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Patients’ Advance Directives for Health Care in Case of Incapacity

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Geriatric Medicine

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Abstract

Many people would like to have some control over their medical care, not only when they are alert but also when they are too sick to participate in decisions. Similarly, those who have to make decisions for patients in this position would like to be guided by the patient’s wishes. Advance care planning, which evolved in response to these needs, is described in this chapter. The first part of the chapter discusses descriptive, historical, legal, and conceptual foundations of advance directives. Since their use requires at least as much skill as any other clinical interaction, the second part of the chapter concerns the practical matters of how to conduct advance care planning with patients. Because this field is relatively new, a final part is devoted to future possibilities for and limits to the use of advance directives.

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References

  1. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical Research. Deciding to Forgo Life-Sustaining Treatment: A Report on the Ethical, Medical, and Legal Issues in Treatment Decisions. Washington, DC: Government Printing Office; 1983.

    Google Scholar 

  2. Lynn J. Why I don’t have a living will. Law Med Health Care. 1991; 19: 101–104.

    PubMed  CAS  Google Scholar 

  3. Seghal A, Galbraith A, Chesney M, Schoenfeld P, Charles G, Lo B. How strictly do dialysis patients want their advance directives followed? JAMA. 1992; 267: 59–63.

    Article  Google Scholar 

  4. Emanuel EJ, Emanuel LL. Proxy decision making. JAMA. 1992; 267: 2221–2226.

    Article  PubMed  CAS  Google Scholar 

  5. Rabkin MT, Gillerman G, Rice NR. Orders not to resuscitate. N Engl J Med. 1976;295:364–366.

    Google Scholar 

  6. Emanuel LL. Does the Do-Not-Resuscitate order need life sustaining intervention? Time for advance care directives. Am J Med. 1989; 86: 87–90.

    Article  PubMed  CAS  Google Scholar 

  7. Bedell SE, Delbanco TL. Choices about cardiopulmonary resuscitation in the hospital: when do physicians talk with patients? N Engl J Med. 1984; 310: 1089–1093.

    Article  PubMed  CAS  Google Scholar 

  8. Bok S. Personal directions for care at the end of life. N Engl J Med. 1976; 295: 367–369.

    Article  PubMed  CAS  Google Scholar 

  9. Relman AS. Michigan’s sensible “living will.” N Engl J Med. 1979; 300: 1270–1272.

    Article  PubMed  CAS  Google Scholar 

  10. Doukas DJ, McCullough LB. The values history: the evaluation of the patient’s values and advance directives. J Fam Pract. 1991; 32: 145–153.

    PubMed  CAS  Google Scholar 

  11. Emanuel LL, Emanuel EJ. The medical directive: a new comprehensive advance care document. JAMA. 1989; 261: 3288–3293.

    Article  PubMed  CAS  Google Scholar 

  12. Schneiderman LJ, Pearlman RA, Kaplan RM, Anderson JP, Rosenberg EM. Relationship of general advance directive instructions to specific life-sustaining treatment preferences in patients with serious illness. Arch Intern Med. 1992; 152: 2114–2122.

    Article  PubMed  CAS  Google Scholar 

  13. Fischer G, Alpert H, Stoeckle JD, Emanuel LL. Relationship between goals and treatment preferences in advance directives. J Gen Intern Med. 1994; 9: 93.

    Article  Google Scholar 

  14. Doukas DJ, Gorenflo DW. Analyzing the values history: an evaluation of patient medical values and advance directives. J Clin Ethics. 1993; 4: 41–45.

    PubMed  CAS  Google Scholar 

  15. Nunnally JC. Psychometric Theory. 2nd ed. New York: McGraw-Hill; 1978: 265–270.

    Google Scholar 

  16. Right to Die Legislation. New York: Choice in Dying; 1994.

    Google Scholar 

  17. Weir RF, Gostin L. Decisions to abate life-sustaining treatment for nonautonomous patients: ethical standards and legal liability for physicians after Cruzan. JAMA. 1990; 264: 1846–1853.

    Article  PubMed  CAS  Google Scholar 

  18. Emanuel EJ. A review of the ethical and legal aspects of terminating medical care. Am J Med. 1988; 84: 29 1301.

    Google Scholar 

  19. Emanuel LL. What makes a directive valid? Hastings Cent Rep. 1994; 24 (suppl): S27–29.

    Article  CAS  Google Scholar 

  20. Dresser RS. Advance directives, self-determination, and personal identity. In: Hackler C, Moseley R, Vawter DE, eds. Advance Directives in Medicine. New York: Praeger; 1989: 155–170.

    Google Scholar 

  21. In re Karen Ann Quinlan 70 N.J. 10, 355 A.2d 647 (1976).

    Google Scholar 

  22. Appelbaum PS, Lidz CW, Meisel A. Informed Consent: Legal Theory and Clinical Practice. New York: Oxford University Press; 1987.

    Google Scholar 

  23. Faden RR, Beauchamp TL. Decision-making and informed consent: a study of the impact of disclosed information. Social Indicators Res. 1980; 7: 313–336.

