The delivery of quality care at the end of life should be seamless across all health care settings and independent from variables such as institutional largeness, charismatic leadership, funding sources and blind luck . . . People have come to fear the prospect of a technologically protracted death or abandonment with untreated emotional and physical stress. (Field and Castle cited in Fins et al.,. 1 Australians are entitled to plan in advance the medical treatments they would allow in the event of incapacity using advance directives (ADs). A critical role of ADs is protecting people from unwanted inappropriate cardiopulmonary resuscitation (CPR) at the end stage of life. Generally, ADs are enacted in the context of medical evaluation. However, first responders to a potential cardiac arrest are often non-medical, and in the absence of medical instruction, default CPR applies. However, the efficacy of AD CPR refusal depends on the synergy of prevailing AD legislation and ensuing policy. When delivery fails, then democratic AD law is bypassed by paradigms such as the Physician Orders for Life-Sustaining Treatment (POLST) community form, as flagged in Australian Resuscitation Council guidelines. 2 Amidst Australian AD review and statute reform this paper offers a perspective on the attributes of a working AD model, drawing on the Respecting Patient Choices Program (RPCP) experience at The Queen Elizabeth Hospital (TQEH) under SA law. The SA Consent to Medical Treatment and Palliative Care Act 1995 and its 'Anticipatory Direction' has been foundational to policy enabling non-medical first responders to honour ADs when the patient is at the end stage of life with no real prospect of recovery. 3 The 'Anticipatory Direction' provision stands also to direct appointed surrogate decision-makers. It attunes with health discipline ethics codes; does not require a pre-existing medical condition and can be completed independently in the community. Conceivably, the model offers a national AD option, able to deliver AD CPR refusals, as an adjunct to existing common law and statute provisions. This paper only represents the views of the author and it does not constitute legal advice.What is known about the topic? Differences in advance directive (AD) frameworks across Australian states and territories and between legislated and common law can be confusing. 4 Therefore, health professionals need policy clarifying their expected response. Although it is assumed that ADs, including CPR refusals at the end of life will be respected, unless statute legislation is conducive to policy authorising that non-medical first responders to an emergency can observe clear AD CPR refusals, the provision may be ineffectual. Inappropriate, unwanted CPR can render a person indefinitely in a condition they may have previously deemed intolerable. Such intervention also causes distress to staff and families and ties up resources in high demand settings. What does this paper add? That effectual AD law needs to not only enshrine the rights of in...
BackgroundApart from the ethical imperatives and improved client outcomes in support of advance care planning, a compelling argument for health care administrators is the containment of escalating health care costs in ageing communities. Advance care planning activity has repeatedly been shown to reduce hospital admissions.1–3In particular, care toward the end of life is expensive, and advance care planning reduces the use of invasive and expensive hospital treatments during terminal illness.AimTo estimate the impact of advance care planning activity on the number of hospital admissions, occupied bed days, and hospital costs in Adelaide, South Australia.MethodsWe apply the results of previous research on the impact of advance care planning,1–3to the number of advance care plans made following implementation of the Respecting Patient Choices (RPC) Program in community and hospital settings in Adelaide, to estimate the number of saved hospital admissions, occupied bed days, and costs.ResultsData records began in 2005 during The Queen Elizabeth Hospital RPC pilot. Data collection from community settings began in 2008, and then from other public hospitals in the Central and Northern Adelaide metropolitan area from 2010. A total of 2604 advance care plans were made and the estimated Occupied Bed Days saved was 23 957. The number of admissions to hospitals from the 42 Nursing Homes engaged in advance care planning was estimated to be reduced by 840 over the last 2–3 years.DiscussionSeveral assumptions are used in applying previous research to calculate the estimated hospital savings. The estimates suggest significant savings, which should be of interest to health administrators. Costs and savings will be detailed in the presentation. Further investment and evaluation of the impact of advance care planning is clearly warranted.ConclusionA relative small investment in advance care planning has the potential to reap considerable savings in hospital use, particularly at the end of life.
BackgroundAustralian States and Territories are called to align ACD legislation with common law principles. However, little is known about the functionality of different ACD frameworks when Nurses or Ambulance Officers/Paramedics attend a situation when an ACD CPR refusal might apply.AimTo construct a working picture of the different ACD legislative and policy frameworks currently operating in Australia and other countries under Westminster systems.MethodsAn ACD law, policy and outcome table was constructed summarising each jurisdictions' ACD operational parameters, who is authorised to implement ACD, and any ACD adherence research.ResultsACD operation parameters varied from: requiring a medical condition to which the refusal related; only applying in the terminal phase, to any period of incapacity nominated by the person as under common law. Policy examples under prescriptive law usually authorised all health professionals could implement ACD. Under permissive law, even with policy support, a preference for community `Not-For-CPR' medical orders was evident. There was little empirical research about ACD adherence in the context under examination.DiscussionLegislative and policy framework affects ACD scope and delivery. Most with broad ACD application parameters also used community `Not-For-CPR' orders, reverting to medical oversight. Others appeared effective in delivery but excluded some people from making ACD.ConclusionThe table illustrated a large variation between jurisdictions and that research is needed to determine whether there is a relationship between adherence to ACD CPR refusals and the type of ACD framework. This knowledge could help optimise ACD adherence and application across all settings.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.