The document outlines the importance of end-of-life decisions and advance directives in healthcare, which allow individuals to express their treatment preferences and ensure their wishes are respected when they are unable to make decisions. It describes different types of advance directives, including living wills and durable powers of attorney, and highlights their roles in alleviating family burdens and reducing conflicts during emotional times. Additionally, the document discusses case studies illustrating how advance directives guide healthcare decisions and the challenges faced in their implementation.

1. Ensuring Dignity and Autonomy in Healthcare
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End-of-Life Decisions
and
Advance Directives

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What Are End-of-Life Decisions and Advance Directives?
End-of-Life Decisions: Choices regarding care and treatment during terminal illness
or incapacity. End-of-life decisions and advance directives are critical aspects of
healthcare planning that ensure a person’s wishes are respected if they become
unable to make medical decisions for themselves
Advance Directives: Legal documents outlining healthcare preferences in advance.

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Why Are These Important?
Respect Autonomy: Ensures your wishes are honored.
Reduces Family Burden: Relieves loved ones of tough decisions.
Minimizes Conflicts: Prevents disputes during emotional times.
Enhances Quality of Life: Aligns care with personal values.
Your paragraph text
The central node represents the overarching benefits,
while the connected nodes highlight the specific
advantages.t

4. Component Description Example
Life-sustaining treatments Medical interventions to prolong life. Ventilators, dialysis, feeding tubes.
Palliative or hospice care
Focused on comfort and quality of life
rather than curative treatment.
Pain management, emotional support.
Do Not Resuscitate (DNR)
Directive to forgo CPR or advanced life
support during cardiac or respiratory
arrest.
Hospital DNR orders, home DNR bracelets.
Euthanasia (where legal)
Assisted dying under strict legal
conditions.
Physician-assisted death (e.g., in Canada,
Netherlands).
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Components of End of Life Decisions

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6. Advance Directives:
are legal documents that communicate a
person’s preferences for end-of-life care.
Formal advance directives are documents written in advance of serious illness that state your choices for health care,
or name someone to make those choices, if you become unable to make decisions.
Through advance directives, such as living wills and durable powers of attorney for health care,
you can make legally valid decisions about your future medical treatment.
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Types of Advance Directives:
1.Living Will-Specifies what kind of medical treatments or life-support measures an
individualwants or does not want. (e.g., ventilators, feeding tubes).
It is a document in which you can stipulate the kind of life-prolonging medical care you want if you become
terminally ill, permanently unconscious, or in a vegetative state and . . . • You are unable to make your own
decisions • It informs medical personnel that you do not want certain life-prolonging medical procedures if
you may die soon. • It helps your durable medical power of attorney, as well as family and loved ones,
understand your wishes. • Your durable medical power of attorney has the prerogative of overriding your
living will.

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Types of Advance Directives:
2. Durable Power of Attorney for Healthcare-Designates a trusted individual (healthcare proxy) to make
medical decisions on the person’s behalf.Vital in unexpected medical situations.
By executing a power of attorney for health care, you are authorizing someone to make health care decisions on your behalf. • It is a signed,
dated, and witnessed document naming another person to be your agent in making health care decisions when you no longer can. • Your
power of attorney for health care may ONLY make medical decisions for you • if you are unable to make them for yourself • at any time, not
just at the end of life. • It is not the same as a power of attorney for financial matters

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Types of Advance Directives:
3.POLST/MOLST (Physician/Medical Orders for Life-Sustaining Treatment)-a medical order indicating
specific treatments a person wants during a medical emergency.

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Types of Advance Directives:
4.Advance Statements of Preferences-Informal documents expressing values and priorities for care.

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Role of Nurses
Advocates: Ensure directives are honored.
Communicators: Bridge gaps between families and doctors.
Educators: Inform patients about their options.
Visual: Nurse-patient interaction.
Challenges in Implementation
Ambiguity in documents.
Conflicts with families.
Cultural and religious sensitivities.