    Article  Google Scholar 

  24. Emanuel LL, Danis M, Pearlman RA, Singer PA. Advance care planning as a process. J Am Geriatr Soc. 1995; 43: 440446.

    Google Scholar 

  25. Singer PA. Disease-specific advance directives. Lancet. 1994; 344: 594–596.

    Article  PubMed  CAS  Google Scholar 

  26. Patrick DL, Starks HE, Cain KC, Uhlmann RF, Pearlman RA. Med Decis Making. 1994; 14: 9–18.

    Article  PubMed  CAS  Google Scholar 

  27. Orentlicher D. Advance medical directives. JAMA. 1990; 263: 2365–2367.

    Article  PubMed  CAS  Google Scholar 

  28. Silverstein MD, Stocking CB, Antel JP, Beckwith J, Roos 36. RP, Siegler M. Amyotrophic lateral sclerosis and life-sustaining therapy: patient’s desires for information, participation in decision making, and life-sustaining therapy. 37. Mayo Clin Proc. 1991; 66: 906–913.

    Article  PubMed  CAS  Google Scholar 

  29. Everhart MA, Pearlman RA. Stability of patient preferences regarding life-sustaining treatments. Chest. 1990; 38. 97: 159–64.

    Article  Google Scholar 

  30. Emanuel LL, Emanuel EJ, Stoeckle JD, Hummel LR, 39. Barry MJ. Advance directives: stability of patients’ treatment choices. Arch Intern Med. 1994; 154: 209–217.

    Article  PubMed  CAS  Google Scholar 

  31. Danis, Patrick DL, Garrett J, Harris R, Patrick DL. Stabil- 40. ity of choices about life-sustaining treatments. Ann Intern Med. 1994; 120: 567–573.

    Google Scholar 

  32. Emanuel LL, Barry MJ, Emanuel EJ, Stoeckle JD. Ad- 41. vance directive: can patients’ stated treatment choices be used to infer unstated choices? Med Care. 1994; 32: 95–105.

    Article  PubMed  CAS  Google Scholar 

  33. Emanuel LL. Appropriate and inappropriate use of ad- 42. vance directives. J Clin Ethics. 1994; 5 (4): 357–359.

    PubMed  CAS  Google Scholar 

  34. The SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients. 43. JAMA. 1995; 274: 1591–1598.

    Google Scholar 

  35. Danis M, Southerland LI, Garrett JM, et al. A prospective study of advance directives for life-sustaining care. N Engl J Med. 1991; 324: 882–888.

    Article  PubMed  CAS  Google Scholar 

  36. Emanuel LL. Structured deliberation to improve decision-making for the seriously ill. Hastings Cent Rep. 1995; 25: 514–518.

    Google Scholar 

  37. Kasper JF, Mulley AG Jr, Wennberg JE. Developing shared decision-making programs to improve the quality of health care. Quality Rev Bull. 1992; 18 (6): 183–190.

    Google Scholar 

  38. Steiber SR. Right to die: public balks at deciding for others. Hospitals. 1987; 61: 72.

    Google Scholar 

  39. Gillick MR, Hesse K, Massapica N. Medical technology at the end of life. What would physicians and nurses want for themselves? Arch Intern Med. 1993; 153: 2542–2547.

    Google Scholar 

  40. Kane RL, Wales J, Bernstein L, Leibowitz A, Kaplan S. A randomized controlled trial of hospice care. Lancet. 1984; 1: 890–894.

    Google Scholar 

  41. Emanuel EJ, Emanuel LL. The economics of dying-the illusion of cost savings at the end of life. N Engl J Med. 1994; 330: 540–544.

    Google Scholar 

  42. Emanuel LL, Emanuel EJ. When patients have no advance directives: institutional default guidelines defined by com¬munities of patients. Hastings Cent Rep. 1993; 23: 6–14.

    Google Scholar 

  43. Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ. Advance care directives; a case for greater use. N Engl J Med. 1991; 324: 889–895.

    Google Scholar 

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Authors
  1. Linda Emanuel
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Editor information

Editors and Affiliations

  1. The Henry L. Schwartz Department of Geriatrics and Adult Development, The Mount Sinai Medical Center, 10029-6574, New York, NY, USA

    Christine K. Cassel M.D. (Professor and Chairman) & Diane E. Meier M.D. (Associate Professor) (Professor and Chairman) &  (Associate Professor)

  2. Center for Study of Aging and Geriatric Research Education and Clinical Center, Duke University Medical Center, 27710, Durham, NC, USA

    Harvey J. Cohen M.D. (Director) (Director)

  3. University of Washington Medical Center, 98195, Seattle, WA, USA

    Eric B. Larson M.D., M.P.H. (Medical Director) (Medical Director)

  4. Gerontology Division, Harvard Medical School, Brigham and Women’s Hospital, 02115, Boston, MA, USA

    Neil M. Resnick M.D. (Chief) (Chief)

  5. Geriatric Research Education and Clinical Center, Sepulveda VA Medical Center, 91343, Sepulveda, CA, USA

    Laurence Z. Rubenstein M.D., M.P.H. (Director) (Director)

  6. Department of Medicine, University of Chicago, 60637, Chicago, IL, USA

    Leif B. Sorensen M.D. (Professor and Vice Chairman) (Professor and Vice Chairman)

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© 1997 Springer Science+Business Media New York

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Emanuel, L. (1997). Patients’ Advance Directives for Health Care in Case of Incapacity. In: Cassel, C.K., et al. Geriatric Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-2705-0_67

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  • DOI: https://doi.org/10.1007/978-1-4757-2705-0_67

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-2707-4

  • Online ISBN: 978-1-4757-2705-0

  • eBook Packages: Springer Book Archive

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