Monday, December 27, 2004

Advanced Directive; A Decision Making Power

November 27, 2004
Cheryl Ford RN

A recent CNN article ("Living Wills Not Always a Clean Solution", 11/26/2004, Associated Press) http://www.cnn.com/2004/LAW/11/26/living.wills.ap/index.htmlargues there are flaws with the use of an advanced directive as opposed to a durable power of attorney(DPOA)/or "trusted loved-one."

The article reports....."People change their minds after they write their living wills but don't update them. Many living wills never make it to the bedside, left in a file cabinet or safety deposit box. And family and doctors often do a poor job of deciphering the patient's wishes even when they have the wills in hand."

"A better end-of-life option, experts say, is to give a trusted loved one the legal authority to make decisions if you become incapacitated. Two large studies found more than 70 percent of people would prefer that doctors rely on family rather than living wills in making decisions about their care."

From my perspective as a health care professional, an advanced directive may not be the 100% cure all for having your wishes carried out correctly, but it would be better than not having one written at all. It is also a better choice than leaving your wishes solely in the hands of a "...trusted loved-one" or Guardian.

The primary flaw in the two large studies cited in the article is our failure to educate the general public about the advantages of the Advance Directive and how to properly prepare one.
For example, if Terri Schindler-Schiavo, a disabled resident of Florida, had prepared an advance directive declaring her wishes, there would be no arguments about what Terri had wanted from either party, be it her parents or her estranged spouse.

Had the Florida courts denied the estranged husband's claims about Terri's wishes as "hearsay" because of the lack of any documentation, the oral arguments would also have been null and void. Michael Schiavo, the estranged husband, was never supported in his claims by anyone except two of his own relatives who were obviously biased. Exactly as his own claims, these two witnesses could never produce any supporting documentation.

The idea of not having an Advance Directive and placing end of life wishes solely into the hands of a family member, or a so-called "trusted loved-one," as cited in the article, is a serious detriment. Placing decisions solely into the hands of any one only opens the doors to any and all influence, be it personal, social, ideological, religious, financial, ethical, etc. The primary drawback is the notion of placing a "decision making power" into someone's hands as opposed to placing a document that clearly and consistently dictates the "decisions" that have already been made.The more effective resolution to this problem as it relates to obliging end of life wishes, (choices resulting out of medical advancement allowing people to remain alive on machinery) is the Advanced Directive.

As a health care professional, I would highly recommend the Advanced Directive as a preferred choice over doing nothing or allowing any individual or entity to take complete control of your destiny. An Advance Directive is an instrument which if handled responsibly by the person to whom it applies, can be fined tuned and updated as necessary. This will ensure consistency between the persons end of life wishes and the document. Legal documents are tools we use in every aspect of our day to day lives. An Advanced Directive, however, can no more be written and left in a safe to collect dust, than any other important document. All such documents require careful monitoring and updates to assure timely accuracy. Such a responsibility is no greater than keeping track of homeowners insurance, stock certificates, car titles, CD's, bank and tax records.

At some point each of us will reach a time when our mental faculties are diminished or taken completely by old age, disease or trauma. We, at that point will not have the ability to go back to change any of the important documents in our life, whether they relate to estate planning, beneficiaries, guardians, or even our own funeral arrangements. It will be assumed by any individual or agency who takes the responsibility to carry our wishes, that we, as responsible individuals, have kept all such important documents updated and current. The only role and responsibility of a trusted loved one/guardian/agency/court ...should be to have access to the documents, make certain the documents reach the appropriate parties, and then monitor the parties to ensure the wishes in the documents have been accurately carried out. The "trusted loved-one" physicians, medical providers or Guardian should never be left in a position, be it in a court of law, acute care setting, skilled nursing facility or hospice of changing or interpreting the documents at anytime. If the document has been written properly, after consulting with the appropriate legal and medical experts of choice, then there should be little or no room left for interpretation or argument.

As it stands with the options available to us today, the Advanced Directive is the most effective tool to ensure each of us our right to self-determination.

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