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 healthcare agent and living wills. These are initiated by the patient. Living wills are written or video statements that outline the healthcare initiates the person wishes under certain circumstances. Durable power of attorney for healthcare names the person who should make healthcare 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 US states have endorsed POLST so that they are applicable across heath care settings (Institute of Medicine, 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 percent talked to their family members about this issue, compared to 36 percent in 2019. Seventy-seven percent of Canadians felt that it’s important to talk to their healthcare providers about their wishes, and 70 percent felt comfortable having ACPs.

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

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Advanced Directives Copyright © 2022 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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