Assessment of competence to complete advance directives: validation of a patient centred approach.
(1/52)
OBJECTIVE: To develop a patient centred approach for the assessment of competence to complete advance directives ("living wills") of elderly people with cognitive impairment. DESIGN: Semistructured interviews. SETTING: Oxfordshire. SUBJECTS: 50 elderly volunteers living in the community, and 50 patients with dementia on first referral from primary care. MAIN OUTCOME MEASURES: Psychometric properties of competence assessment. RESULTS: This patient centred approach for assessing competence to complete advance directives can discriminate between elderly persons living in the community and elderly patients with dementia. The procedure has good interrater (r=0.95) and test-retest (r=0.97) reliability. Validity was examined by relating this approach with a global assessment of competence to complete an advance directive made by two of us (both specialising in old age psychiatry). The data were also used to determine the best threshold score for discriminating between those competent and those incompetent to complete an advance directive. CONCLUSION: A patient centred approach to assess competence to complete advance directives can be reliably and validly used in routine clinical practice. (+info)
A problem for the idea of voluntary euthanasia.
(2/52)
I question whether, in those cases where physician-assisted suicide is invoked to alleviate unbearable pain and suffering, there can be such a thing as voluntary euthanasia. The problem is that when a patient asks to die under such conditions there is good reason to think that the decision to die is compelled by the pain, and hence not freely chosen. Since the choice to die was not made freely it is inadvisable for physicians to act in accordance with it, for this may be contrary to the patient's genuine wishes. Thus, what were thought to be cases of voluntary euthanasia might actually be instances of involuntary euthanasia. (+info)
Debate: what constitutes 'terminality' and how does it relate to a living will?
(3/52)
A moribund and debilitated patient arrives in an emergency department and is placed on life support systems. Subsequently it is determined that she has a 'living will' proscribing aggressive measures should her condition be judged 'terminal' by her physicians. But, as our round table of authorities reveal, the concept of 'terminal' means different things to different people. The patient's surrogates are unable to agree on whether she would desire continuation of mechanical ventilation if there was a real chance of improvement or if she would want to have her living will enforced as soon it's terms were revealed. The problem of the potential ambiguity of a living will is explored. (+info)
'Round-table' ethical debate: is a suicide note an authoritative 'living will'?
(4/52)
Living wills are often considered by physicians who are faced with a dying patient. Although popular with the general public, they remain problems of authenticity and authority. It is difficult for the examining physician to know whether the patient understood the terms of the advance directive when they signed it, and whether they still consider it authoritative at the time that it is produced. Also, there is little consensus on what spectrum of instruments constitutes a binding advance directive in real life. Does a 'suicide note' constitute an authentic and authoritative 'living will'? Our panel of authorities considers this problem in a round-table discussion. (+info)
Annual report of Council, 1983-1984: medical ethics.(5/52)
Record health care directives before terminal illness!
(6/52)
Physicians share the grief and tension of families who must make decisions for incompetent, dying members. The author recorded the wishes of 1000 competent patients to guide families and the health care team during terminal illness. A questionnaire, which became part of the medical record, was used to determine views of organ donation, religious beliefs, and other directives. Patients were eager to record and discuss their wishes during an office or hospital visit; 94% of all patients wanted to participate in health care decisions. When directives for terminal care are available, families will not be forced to make blind crisis decisions for a dying member. (+info)
Legal assistance matters. Final rule.
(7/52)
This part establishes a uniform approach for the execution of military testamentary instruments (including wills), powers of attorney, and advance medical directives. It seeks public comment on specific aspects of the activity. (+info)
Withholding the artificial administration of fluids and food from elderly patients with dementia: ethnographic study.
(8/52)
OBJECTIVE: To clarify the practice of withholding the artificial administration of fluids and food from elderly patients with dementia in nursing homes. DESIGN: Qualitative, ethnographic study in two phases. SETTING: 10 wards in two nursing homes in the Netherlands. PARTICIPANTS: 35 patients with dementia, eight doctors, 43 nurses, and 32 families. RESULTS: The clinical course of dementia was considered normal and was rarely reason to begin the artificial administration of fluids and food in advanced disease. Fluids and food seemed to be given mainly when there was an acute illness or a condition that needed medical treatment and which required hydration to be effective. The medical condition of the patient, the wishes of the family, and the interpretations of the patients' quality of life by their care providers were considered more important than living wills and policy agreements. CONCLUSIONS: Doctors' decisions about withholding the artificial administration of fluids and food from elderly patients with dementia are influenced more by the clinical course of the illness, the presumed quality of life of the patient, and the patient's medical condition than they are by advanced planning of care. In an attempt to understand the wishes of the patient doctors try to create the broadest possible basis for the decision making process and its outcome, mainly by involving the family. (+info)