No Advance 9053900678 Chandigarh Call Girls , Indian Call Girls For Full Ni...
Advance Care Planning & Advance Healthcare Directives with People with Dementia
1. ADVANCE CARE PLANNING & ADVANCE
HEALTHCARE DIRECTIVES WITH PEOPLE
WITH DEMENTIA
Deirdre Shanagher, Marie Lynch, Dr John Weafer, Prof
Willie Molloy, Dr Sharon Beatty, Dr Geraldine McCarthy, Patricia
Rickard-Clarke, Emer Begley, Esther Beck, Sarah Murphy
2nd Annual SPHeRE Network Conference, February, 2016
2. Today:
• Background to development of document
• 4 Key considerations to inform good practice
• Advance care planning
• Advance healthcare directives
6. Background to Development:
Draft Guidance Prepared
External consultation Final version published
Systematic Literature Reviews
EAG consensus on themes
Themes informed key considerations &
Guidance
Oversight from Project Advisory
GroupEstablishment of Expert Advisory Group (EAG)
7. Guidance Document 2
The four key considerations to inform good practice are as
follows:
1. Develop understanding of dementia
2. Recognise that under Human rights legislation everyone has the
right to make their own decisions.
3. Develop understanding of advance care planning
4. Become familiar with aspects of the Assisted Decision Making
(Capacity) Act 2015, specifically in relation to:
• The Functional approach to capacity
• Advance healthcare directives
8. Functional Approach to Capacity:
• Presumption of Capacity
• Understand
• Retain
• Weigh
• Communicate
9. Advance Healthcare Directives:
• A document where a person can write down what they
would like to happen in relation to certain medical care
treatments
• Only comes into force when a person loses capacity,
becomes ill and the circumstances in their advance
healthcare directive arise. (A record of advance healthcare directives will
be held by the Director of Decision Support Services).
10. Issues that may be covered in an advance
healthcare directive
• Treatments that a person would refuse in the future – this is legally
binding
• A request for a specific treatment. This is not legally binding but must be taken
into consideration during any decision-making process which relates to treatment for the
person in question if that specific treatment is relevant to the medical condition for which
the person may require treatment.
11. Three areas of guidance:
• Advance care panning and advance healthcare directives:
• For People with dementia
• For family members
• For healthcare professionals
12.
13. Guidance for Healthcare Professionals:
If Decision-making capacity is an issue:
1. Support the person to be involved in the decision-making process by
engaging in capacity building and maximising.
2. Consider the level of support that the person requires to make the decision
in question.
3. Seek evidence of previously expressed preferences.
4. Consider which option, including not to treat, would be least restrictive of the
person’s future choices.
5. Consider the views of anyone indicated by the person. These people may be
those appointed by the person to support them when making decisions.
6. A Consider involving advocacy support.
If there is nobody appointed by the person whose decision making capacity is at
issue and/or an urgent decision is required, an application can be brought to the
circuit court seeking the appointment of one or more persons to act as a decision
making representative.
15. Acknowledgements
Thank you and
Questions
For more information:
Deirdre Shanagher
Deirdre.shanagher@hospicefoundation.ie
People with dementia and carers who have
contributed and advised IHF
IHF Changing Minds Team
Project and Expert Advisory and Governance
Groups
Atlantic Philanthropies
Editor's Notes
The number of people living with dementia is rising continuously as people are living longer with more chronic illnesses to include dementia.
By 2046 within Ireland alone the number of people with dementia will have increased by over 170%! Doubling in the next ten years and trebling in the next 30 years.
From a policy point of view, the need for a palliative approach in the care of people with illnesses other than cancer has been recognised in Ireland since 2001 with many reports to include the PCFA report in 2008 and more recently the National Dementia Strategy in 2014 particularly emphasising the need for a palliative care approach for people with dementia
People with dementia have unique care needs
Long illness trajectory combined with diminishing capacity
May be complicated with responsive behaviours and communication difficulties
Compounded by professionals lacking skills and PWD not being referred to SPC teams
Course of a person’s illness may be punctuated by episodes of confusion, hallucinations and delusions and possible personality and / or behavioural changes
Recognising dementia’s terminal nature has been associated with greater comfort for pts dying with dementia
All of this coinciding with the legislation on Assisted Decision Making that impacts on the PWD and all those that care for them
The programme of work was overseen by a project advisory group, made up of healthcare professionals, a lawyer, researchers and a representative from ASI. 2 people with dementia provided feedback on a draft of the document.
A systematic literature review took place and was informed by 4 other literature reviews about advance care planning, advance care planning, communication and dementia people with intellectual disabilities and dementia and those with young onset dementia.
The themes from the literature review were presided over by the expert advisory group and consensus was gained on the key considerations and guidance based on the literature.
Finally a draft document was prepared and will be going for public consultation middle/end of March???
Progressive, staff need to respond appropriately when opportunities arise
The Universal Declaration on Bioethics and Human Rights (2005) addresses the right of a person to consent to and to refuse medical treatment. United Nations Convention on the Rights of Persons with Disabilities (2006) called on countries to facilitate people with disabilities to exercise their right to make choices and express preferences in relation to their care on a similar basis equal to those who do not have any disability . Council of Europe Recommendations: Self determination and to protect the rights of older people. Constitution of Ireland right of people to decide for themselves and bodily integrity when a person does not have the capacity to consent the intervention may only be carried out with the authorisation of his or her representative, an authority or a person or body provided by law, a person has the right to make decisions (even unwise decisions) on their own behalf and is assumed to have capacity to do this unless proven otherwise. The responsibility for proving otherwise rests with the person challenging capacity.
The Health Service Executive National Consent Policy clearly states that advance care planning is a process of discussion. A person can choose to or not to engage with this
A person can refuse treatment up to and including life-sustaining treatments but cannot refuse what is termed “basic care”. The legislation on advance healthcare directives defines basic care as including, (but is not limited to), warmth, shelter, oral nutrition, oral hydration and hygiene measures but does not include artificial nutrition or artificial hydration (which would be termed as medical treatment) (6). A person has the legal right to refuse life-sustaining treatment in an advance healthcare directive even if it means that their life is at risk. This promotes individual autonomy and respect for a person’s will and preferences. A healthcare professional will be obliged to follow a person’s valid advance healthcare directive even if he/she disagrees with such decision.
Minister for Health will be appointing a multi-disciplinary Working Group to make recommendations for a code of practice specifically for the guidance of designated healthcare representatives and healthcare professionals.. The Director of the Decision Support Service has the function of preparing and publishing the code of practice when finalised.
The difference between an ACP and AHD is the refusal and legal binding with refusing treatments.
The final product is a full document and a 2 page factsheet that was designed to be accessible by healthcare staff so it can be hung on clinic room walls as a prompt.
I’d like to acknowledge these people and will now take some questions if there are any.