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Der Anaesthesist Feb 2020
Topics: Advance Directives; Attitude of Health Personnel
PubMed: 32020263
DOI: 10.1007/s00101-019-00723-3 -
International Nursing Review Jun 2022In 2016, the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care was implemented in Korea, providing a broad framework for... (Review)
Review
BACKGROUND
In 2016, the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care was implemented in Korea, providing a broad framework for end-of-life decision-making for the first time and making advance directives legally recognized documents. This Act can correct long-standing under-recognition of patients as valid decision makers for their own treatment choices. However, limited recognition of patient self-determination, rigid legal forms for documenting patient wishes, and the roles of family under the Act may pose challenges both to patients and nurses.
AIM
This paper critiques whether this newly introduced system of advance directives can truly guarantee protection of the patient's interests and respect for patient autonomy in real life, and discusses ethical and legal issues regarding the Act.
SOURCE OF EVIDENCE
We reviewed the current system of advance directives by raising three questions: (1) Do advance directives reflect a competent person's voluntary and informed choice?, (2) Are advance directives applicable in diverse clinical situations?, and (3) Does the Korean advance directive system ensure that such directives are honored in reality?
CONCLUSION
Although the Act is an important first step in respecting patient autonomy in end-of-life decision-making, it remains inadequate as it fails to provide thorough guidance in terms of the quality of writing process, applicability, and the guaranteed effects of advance directives.
IMPLICATIONS FOR NURSING AND HEALTH POLICY
As nurses are best situated for addressing these limitations due to their roles and competencies in clinical practice, expanding the roles of nurses in every stage of advance directive practice could help achieve the original purpose of advance directives. This calls for a policy that promotes an expanded role of nurses to improve the quality of advance directive practice.
Topics: Advance Directives; Death; Hospice Care; Humans; Nurse's Role; Personal Autonomy
PubMed: 34115378
DOI: 10.1111/inr.12683 -
Der Nervenarzt Mar 2018In the fourth Act on the amendment of pharmaceutical legal and other regulations in November 2016, the legislature has designated the proband advance directive based on... (Review)
Review
In the fourth Act on the amendment of pharmaceutical legal and other regulations in November 2016, the legislature has designated the proband advance directive based on the instrument of patient advance directive to enable group beneficial research with persons not capable of giving consent. This article describes the existing conditional need for group beneficial research and presents the problem of the decisive instrument for advance directives at the center of the considerations. The features of the proband advance directive concluded by the legislature stand in opposition to a successful implementation, particularly due to the necessary concrete clarification content far in advance for informed research participants. This article describes solution possiblities, which refer to the realization of the instrument of a proxy research authorization as well as the consideration of an advance research planning based on the advance care planning.
Topics: Advance Directives; Ethics, Medical; Germany; Humans; Mental Competency; Pharmaceutical Research; Proxy
PubMed: 28831512
DOI: 10.1007/s00115-017-0392-1 -
Singapore Medical Journal Aug 1996The advance directive is a document that enables a competent individual to specify the form of health care he would like to have, in the event that he is unable to make... (Review)
Review
The advance directive is a document that enables a competent individual to specify the form of health care he would like to have, in the event that he is unable to make such decisions in the future. This review paper traces the development of the advance directive from 1967, when it was first proposed by Luis Kutner. The Karen Ann Quinlan case and the Nancy Cruzan case are cited as examples of the case for the advance directive. The argument is that advance directives assist doctors, patients, family members and other carers with the increasingly complex health care decision making. Reservations have been expressed about the anticipatory nature of the decision, possible conflict with personal and religious ethics and the risk of cost containment considerations being over-riding concerns. The advance directive in America has undergone changes since the California Natural Death Act 1976 was passed. In the 1980s, "terminal" included permanent unconsciousness and advanced dementia. The declarant was also given a wider choice of treatment procedures that they wish to be withheld. Proxy directives were also introduced. In the 1990s, the declarant is even allowed to request the use of life-prolonging procedures. When appropriately implemented, the advance directive can perform its intended functions of clarifying the patient's perspective on life, death and medical care. When it is vague in terminology or applied to patients with uncertain prognoses, it can cause confusion to the patient's carers; and when improperly used, it can become an instrument not of patient's preferences, but of economic purpose, family bias, or physician's values.
Topics: Advance Directives; Humans
PubMed: 8993145
DOI: No ID Found -
Journal of the American Medical... Nov 2019To explore advance directive (AD) preferences and the facilitators and barriers of promoting ADs among terminally ill older patients in China. (Review)
Review
OBJECTIVES
To explore advance directive (AD) preferences and the facilitators and barriers of promoting ADs among terminally ill older patients in China.
DESIGN
A scoping review was used to identify key themes in ADs.
SETTING AND PARTICIPANTS
Studies from 2007 to 2017 were identified from the MEDLINE and Cochrane libraries. Articles concerning important components of ADs in terminally ill older patients were selected.
MEASURES
Eligible articles concerning important components of ADs in terminally ill older patients were thematically synthesized. Later, implementation evidence was identified from core components.
