Advance Directives
- Why does informed consent matter?
- Individuals have the right to live by their values
- Their values inform medical decision making
- They need to be informed so they can make choices that best reflect their values
- Gold standard of end of life decision making- informed choice
- Patients able to make choices based on their values when given proper information
- Don’t be too quick in assuming patient understands their options
- Silver standard of end of life decision making - advanced directives (living will, Healthcare Power of Attorney/Durable Power of Attorney)
- Living wills
- List of do and don’t wants
- Applicable if a person is unable to make decisions & permanently conscious/terminally ill
- Problems
- Narrow scope of applicability
- Lack an “agent” to assess current circumstances and make choices based on them
- DPOA/HCPOA- the real silver standard
- Designates surrogate to make decisions in event that patient cannot → broader scope of applicability
- may or may not have list of do and don’t wants
- Problems
- Designated surrogates need to properly understand, be willing and able to carry out their role
- Bronze standard of end of life decision making- non designated surrogates (unfortunately this tends to be most cases)
- Problems
- Identifying proper surrogate
- Focusing family member/loved one on surrogate’s role
- Consensus among surrogates
- Consensus among surrogates and other parties
- Some states have hierarchy in finding surrogates:
- Legal guardian
- Spouse
- Adult son/daughter or majority
- Parent
- brother/sister or majority
- Close friend
- Problem is that these people may not be the closest person/person who understand the patient most
- Fundamental role of surrogate is to help others understand the patient’s values & what the patient would have wanted if they could speak for themselves
- Use best interest standard if surrogate isn’t available and patient can’t make decisions