Advance healthcare directive
An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. In the U.S. it has a legal status in itself, whereas in some countries it is legally persuasive without being a legal document.
A living will is one form of advance directive, leaving instructions for treatment. Another form is a specific type of power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf when they are incapacitated. People are often encouraged to complete both documents to provide comprehensive guidance regarding their care, although they may be combined into a single form. An example of combination documents includes the Five Wishes in the United States. The term living will is also the commonly recognised vernacular in many countries, especially the U.K.[1]
Background[edit]
Advance directives were created in response to the increasing sophistication and prevalence of medical technology.[2][3] Numerous studies have documented critical deficits in the medical care of the dying; it has been found to be unnecessarily prolonged,[4] painful,[5] expensive,[6][7] and emotionally burdensome to both patients and their families.[8][9]
Worldwide[edit]
Australia[edit]
The laws regarding advance directives, powers of attorney, and enduring guardianships vary from state to state. In Queensland, for example, the concept of an advance health directive is defined in the Powers of attorney act of 1998 and Guardianship and Administration act of 2000.[48] Tasmania has no specific legislation concerning advance healthcare directives.[49] Advance Care Planning (ACP) has been gaining prominence in Australia for its role in enhancing a patient's autonomy and as an important component of good end-of-life care.[50]
Canada[edit]
Health Canada – Canada's federal health agency – has acknowledged the need for a greater investment in palliative and hospice care as the country faces a rapidly growing population of elderly and terminally ill citizens.[51]
Much of the current focus in Canada is on advance care planning which involves encouraging individuals to reflect on and express their wishes for future care, including end-of-life care, before they become terminally ill or incapable of making decisions for themselves. A number of publicly funded initiatives exist to promote advance care planning and to encourage people to appoint "substitute decision makers" who make medical decisions and can give or withhold consent for medical procedures according to the patient's pre-expressed wishes when the patient becomes incapable of doing so themselves[52][53][54][55]
In 2008, The Advance Care Planning in Canada: A National Framework and Implementation Project was founded.[56] The goal was to engage healthcare professionals and educate patients
about the importance of advance care planning and end of life care.
Polling indicates that 96% of Canadians think that having a conversation with a loved one about planning for the end of life is important. However, the same polls show that only about 13% have actually done so, or have created an advance care plan for themselves.
[57]
A 2014 Ipsos Reid Survey[58] reveals that only about a third of Canadian doctors and nurses working in primary care feel comfortable discussing end of life issues with their patients. End-of-life issues in Canada have recently been highlighted due to the ongoing related debate about physician-assisted death in Canada. Former Federal Health Minister Rona Ambrose (July 15, 2013 to November 4, 2015) has stated: "I think the starting point for me is that we still don't have the best elderly care and palliative care yet… So let's talk about making sure we have the best end-of-life care before we start talking about assisted suicide and euthanasia."[59]