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Advance Directives

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Advance directives are legal documents prepared in order to express the health care wishes of a patient who may be unable to speak directly with health care personnel due to health issues. This document could have a variety of different titles, including Living Will, Do Not Resuscitate Order (DNR) or even Health Care Proxy or Power of Attorney. The latter two documents can simply be used to name the individual who is responsible to make health care decisions for a patient who is unable to communicate, but can also include the patient’s wishes in an end of life scenario.

This advance directive would be put into play in a situation where a patient is unable to make and express their own medical decisions. That the patient is indeed in such a state must be certified by more than one physician. As state laws vary, other requirements may exist and different terminology may be used in the documents. Generally, the medical condition must be certified as “terminal illness” or “permanent unconsciousness” in order for an advance directive to be put into use. Further, should the patient again become able to make their own health care decisions, the agent’s authority under the advance directive would end.

One situation in which an advance directive would not be applicable is in the care of emergency personnel who may be called to the scene of an accident. In such a case, the emergency personnel are obligated to stabilize a patient’s condition and transfer them to the appropriate health care facility for further treatment. At that point, once a patient’s situation has been evaluated by a medical doctor, an advance directive may be put into use.

While advance directives, under a variety of terms, are valid throughout the United States, as stated previously, state laws vary and not all states will acknowledge a directive drafted under another state’s laws. Therefore, anyone who maintains a residence in more than one state, or who may work or travel often to another state, should prepare a directive in each state according to each state’s laws, in order to protect themselves properly.

Only completion of a new advance directive will invalidate the old directive, as these directives do not expire. Nevertheless, advance directive should be reviewed periodically to determine if they still reflect the wishes of the patient. If you wish to make even one change in the directive, it is advisable to prepare a completely new document.

Special Sources To Note:

Understanding Your Living Will (Addicus Books, 2006) http://www.addicusbooks.com/show_title.cfm?isbn=1886039771  

Mirarchi,Ferdinando Does a Living Will Equal a DNR? Is Patient Safety Compromised?, Journal of Emergency Medicine, Vol. 33, No.3, pp299-305, 2007.

Mirarchi, Ferdinando L “Living Wills & DNR: Is Patient Safety Compromised?”. Human Life Review. . FindArticles.com. 23 Sep. 2008. http://findarticles.com/p/articles/mi_qa3798/is_200710/ai_n24394969


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