178 Advanced Directives

Martha Lally; Suzanne Valentine-French; and Dinesh Ramoo

Advanced care planning (ACP) refers to all documents that pertain to end-of-life care. These include advance directives and medical orders. Advance directives include documents that mention a health care agent and living wills. These are initiated by the patient. Living wills are written or video statements that outline the health care initiates the person wishes under certain circumstances. Durable power of attorney for health care names the person who should make health care decisions in the event that the patient is incapacitated. In contrast, medical orders are crafted by a medical professional on behalf of a seriously ill patient. Unlike advanced directives, as these are doctor’s orders, they must be followed by other medical personnel. Medical orders include Physician Orders for Life-sustaining Treatment (POLST), do-not-resuscitate, do- not-incubate, or do-not-hospitalize. In some instances, medical orders may be limited to the facility in which they were written. Several states have endorsed POLST so that they are applicable across heath care settings (IOM, 2015).

ACP in Canada commissioned a national poll in 2021 where Canadians were asked about their end-of-life care planning. They found that between 2019 and 2021, 59%  talked to their family members about this issue compared to 36% in 2019. 77% of Canadians felt that it’s important to talk to their health care providers about their wishes. 70% felt comfortable having ACPs.

Refusal of treatment form with a pair of glasses on top
Figure 10.7: Living wills help identify what treatments are acceptable to the patient or which are refused.


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Advanced Directives by Martha Lally; Suzanne Valentine-French; and Dinesh Ramoo is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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