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Results for “Advance Directive Adherence”

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PubMed1992

Adding constitutional depravation to untimely death: South Dakota's living will pregnancy provision.

In 1991, the South Dakota Legislature enacted a living will statute. Included is a pregnancy provision that prevents pregnant women from obtaining the full benefit of the statute. A South Dakota Attorney General's opinion was released discussing the conflict of laws problems posed by the statute. That opinion, however, did not address the more important question of the constitutionality of the pregnancy provision. This comment analyzes the pregnancy provision under the Due Process, Equal Protection, and the Establishment Clauses and concludes that South Dakota's pregnancy provision is unconstitutional under all three doctrines.

Abortion, Induced↗
PubMedDate not supplied

Whether no means no.

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Acquired Immunodeficiency Syndrome↗
PubMed2005

Respecting end-of-life treatment preferences.

Most patients eventually must face the process of planning for their future medical care. However, few Americans have a living will or a durable power of attorney for health care. Although advance directives provide a legal basis for physicians to carry out treatment using a health care proxy or a living will, they also should reflect the patient's values and preferences. Family physicians are in a position to integrate medical knowledge, individual values, and cultural influences into end-of-life care. Family physicians can best respect the autonomy of patients by allowing the patient and family to prospectively identify relevant health care preferences, by sustaining an ongoing discussion about end-of-life preferences, and by abiding by the decisions their patients have made.

Advance Care Planning↗
PubMed2005

End-of-life care in acute care hospitals in Canada: a quality finish?

Understanding patients' and family members' perspectives on the relative importance of elements of end-of-life (EOL) care and their satisfaction with those elements will help prioritize quality improvement initiatives. We administered a face-to-face questionnaire containing a selection of 28 elements of care to eligible inpatients with advanced lung, heart, or liver disease, or metastatic cancer, and available family caregivers (FCGs) in five tertiary care hospitals across Canada. 440 of 569 (78%) eligible patients and 160 of 176 (91%) FCGs participated. No respondent reported complete satisfaction with all elements of care. The average satisfaction score was 4.6 on a 26 point scale. Medical patients reported lower levels of satisfaction than cancer patients. Elements rated as "extremely important" and anything other than "completely satisfied" most frequently by respondents related to discharge planning, availability of home health services, symptom relief, not being a burden, physician trust, and communication. In conclusion, most patients and their family members in our survey were not completely satisfied with EOL care. Improvement initiatives to target key elements identified by patients and FCGs have the potential to improve satisfaction with EOL care across care settings.

Advance Directive Adherence↗
PubMed2005

Critical care physicians' practices and attitudes and applicable statutes regarding withdrawal of life-sustaining therapies.

OBJECTIVE: To describe intensivist-educators' practices and opinions regarding the withdrawal of life-sustaining therapies, and to juxtapose these with applicable end-of-life statutes. METHODS: A questionnaire was sent to critical care program directors in Connecticut, New York, Illinois, California, Florida and Texas (to examine regional variability). Statutes regarding end-of-life care were ascertained for these states. RESULTS: Sixty-eight of 128 queried intensivists responded to the questionnaire. They reported having withdrawn life-sustaining therapies to a median of 28 patients in the previous year. Overall, respondents answered that of patients in whom they had withdrawn life-sustaining therapies, 55% were terminal, 20.5% weren't necessarily terminal but advance directives were applied to the situation and 22% weren't necessarily terminal but families requested withdrawal. The ranges of responses were highly variable (ranging from 5%-100% patients deemed terminal). All respondents agreed that withdrawal should be allowed in non-terminal conditions in which the likelihood or quality of survival would be unacceptable to the patient. Forty-eight respondents answered that advanced Alzheimer's Disease qualifies as a terminal illness. Connecticut's end-of-life statutes were unlike those in the five other states that allowed withdrawal of life-sustaining therapies based on advance directives and/or surrogates' consent. Practices of Connecticut respondents were similar to other sampled states. CONCLUSIONS: These data suggest that Connecticut's statutes requiring that patients be deemed terminal (or permanently unconscious) before withdrawal of care are dissimilar from those in several other states. Connecticut intensivists who responded to our survey appear to practice end-of-life care that is similar to practices elsewhere.

Advance Directive Adherence↗
PubMed1998

Withdrawal from dialysis: ethical issues.

Since 1991, death following withdrawal from dialysis has increased greatly in our dialysis unit. This report is based on our observations of those patients who followed that course. Four types of patients who withdrew from dialysis were identified: those with a terminal illness, demented patients, those with a progressive disability, and those who had no serious medical problem other than end-stage renal failure. We analyzed the risk factors for withdrawal and attempted to define the ethical principles involved in each patient category. The authors conclude that although the decision of a competent patient to stop dialysis must be honored, some of those deaths might be preventable if patients on chronic dialysis are prospectively followed and treated by those who are expert in the behavior of patients with chronic illness.

Activities of Daily Living↗
PubMed2001

In re Duran.

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Adult↗