PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Advance Directive Adherence”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

Determining the relationship between end-of-life decisions expressed in advance directives and resuscitation efforts during cardiopulmonary resuscitation.

In recent years, there has been an increased focus on end-of-life decisions and the use of medical technology. It is not well documented in the literature whether or not and to what extent patients' advance directives are used for directing resuscitative efforts. The purpose of this study was to determine how useful patients' advance directives were to members of the health care team in determining treatment and end-of-life decisions among patients who received cardiopulmonary resuscitation (CPR) efforts. Medical records of 135 adult patients who had undergone CPR efforts within the previous year were reviewed to determine if and to what extent advance directives were useful in directing end-of-life care and treatment decisions. Only 35 of these patients had advance directives. Three categories for advance directives emerged: those that were "independently directive," those that were "vague and required further clarification," and those that were "nondirective." Information from this study may be used to clarify treatment options for end-of-life care and to determine if and what further interventions are required to ensure that advance directives can be executed as meaningful documents.

Advance Directive Adherence↗
PubMed1999

Advanced directives, the right to die and the common law: recent problems with blood transfusions.

The Australian common law suffers from a lack of judicial authority on the right to die, in particular the right of patients to make anticipatory decisions to refuse treatment. Recent cases concerning the right of patients to refuse life-saving blood transfusions have highlighted the need for a substantial judicial clarification of this area. This article critically examines one of the most recent Australian cases in detail and compares its approach with those from other common countries. After taking this comparative analysis the article puts forth a common law model of anticipatory decision-making and examines how that model might work in the context of current legislative frameworks.

Advance Directive Adherence↗
PubMed1998

Foreword: planning for the future through advance directive instruments.

The Foreword traces the development of advance directive instruments and discusses their legal enforceability and many benefits. Despite their advantages, advance directives remain underused and are frequently ignored by service providers. The contributors to this special issue discuss why this is so and offer and debate a variety of remedial proposals. They analyze the various legal, clinical, ethical, and practical issues presented by the use of advance directives for health and mental health care and examine new directions in their application. The Foreword describes the organization of this special issue, summarizes the articles it contains, and comments on their significance.

Advance Care Planning↗
PubMed1998

Personhood, patienthood, and clinical practice: reassessing advance directives.

This article considers 2 major critiques of advance directives and offers a defense to each of them. The 1st critique is philosophical in nature and maintains that the moral authority of an advance directive is undercut by a failure of personal identity to survive the loss of decisional capacity. The response in this article is that this critique relies on a flawed and disfavored concept of persons and their persistence over time. The 2nd critique, pragmatic in nature, argues that advance directives cannot be authoritative because the requisite elements of an informed consent to or refusal of treatment are rarely present, and many such instruments are ambiguous. The author argues that if the creation of advance directives, as a form of advance care planning, is made an integral aspect of clinical practice, many more patients will elect to execute directives, and those directives will not be ambiguous.

Advance Care Planning↗
PubMed1998

Optimal use of orders not to intervene and advance directives.

More rigorous efforts in advance care planning are required in order to tailor end-of-life care to the preferences of patients so that they can experience a satisfactory last chapter of their lives. There is need for better availability and tracking of advance directives, and more uniform adoption of form documents that can be honored in every state. The discouraging evidence of inadequate end-of-life decision making indicates the necessity of several improvement strategies. In response to this need, the Council on Ethical and Judicial Affairs of the American Medical Association has examined this issue again and presents the following report and recommendations.

Advance Care Planning↗
PubMed1998

Advance directives for psychiatric care: a theoretical and practical overview for legal professionals.

An advance directive for psychiatric care is a legally enforceable document that specifies the manner in which psychiatric treatment decisions are to be made in the event that a person later becomes incompetent to make informed health care decisions. Although the concept of psychiatric advance directives has gained considerable popularity in recent years, the groundswell of interest in these instruments largely precedes the development of a coherent body of governing law. Existing state statutes and case law provide significant legal authority for the use and enforcement of advance directives in psychiatric settings, but serious questions remain concerning the scope of their enforceability, particularly in the context of involuntary treatment.

Advance Directive Adherence↗
PubMed2003

The disutility of advance directives: we know the problems, but are there solutions?

Advance directives (ADs) are recognized in some form by the laws of every state. Despite the availability of ADs for more than twenty years, few adults have completed any type of AD document. Even when ADs are validly executed, physicians routinelyfail to honor patients' wishes. The lack of communication between physicians and patients may be the primary reason why AD completion rates remain so low. The failure to honor an AD may stem from the physician's belief that to honor a directive would not be in the patient's best interest. The adoption and enforcement by all states of the Uniform Health-Care Decisions Act, recognition of a physician's ethical duty to assist patients in AD formulation, and routine third-party payor reimbursement to physicians for their role in patients' advance care planning will encourage and facilitate the completion and subsequent honoring of patients' directives.

Adult↗
PubMed1992

How strictly do dialysis patients want their advance directives followed?

OBJECTIVE: The Cruzan case and the Patient Self-Determination Act will encourage patients to specify in advance which life-sustaining treatments they would want if they become mentally incompetent. However, strictly following such advance directives may not always be in a patient's best interests. We sought to determine whether patients differ in how strictly they want advance directives followed. DESIGN: Interview study. SETTING: Seven outpatient chronic dialysis centers. PARTICIPANTS: One hundred fifty mentally competent dialysis patients. INTERVENTION: Using a structured questionnaire, we asked the subjects whether they would want dialysis continued or stopped if they developed advanced Alzheimer's disease. We then asked how much leeway their physician and surrogate should have to override that advance directive if overriding were in their best interests. Subjects granting leeway were also asked what factors should be considered in making decisions for them. RESULTS: Subjects varied greatly in how much leeway they would give surrogates to override their advance directives: "no leeway" (39%), "a little leeway" (19%), "a lot of leeway" (11%), and "complete leeway" (31%). Subjects also varied in how much they wanted various factors considered in making decisions, such as pain or suffering, quality of life, possibility of a new treatment, indignity caused by continued treatment, financial impact of treatment on family members, and religious beliefs. CONCLUSIONS: Strictly following all advance directives may not truly reflect patients' preferences. To improve advance directives, we recommend that physicians explicitly ask patients how strictly they want their advance directives followed and what factors they want considered in making decisions.

Adolescent↗