1. End of life issues A 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