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Advance directives are directions, usually in the form of documents, given by people regarding their their wishes about their future medical care should they become incapacitated. A living will, also called will to live, is one type of advance health directive, or advance health care directive. It is often accompanied by a specific type of power of attorney or health care proxy. These are legal instruments that are usually witnessed or notarized.

  • A living will usually covers specific directives as to the course of treatment that is to be taken by caregivers, or, in particular, in some cases forbidding treatment and sometimes also food and water, should the principal be unable to give informed consent ("individual health care instruction") due to incapacity.
  • A power of attorney for health care appoints an individual (a proxy) to direct health care decisions should the principal be unable to do so.
Refusal of treatment form

Refusal of treatment form

As the name suggests, the term "will to live", as opposed to the other terms, tends to emphasize the wish to live as long as possible rather than refusing treatment in the case of serious conditions.

In the Netherlands, patients and potential patients can specify the circumstances under which they would want euthanasia for themselves. They do this by providing a written euthanasia directive. This helps establish the previously expressed wish of the patient even if the patient is no longer able to communicate. However, it is only one of the factors that is taken into account. Apart from the will in writing of the patients, at least two physicians, the second being totally unrelated to the first physician in a professional matter (e.g. working in another hospital, no prior knowlegde of the medical case at hand), have to agree that the patient is terminally ill and that no hope for recovery exists.

In Switzerland, there are several organizations which take care of registering patient decrees, forms which are signed by the patients declaring that in case of permanent loss of judgment (e.g., inability to communicate or severe brain damage) all means of prolonging life shall be stopped. Family members and these organizations also keep proxies which entitle its holder to enforce such patient decrees. Establishing such decrees is relatively uncomplicated.

In the United States, most states recognize living wills or the designation of a health care proxy.[1] However, a "report card" issued by the [Robert Wood Johnson Foundation in 2002 concluded that only seven states deserved an "A" for meeting the standards of the model Uniform Rights of the Terminally Ill Act.[2] Surveys show that one-third of Americans say they've had to make decisions about end-of-life care for a loved one.[3]

Psychological aspects

=Psychological considerations when producing an advance directive

The family's perspective

The attitude of medical staff


See also

References & Bibliography

Key texts

Books

Papers

  • Optimal use of orders not to intervene and advance directives. (1998).): Psychology, Public Policy, and Law Vol 4(3) Sep 1998, 668-675.
  • Alexander, G. J. (1998). Durable powers of attorney as a substitute for conservatorship: Lessons for advance directives: Psychology, Public Policy, and Law Vol 4(3) Sep 1998, 653-667.
  • Allen, R. S., DeLaine, S. R., Chaplin, W. F., Marson, D. C., Bourgeois, M. S., Dijkstra, K., et al. (2003). Advance care planning in nursing homes: Correlates of capacity and possession of advance directives: The Gerontologist Vol 43(3) Jun 2003, 309-317.
  • Alpert, H. R., Hoijtink, H., Fischer, G. S., & Emanuel, L. (1996). Psychometric analysis of an advance directive: Medical Care Vol 34(10) Oct 1996, 1057-1065.
  • Amering, M., Denk, E., Griengl, H., Sibitz, I., & Stastny, P. (1999). Psychiatric wills of mental health professionals: A survey of opinions regarding advance directives in psychiatry: Social Psychiatry and Psychiatric Epidemiology Vol 34(1) Jan 1999, 30-43.
  • Amering, M., Stastny, P., & Hopper, K. (2005). "Advance directives and advance agreements": Reply: British Journal of Psychiatry Vol 187(4) Oct 2005, 388-389.
  • Amering, M., Stastny, P., & Hopper, K. (2005). Psychiatric advance directives: Qualitative study of informed deliberations by mental health service users: British Journal of Psychiatry Vol 186(3) Mar 2005, 247-252.
  • Appelbaum, P. S. (2004). Psychiatric Advance Directives and the Treatment of Committed Patients: Psychiatric Services Vol 55(7) Jul 2004, 751-752, 763.
  • Appelbaum, P. S. (2005). Advance Directives: Stigma Strikes Again: Psychiatric Services Vol 56(5) May 2005, 515.
  • Appelbaum, P. S. (2006). Commentary: Psychiatric advance directives at a crossroads--When can PADs be overridden? : Journal of the American Academy of Psychiatry and the Law Vol 34(3) Sep 2006, 395-397.
  • Appelbaum, P. S., & Goldman, H. H. (2005). In Reply: Psychiatric Services Vol 56(7) Jul 2005, 875.
  • Aronson, S. G., & Kirby, R. W. (2002). Improving Knowledge and Communication Through an Advance Directives Objective Structured Clinical Examination: Journal of Palliative Medicine Vol 5(6) Dec 2002, 916-919.
  • Atkinson, J. M. (2004). Ulysses' crew or Circe? - The implications of directives in mental health for psychiatrists: Psychiatric Bulletin Vol 28(1) Jan 2004, 3-4.
  • Atkinson, J. M., & Garner, H. C. (2003). Advance directives in mental health: Psychiatric Bulletin Vol 27(11) Nov 2003, 437.
  • Atkinson, J. M., Garner, H. C., & Gilmour, W. H. (2004). Models of advance directives in mental health care: Stakeholder views: Social Psychiatry and Psychiatric Epidemiology Vol 39(8) Aug 2004, 667-672.
  • Atkinson, J. M., Garner, H. C., Patrick, H., & Stuart, S. (2003). Issues in the development of advance directives in mental health care: Journal of Mental Health Vol 12(5) Oct 2003, 463-474.
  • Backlar, P. (1995). The longing for order: Oregon's Medical Advance Directive for Mental Health Treatment: Community Mental Health Journal Vol 31(2) Apr 1995, 103-108.
  • Backlar, P. (1997). Ethics in community mental health care: Anticipatory planning for psychiatric treatment is not quite the same as planning for end-of-life care: Community Mental Health Journal Vol 33(4) Aug 1997, 261-268.
  • Backlar, P. (1998). Advance directives for subjects of research who have fluctuating cognitive impairments due to psychotic disorders (such as schizophrenia): Community Mental Health Journal Vol 34(3) Jun 1998, 229-240.
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  • Backlar, P. (2004). Anticipatory Planning for Psychiatric Treatment: Liberty or Limitation for our Future Life Plans? : Journal of Forensic Psychology Practice Vol 4(4) 2004, 83-96.
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  • Backlar, P., & McFarland, B. H. (1998). Oregon's advance directive for mental health treatment: Implications for policy: Administration and Policy in Mental Health Vol 25(6) Jul 1998, 609-618.
  • Backlar, P., McFarland, B. H., & Mahler, J. (2002). "Can I plan now for the mental treatment I would want if I were in crisis?" Oregon's psychiatric advance directive. New York, NY: Kluwer Academic/Plenum Publishers.
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  • Briggs, L. (2004). Shifting the Focus of Advance Care Planning: Using an In-depth Interview to Build and Strengthen Relationships: Journal of Palliative Medicine Vol 7(2) Apr 2004, 341-349.
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