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Lecture for 4th year medical students Salman bin Abdulaziz University Kharj on May 14, 2013 by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard)
ADVANCE STATEMENT
In an advance statement, a competent adult gives instructions about what will be done if they lose competence in the future. An advance statement can cover: refusal of treatment, request for treatment, wishes, and naming a proxy decision maker. An advance directive is a form of an advance statement.
ADVANTAGES OF AN ADVANCE STATEMENT
The living will has the following advantages: (a) reassuring the patient that terminal care will be carried out as he or she desires (b) provide guidance and legal protection and thus relieve the physicians of the burden of decision making and legal liabilities (c) relieve the family of the mental stress involved in making decisions about terminal care.
DISADVANTAGES OF AN ADVANCE STATEMENT
The disadvantage of a living will is that it may not anticipate all developments of the future thus limiting the options available to the physicians and the family.
FORMAT OF AN ADVANCE STATEMENT
The advance statement is part of the medical record. It should have the full name and address of the patient. It should also document advice and information given by the healthcare providers before the statement was made. It should have a clear statement of the wishes of the patient. It must be signed and dated. The making of an advance statement must be witnessed. Usually healthcare providers act as witnesses. They should make sure that the patient is competent before witnessing the statement.
LIMITATIONS OF ADVANCE STATEMENTS
Patients cannot authorize in their advance statements illegal procedures such as euthanasia or treatments that are considered futile. They also cannot refuse basic care such as pain relief. Some patients leave advance directives not to be resuscitated after attempting suicide; such directives are not honored because suicide is an illegal act.
ADVANCE DIRECTIVE
The term advance directive is usually used for an advance statement involving refusal of treatment. An advance refusal of treatment is legally binding under the following conditions: the patient was competent at the time of making the directive, the patient received all pertinent information and explanation, the patient made the directive voluntarily with no undue pressure, and the circumstances on which a decision is to be made are like those envisaged by the patient at the time of making the advance directive.
Advance directives by children are not legally binding.
An advance refusal of treatment can be valid if made orally provided it was witnessed.
An advance directive by a pregnant woman refusing procedures that are in the best interests of the fetus is not valid according to principles of Islamic Law but can be valid in other jurisdictions.
Advance directives refusing nutrition for people on hunger strikes are respected if they are competent adults.
POWER OF ATTORNEY
The device of the power of attorney can be used instead of the living will or advance directive. Decision by a proxy can work in two ways: (a) decide what the patient would have decided if able (b) decide in the best interests of the patient.
ADVANCE STATEMENT IN PROGRESSIVE NEUROLOGICAL CONDITIONS
Advance statements are especially useful in dealing with progressive neurological conditions. The downward course of such conditions is accurately predictable and provides an opportunity for patients to retain autonomy by making decisions about their future care while they are still competent.
ADVANCE STATEMENT
In an advance statement, a competent adult gives instructions about what will be done if they lose competence in the future. An advance statement can cover: refusal of treatment, request for treatment, wishes, and naming a proxy decision maker. An advance directive is a form of an advance statement.
ADVANTAGES OF AN ADVANCE STATEMENT
The living will has the following advantages: (a) reassuring the patient that terminal care will be carried out as he or she desires (b) provide guidance and legal protection and thus relieve the physicians of the burden of decision making and legal liabilities (c) relieve the family of the mental stress involved in making decisions about terminal care.
DISADVANTAGES OF AN ADVANCE STATEMENT
The disadvantage of a living will is that it may not anticipate all developments of the future thus limiting the options available to the physicians and the family.
FORMAT OF AN ADVANCE STATEMENT
The advance statement is part of the medical record. It should have the full name and address of the patient. It should also document advice and information given by the healthcare providers before the statement was made. It should have a clear statement of the wishes of the patient. It must be signed and dated. The making of an advance statement must be witnessed. Usually healthcare providers act as witnesses. They should make sure that the patient is competent before witnessing the statement.
LIMITATIONS OF ADVANCE STATEMENTS
Patients cannot authorize in their advance statements illegal procedures such as euthanasia or treatments that are considered futile. They also cannot refuse basic care such as pain relief. Some patients leave advance directives not to be resuscitated after attempting suicide; such directives are not honored because suicide is an illegal act.
ADVANCE DIRECTIVE
The term advance directive is usually used for an advance statement involving refusal of treatment. An advance refusal of treatment is legally binding under the following conditions: the patient was competent at the time of making the directive, the patient received all pertinent information and explanation, the patient made the directive voluntarily with no undue pressure, and the circumstances on which a decision is to be made are like those envisaged by the patient at the time of making the advance directive.
Advance directives by children are not legally binding.
An advance refusal of treatment can be valid if made orally provided it was witnessed.
An advance directive by a pregnant woman refusing procedures that are in the best interests of the fetus is not valid according to principles of Islamic Law but can be valid in other jurisdictions.
Advance directives refusing nutrition for people on hunger strikes are respected if they are competent adults.
POWER OF ATTORNEY
The device of the power of attorney can be used instead of the living will or advance directive. Decision by a proxy can work in two ways: (a) decide what the patient would have decided if able (b) decide in the best interests of the patient.
ADVANCE STATEMENT IN PROGRESSIVE NEUROLOGICAL CONDITIONS
Advance statements are especially useful in dealing with progressive neurological conditions. The downward course of such conditions is accurately predictable and provides an opportunity for patients to retain autonomy by making decisions about their future care while they are still competent.