End of Life Care Decisions

Advanced directive

  • Aka: personal directive, living will, power of attorney for personal care
  • This is a legal document
  • Created by a capable/competent individual (understand treatment options, consequences, etc)
  • Not put into effect until individual is incapable/incompetent
  • Contains a proxy directive (designates someone who will undertake the individual’s decision making should that individual be unable to do so themselves) and an instruction directive (outlines personal care choices an individual would choose in particular circumstances)
  • More than one proxy may be designated, however it should be specified whether they are to act as a group or individually
  • In Alberta, Canada, there is a legislation recognizing advanced directives (Personal Directives Act)

Power of attorney of property

  • This is a legal document
  • Created by a capable/competent individual (understand treatment options, consequences, etc)
  • Not put into effect until individual is incapable/incompetent
  • Designates who will make financial decisions on the individual’s behalf



 

Life sustaining treatments

  • CPR
  • Defibrillation
  • Intubation and Ventilation (i.e. ventilator)
  • Dialysis
  • Life sustaining surgery
  • Blood transfusions
  • Antibiotics
  • Tube feeding

Do Not Resuscitate order

  • Legal document instructing medical professionals not to intervene in situations of medical crisis (cardiac or respiratory arrest)
  • DNR orders can be prepared by the patient, or should they be incapacitated, their proxy
  • In cases where the patient is unable to make this decision (i.e. deemed incompetent) and does not have an advanced directive, for the most part the decision is a collective one between physicians and other medical professionals, the patient’s family, and possibly an ethicist. There is no clear legislation on this.
  • Patients can change their mind about their decision (so long as they remain competent to do so)

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