RESULTS
We used 13 articles and identified key components in ADs: (1) Chinese cultural characteristics; (2) policy support; (3) advance care planning (ACP); (4) hospice-palliative care (HPC); (5) prognosis disclosure and life-sustaining treatment preference; (6) knowledge about ADs for patients and their families; (7) the prevalence of ADs; (8) implementation of ADs; (9) staff experience and training; and (10) effective communication between patients, their families, and health care professionals. Facilitators in implementing ADs included previous comfort-oriented end-of-life care experience of patients or their families, and the enactment of relevant policy. Barriers included traditional Chinese cultural beliefs; lack of policy; lack of knowledge of ADs, ACP, and HPC; and poor communication between physicians, patients, and family members.
CONCLUSIONS/IMPLICATIONS
Chinese patients still showed positive preferences toward ADs. The implementation of ADs could be promoted through public education about ADs, the learning of ACP and HPC, and relevant policy development in China.
Topics: Advance Directives; Caregivers; China; Cultural Characteristics; Family; Female; Humans; Male; Terminal Care; Terminally Ill
PubMed: 31281114
DOI: 10.1016/j.jamda.2019.05.013 -
Aging Clinical and Experimental Research Feb 2015As the population ages, end-of-life care (EOLC) becomes an increasingly pressing issue. Advance directives (ADs) are legal documents that allow individuals to convey...
As the population ages, end-of-life care (EOLC) becomes an increasingly pressing issue. Advance directives (ADs) are legal documents that allow individuals to convey their decisions about EOLC. Although ADs have been shown to reduce EOLC costs, most people do not have ADs. To address this issue, we recently proposed that Congress instruct the Centers for Medicare and Medicaid Services (CMS) to collect ADs from Medicare beneficiaries. Herein, we outline how to implement this solution.
Topics: Advance Directives; Humans; Medicare; Terminal Care; United States
PubMed: 24859789
DOI: 10.1007/s40520-014-0237-8 -
The American Journal of Hospice &... Nov 2020Increased attention is being paid to "dementia directives," advance directives tailored to persons with dementia that outline what treatments an individual with dementia... (Review)
Review
Increased attention is being paid to "dementia directives," advance directives tailored to persons with dementia that outline what treatments an individual with dementia might wish to receive or forgo should they lose capacity. Particular focus has been placed on the request to have assisted oral feedings withheld, the so-called Stopping of Eating and Drinking by Advance Directive (SED by AD), the purpose of which is to hasten death. This article reviews the available literature regarding the practice of SED by AD and explores the clinical and ethical aspects as they present at the bedside. Our review aims to show that practical, clinically applicable ways to approach such requests must be developed in order to balance the fundamental principles at play.
Topics: Advance Directives; Alcohol Drinking; Humans
PubMed: 32166954
DOI: 10.1177/1049909120912951 -
Health Affairs (Project Hope) Jul 2017Efforts to promote the completion of advance directives implicitly assume that completion rates of these documents, which help ensure care consistent with people's... (Review)
Review
Efforts to promote the completion of advance directives implicitly assume that completion rates of these documents, which help ensure care consistent with people's preferences in the event of incapacity, are undesirably low. However, data regarding completion of advance directives in the United States are inconsistent and of variable quality. We systematically reviewed studies published in the period 2011-16 to determine the proportion of US adults with a completed living will, health care power of attorney, or both. Among the 795,909 people in the 150 studies we analyzed, 36.7 percent had completed an advance directive, including 29.3 percent with living wills. These proportions were similar across the years reviewed. Similar proportions of patients with chronic illnesses (38.2 percent) and healthy adults (32.7 percent) had completed advance directives. The findings provide benchmarks for gauging future policies and practices designed to motivate completion of advance directives, particularly among those people most likely to benefit from having these documents on record.
Topics: Advance Directives; Decision Making; Humans; Surveys and Questionnaires; Terminal Care; United States
PubMed: 28679811
DOI: 10.1377/hlthaff.2017.0175 -
Journal of Applied Gerontology : the... Dec 2020Contrary to expectations of joint decision-making, a substantial minority of older married couples report only one spouse possessing an advance directive. Using Health...
Contrary to expectations of joint decision-making, a substantial minority of older married couples report only one spouse possessing an advance directive. Using Health and Retirement Study data, the authors examined advance directive discordance among heterosexual married couples in which at least one spouse had completed an advance directive. It was predicted that spouses who differed in age, self-rated health, or race/ethnicity would be more apt to adopt individualistic as opposed to relational motivational stances, resulting in higher odds of nonmatching advance directive status. Heterogamy did not account for discordance, but couples in which one or both spouses attended some college were more likely to report advance directive concordance. In contrast, couples in which one or both spouses were non-White were more likely to display advance directive discordance. Study results raise concerns about the effectiveness and reach of advance care planning promotion efforts among low-education and non-White older married adults.
Topics: Advance Care Planning; Advance Directives; Aged; Humans; Spouses
PubMed: 31658866
DOI: 10.1177/0733464819884439 -
Journal of ET Nursing : Official... 1992
Topics: Advance Directives; Enterostomy; Humans; Nursing Care; Role
PubMed: 1637907
DOI: 10.1097/00152192-199207000-00003