Obtain all the information about your health care to make the right decisions • Make clear and precise decisions of what you would want • Contact your doctor and/or attorney about advance directive options

20. Things you can do • Talk to friends and family who have completed advance directives • Discuss your decisions with whom you want to have represent you • Trust that person to make choices when unable