Leah L. Markley
Health Rights and Responsibilities
March 25, 2011
Advance Directives: Patient End-of-Life Decisions
Medical technology today has come a long way. Numerous life prolonging procedures are available that can extend a person’s life where once they would have expired. Kidney dialysis, chemotherapy, cardiopulmonary resuscitation (CPR), feeding tubes, intravenous hydration, and ventilators are but a few of these means for extending one’s life. The choice between quantity versus quality of life is complex, and not one that should be left up to chance. In 1990, Congress passed the Patient Self-Determination Act (PSDA). According to the American Cancer Society (2009), the PSDA “encourages everyone to decide now about the types and extent of medical care they want to accept or refuse if they become unable to make those decisions due to illness. The PSDA requires all health care agencies to recognize the living will and durable power of attorney for health care.” Advance directives are a means by which an individual can provide their own unique instructions for their medical care should they become unable to do so for themselves.
Advance Directives Defined
According to Medline (2011), “Advance directives are legal documents that allow you to convey your decisions about end-of-life care ahead of time. They provide a way for you to communicate your wishes to family, friends and health care professionals, and to avoid confusion later on.” Legal requirements vary from state to state as to what is included, whether or not witnesses are necessary, and what can be designated. It is best that these documents be drawn prior to becoming ill or incapacitated so that there are limited questions as to how to handle one’s care. Three different types of advance directives for medical care are available. First, a living will allows you to make specific decisions about your health care if you become terminally ill or medically unable to make your own decisions. Second, the durable power of attorney for health care or health care power of attorney allows you to designate someone to make health care decisions for you based on what he/she thinks you would want if you are unable to make those decisions for yourself. Third, the Uniform Anatomical Gift Act (UAGA) allows for decisions on whether or not to donate organs and/or tissues. Any or all of these documents can be used depending on the laws for the state in which you reside.
Legal and Ethical Issues
A number of legal and ethical issues exist when the concept of what exactly constitutes death is applied. Traditionally, death legally occurs when cardiac function has stopped and cannot be restored. However, with the advances in medicine, the concept of brain death has gained popularity in some countries. If the brain has stopped functioning and it is considered irreversible, it is widely accepted that the person is dead. According to Fremgen (2009), the Universal Determination of Death Act (UDDA) was approved by a number of legal and medical agencies, and adopted by many states. It states that “An individual, who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” Many groups feel that brain death alone is not sufficient for declaring that death has actually occurred. Both legal and ethical concerns arise from pulling the proverbial plug on a brain dead individual who is being kept alive by artificial means. For many individuals, the idea of being kept alive mechanically is abhorrent. If a person has stated via a living will that they do not wish to be kept in such a state, it becomes an ethical dilemma for the physician and at times, the family of the individual.
In the healthcare profession, ethics and law...