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Case #1: Mr. Jones
Mr. Jones, a widower, is a 78-year-old terminal cancer patient. Over the last several months his health has deteriorated to the point where he is
confined to a hospital bed. Although he receives hospice care at home, including a visiting nurse, he can no longer voice coherent thoughts
about his health care. However, Mr. Jones previously made out an advance directive which names his son as a medical proxy. The advance
directive also outlines his wishes not to be kept alive via artificial means. When doctors suggest putting Mr. Jones on a ventilator to extend his
life, his son informs them that this is not what his father would have wanted. Mr. Jones passes away peacefully without the ventilator,
surrounded by his son and other loved ones.
Case #2: Mrs. Patel
Mrs. Patel is a 90-year-old woman who has still been able to drive until recently. A few weeks back, she was in a car accident which left her in a
coma. Her doctors say she can come home with a 24-7 home health aide, but the coma left her at risk for cardiac failure. Mrs. Patel’s husband
has dementia and has been declared legally incompetent.[2. “Incompetence,” https://www.law.cornell.edu/wex/incompetence] Although he is
her next-of-kin, he cannot make legal decisions for her.
However, Mrs. Patel filled out an advance directive prior to her accident, stating she wanted to be resuscitated under any circumstances—even
if there was no chance of her regaining consciousness. Before her discharge from the hospital, Mrs. Patel goes into cardiac failure. The staff
resuscitates her per her wishes, and she remains in her comatose state.
Case #3: Mr. Suarez
Mr. Suarez is a 73-year-old man who is estranged from his wife. Since he prefers that she doesn’t make any medical decisions for him should
the need arise, he has filled out an advance directive naming his daughter as his health care proxy. He has suffered from diabetes for many
years and is adamant that he does not want dialysis—even if it would sustain his life. He does, however, wish to have tube feeding for however
long it will sustain him (if necessary).
One evening while his overnight aide is caring for him, Mr. Suarez has a seizure. He is taken to the hospital immediately, but never regains
consciousness and doctors do not expect him to do so. They want to put him on dialysis (as his diabetes is worsening) and a feeding tube (as
there is no other way for him to receive nutrients). His daughter informs the doctors of her father’s end-of-life wishes. The doctors warn her
that without dialysis her father will pass away more quickly, even with the feeding tube. Mr. Suarez’s daughter says that although she is aware,
she wants them to carry out her father’s wishes. They do so and the feeding tube gives Mr. Suarez a few more days of life, though not as many
as he would have had by adding dialysis.

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End-of-Life Decisions If You or a Loved One Have Alzheimer’s or Dementia
Alzheimer’s disease and other kinds of dementia are devastating conditions that require intensive caregiving. It’s hard to predict who will get the
disease and who won’t, but when dementia starts, there’s a gradual or sudden decline in functioning, eventually leading to death.
Planning is vital to the wellbeing of you or your loved one if you or they have dementia. Consider all of the advance planning we have discussed, along
with these other decisions.
11. Where you want to live
Where to care for a person who has dementia is a huge decision. Most people would prefer to be cared for at home, but when family caregiving
becomes too stressful or unsafe, you or your loved one may need specific dementia care. That care comes at a cost. Memory care communities can
be very expensive, but so can extensive home care.
Planning end-of-life care should be based on personal preferences, but it also depends on the financial consequences of each decision. Even family
caregiving can take a financial toll on the person providing the care if they leave employment or reduce their working hours.
12. When to transition into comfort care
You or a loved one may reach the point where you can no longer make rational decisions and communicate your wishes. It’s not unusual for people
with dementia to suffer from significant mental impairment but be in relatively good health physically. On the other hand, someone may be both
mentally and physically impaired and continuing to decline. At what point do you want to stop treatment for medical problems and switch to hospice
care?
To the best of your ability, try and express in writing under what conditions you want comfort care only. By the time your condition deteriorates, it
will be too late to communicate those wishes.

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Sources
National Institute on Aging. "Advance Care Planning: Healthcare Directives." https://www.nia.nih.gov/health
American Bar Association. "Tools for Advance Directives." https://www.americanbar.org
Centers for Medicare & Medicaid Services. "Understanding POLST Forms." https://www.cms.gov
World Health Organization. "Palliative Care." https://www.who.int
Mayo Clinic. "Living Wills and Advance Directives for Medical Decisions." https://www.mayoclinic.org
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