Advance directives

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.

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. 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. Surveys show that one-third of Americans say they've had to make decisions about end-of-life care for a loved one.

The attitude of medical staff
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Papers

 * Google Scholar