Advance Directives, Autonomy and Unintended Death

Abstract

This paper argues that living wills are typically nebulous and confused documents that do not effectively enable you to determine your future treatment. Worse, signing a living will can end your life in ways you never intended, long before you are either incompetent or terminally ill. This danger is compounded by the fact that those who implement living wills are often themselves dangerously confused, so that, for example, they cannot be relied upon to distinguish living wills from DNR orders. In addition, the paper argues that advance directives concerning resuscitation are often so confused that they end the lives of healthy, alert people who have not suffered cardiac or pulmonary arrest. Finally, the paper argues that advance directives establishing durable power of attorney for health care often preserve the chief dangers of living wills. Suggestions are offered as to how you can most effectively direct your future treatment without endangering your life.

Effect of Do‐Not‐Resuscitate Orders on Hospitalization of Nursing Home Residents Evaluated for Lower Respiratory Infections

“…Equally important, many clinicians who provide care for NH residents are concerned that DNR orders sometimes are broadly interpreted as orders to limit care in ways that were not clarified with the patient or the appropriate surrogate decision‐maker. Although some might argue that most, if not all, long‐term residents of NHs should receive mainly palliative care, 9 none would agree that a DNR order, designed to limit care in the most extreme circumstances, should be generalized to limit other care 10,11 …”

“…Although some might argue that most, if not all, long-term residents of NHs should receive mainly palliative care, 9 none would agree that a DNR order, designed to limit care in the most extreme circumstances, should be generalized to limit other care. 10,11 The effect of DNR orders on clinical care, including hospitalization, may be particularly relevant to care for lower respiratory infection (LRI). LRI, including pneumonia, is the leading cause of hospitalization and mortality in NH residents.…”

Approaches and reflexions on advance healthcare directives in Brazil

“…An alternative is the approach of terms called Advanced Care Planning, which expresses the preference or refusal of the patient to certain interventions, such as mechanical ventilation, parenteral nutrition and hemodialysis as care goals (32) .…”

Diretivas antecipadas de vontade: benefícios, obstáculos e limites

“…Outro ponto contencioso sobre as DAV é abordado por Stone 50 , que em seu artigo escrutina os termos nelas utilizados, colocando quão difícil é defini-los de maneira que todos os entendam igualmente. O autor relata que muitas DAV não contêm a definição ou o significado dos termos usados em sua descrição e adverte que sem uma definição de "doen ça terminal" no próprio documento a maioria dos assinantes entenderá apenas de forma vaga em que circunstâncias isso se aplica -mas, provavelmente, não terá sequer consciência de que desconhecem esse fato determinante.…”

“…Stone 50 também chama a atenção para a noção de tratamentos de suporte de vida que apenas servem para prolongar o processo de morte e contesta que isso não faz sentido. O autor advoga que, no geral, assinar uma DAV não preserva a autonomia do paciente; ao invés disso, o coloca inteiramente à mercê do médico, que decide se o paciente é competente para participar das decisões sobre seu tratamento, quanto tempo é relativamente um curto tempo e que define que tratamentos de suporte de vida são inevitáveis.…”