Page 46 - Encyclopedia of Nursing Research

ADvANCE DiRECTivES n 13

encourage the development and implemen- desire on the basis of past discussions and the
tation of advance directives. individual’s moral, spiritual, and personal
There are two forms of advance direc- beliefs. The health care proxy has the same A
tives: the development of a living will and the rights to accept, to refuse, or to request medi-
designation of health care powers of attor- cal treatment that the individual would have
ney. in 1967, Luis Kutner, an attorney from if he or she has capable of making and com-
illinois, proposed that individuals needed to municating decisions. Because of this, some
have a way to speak to how they envisioned states statutes combine a power of attorney
their health care management when they and a living will into one document.
would not be able to verbally express their Should a patient not execute a health
wishes. This document is a written state- care proxy or living will, many states will
ment that states under what specific condi- designate a surrogate decision maker. Some
tions and individual would want to accept states will only do so under certain condi-
or reject life sustaining medical treatment. tions such as an individual having a terminal
Because the individual is alive, yet not able illness who is permanently unconscious or
to make decisions, this document is titled for specific types of treatment such as cardio-
a “living will.” The living will is only to be pulmonary resuscitation. in an emergency
used if the individual is unable to provided setting, outside of a hospital or medical facil-
informed consent or is medically incapaci- ity, advance directives may not apply. Some
tated. The living will includes specific infor- states may or may not allow emergency med-
mation regarding an individual’s desire for ical service personnel to resuscitate patients
medical interventions such as the use of life who have a bracelet designating themselves
support equipment such as ventilators, life as a “do not resuscitate” patient.
saving procedures such as cardiopulmonary The topic of advance directives is an
resuscitation, organ and tissue donation and extremely controversial subject that has
medical management such as the use of feed- created much debate regarding the right to
ing tubes, analgesia, and administration of stop medical treatments that could prolong
hydration. in 1976, California became the a patient’s life and allow natural death to
first state in the United States to legally sanc- occur. The debate and discussion became
tion living wills. Within a year, 7 states had widely known to the public in 1976 dur-
passed bills and 43 states had considered the ing the first “right to die” case surrounding
living will legislation, which subsequently Karen Ann Quinlan and again in 1990 dur-
progressed on a state-by-state basis. By 1992, ing the case of Cruzan v. Director Missouri
all 50 states had passed legislation to legalize Department of Health. Both cases involved
some form of advance directives. the desire of the patient’s families to dis-
A health care power of attorney, also continue feedings that were prolonging the
known as a durable power of attorney or a lives of two young individuals who did not
health care proxy, appoints a key individual have any clear verbal or written instruc-
to function as the formal decision maker and tions regarding their end-of-life treatment
make all decisions regarding the medical care desires. it was not until 1990 and the case
and treatment of an individual should that of Cruzan v. Director Missouri Department of
individual lose their decision making abil- Health that the U.S. Supreme Court agreed
ity. The designation of a health care power of to review a case regarding advance direc-
attorney is broader than the development of tives. Until that time, the Supreme Court
a living will because it includes all medical held the belief that legislation surrounding
decisions besides those pertaining to life sus- advance directives should be determined
taining treatment. The appointed designee at the state rather than the federal level.
must determine what the individual would in 1990, the U.S. Supreme Court upheld