Decision Making About End of Life Care: Advance Directives, Durable Power of Attorney for Healthcare, and Talking with Patients with Heart Disease About Dying

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Abstract

Advancing technology has complicated decision making about end of life care. Advance directives arose as a legal response to concerns about patients receiving unwanted interventions near the end of life. Healthcare advance directives and durable power of attorney for healthcare held the promise of controlling medical care at the end of life. This promise has not been realized. All clinicians providing care to patients with heart failure or other life-limiting illnesses should develop a set of communication skills to discuss goals of care, resuscitation preferences and wishes for end of life care. Patient centered communication skills and empathetic response to emotion are the foundational tools for addressing these issues. Newer models of advance care planning are more based on communication between providers, patients and families than on legal documents The POLST paradigm represents an important innovation in allowing patients to document their preferences for care in a portable document which is a legal physician order.

Keywords

Advance directives Advance care planning End of life Palliative care POLST Resuscitation Communication skills Empathy Living will Power of attorney Durable power of attorney for healthcare 
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Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.General Medicine and GeriatricsPortland VA Medical CenterPortlandUSA
  2. 2.Medicine DepartmentOregon Health & Science UniversityPortlandUSA

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