Importance of Advance Directives

Topics: Medical ethics, Persistent vegetative state, Health care proxy Pages: 8 (2113 words) Published: September 19, 2009
The Importance of Advance Directives

Tara J. DiDonato

Axia College of University of Phoenix

The Importance of Advance Directives

While most people do not speak about end of life issues either because of their background or religion, it is not only for the elderly, we should all make our wishes known. According to the Pew Research Center, (January 2006), “42% of Americans have had a friend or relative suffer from a terminal illness or coma in the last five years and for a majority of these people , the issue of withholding life sustaining treatment came up”. Although many people feel it is taboo, all adults over the age of 18 should think about what their healthcare wishes would be if they could not speak for themselves. These wishes should be documented in an advance directive, so that loved ones know what they are. 

Power of Communication

According to the Mayo Clinic (2005), “The issues surrounding serious illness and death are not easy to discuss. Decisions are much easier on our loved ones if we have an advance directive in place before we are faced with a serious illness or accident”. Without communicating our wishes, we might find ourselves in a condition that we are unable to communicate the medical treatment we wish to receive, such as resuscitation or life support.

Having a conversation with loved ones is important to clarify medical wishes. We should explain our wishes and explain how our values have shaped our decision.

Types of Advance Directives

According to the Mayo Clinic (2005), “Advance Directives are written instructions regarding your medical care preferences”. There are various types of advance directives, such as; a Living Will, Durable Power of Attorney, Healthcare Proxy and Do Not Resuscitate Order (DNR). Durable power of attorney and living wills have limitations, they do not include instructions for every situation, which means that we need to trust that the person we have named will make the decisions which are in our best interest and are what we would have wanted.

A DNR order is a form that is commonly discussed with a physician. A DNR order alerts physicians and emergency medical personnel that if a patient’s heart stops beating or if the patient stops breathing, there should be no attempts to revive them.

Another advance directive is a Healthcare Proxy (HCP). This document allows patients to choose an agent to act on their behalf if they are temporarily or permanently unable to make healthcare decisions on their own. According to Fell, Kukula and Taylor (2005), as with other advance directives, “it is very important to discuss, in detail, all of your wishes with your surrogate and make sure they clearly understand and are willing to make these decisions on your behalf” (p. 4).

Everyone should have a voice, not just the elderly

Advance directives are not just for the elderly, anyone over the age of 18 should have one. Unexpected situations can arise at any age and there might be end of life decisions that needs to be made.

In the event that a person does not have an advance directive in place, according to Fell, et al. (2005), “you will receive medical care to the fullest extent appropriate for your condition”. Without an advance directive the patient might receive more treatment than he or she would have wanted. The biggest misconception about an advance directive is that people think that having one means “do not treat”, this is incorrect.

Frequently used medical terms

There are many different types of medical terms used, according to the Mayo Clinic (2005), the following are the most common:

1. Resuscitation is if the patient’s heart stops beating, all efforts are made to revive them.

2. Mechanical Ventilation takes over a patient’s breathing if they cannot do so by themselves.

3. Artificial Nutrition and Hydration is fluid and nutrients through tubes and intravenous lines.

4. Persistent Vegetative State is...

References: Larson, Edward J. (2005). From Cruzan To Schiavo: Similar Bedfellows in Fact and at
Law. Constitutional Commentary, 22(3), 405-417
Fell, S.D., Kulula, C.L., Taylor, P. (2005). Advance Directives. WebMD. Retrieved June 25,
2009, from
Mayo Clinic. (2007). Living wills and advance directives: Tools for medical
wishes. Retrieved June 23, 2009, from
Pew Research Center. (2006). National Healthcare Decisions Day. Retrieved June 30, 2009,
Searight, H.R., Gafford, J. (2005). Cultural Diversity at the End of Life: Issues and Guidelines
for Family Physicians. American Family Physician, 71(3), 515 - 521.
Surrogate Decision Making: Reconcilling Ethical Theory and Clinical Practice (2008). 
Country of Publication
Yates, Jr., Ferdinand. (2005). What would Terri have said?. The Center for Bioethics and Human
Dignity. Retrieved June 18, 2009, from
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