New Advance Directive Form Provides More Options
Major VEN Conference planned for February 7, 2005
In the News . . .
Organ Donation
Terri Shiavo case in Florida
The Hastings Center Report
New Book about Alzheimer’s Disease
Back
to VEN Home Page
For the past several months the Vermont Ethics Network has been working with colleagues in the field to craft a new, comprehensive Advance Directive form that will incorporate elements of the two older standard Vermont forms. The unveiling of a new form in the next edition of Taking Steps (expected to be available in January 2005) will not mean that the previous forms in the earlier editions are not still perfectly good and valid. People can still use these shorter standard forms (the Terminal Care Document and the Durable Power of Attorney for Health Care) if they prefer.
Striking a Balance between clarity and comprehensiveness The attempts to keep the language as everyday as possible and yet explain certain complex medical decision options to people in a format they can follow and readily understand has been a challenge. Some will be disappointed in the length of the new form. Others are pleased that more attention is paid to options such as a “trial of treatment” for a period of time to see if people can recover or maintain their health status and functioning.
The Vermont Legislature, in Act 162, made clear that any appropriate written advance directive that was properly witnessed would be honored in Vermont. We expect that this will lead other individuals and organizations to craft very personalized and specific documents. The use of documents developed in other states and recognized in many jurisdictions, documents such as Five Wishes, developed in Florida by the organization called Aging with Dignity, will also probably become more common in our State in the years ahead as a result.
Still, the need for a widely recognized and comprehensive document with which most health clinicians and patients become familiar, has spurred VEN to seek the widest possible input to develop such a new form. Drafts that have circulated this Fall have received generally high levels of support. Comments and suggestions that have flowed in from a variety of health professionals and ordinary Vermonters who have agreed to try them out within their own families, have helped us polish and improve upon earlier versions.
New parts to this form address specific wishes for care near the end of life and for such specific wishes as those relating to organ donation and funeral arrangements. The new Advance Directive for Health Care also has the flexibility (as did the former standard Durable Power of Attorney form) to capture a person’s wish that all available treatments and life-sustaining procedures be continued regardless of a person’s condition or prognosis. This option is described in option C. in the excerpt of the form reproduced below.
The concepts of patient-centered care, respect for autonomy and self-determination and even greater potential savings to health care system from following explicit patient directives will be fostered by a more comprehensive method of communication in advance about wishes for health care. In addition to less conflict and confusion, it is hoped that greater attention will be paid to addressing the fears and pain people dread or now all too frequently experience in critical care situations, particularly near the end of life.
The appointment of a health care “agent” to speak for the patient when he or she no longer has the capacity to participate directly in health care decision-making remains the centerpiece of the new advance directive form. Yet, even for those who have no agent at hand or in mind, Part Two will allow for a statement of Treatment Wishes that can guide a health care team far better than the old “Living Will”. An excerpt from Part Two of the new document is reproduced below:
(excerpt from Part Two of the new draft Vermont Advance Directive. . .)
Please express your preferences that follow by checking or initialing the statements. You may check or initial more than one choice. If you do nothing, your agent or others such as family members and doctors treating you will assume you want them to decide for you. If you do not state a preference for withholding or withdrawing artificial food (tube feeding) and hydration, your agent may not have authority to withhold or withdraw it, without a court order, if you are being treated in a New York or New Hampshire hospital.
_____ A. My Choice is to Limit Treatment - I do not want to be kept alive if: ( Initial those statements below that you agree with)
____ 1. I am so sick that I will die within a relatively short time (I cannot get better and have only weeks, days or hours left to live),
____ 2. I become unconscious or unaware of my surroundings and most doctors agree that I will never regain consciousness,
____ 3. I become unable to think or act for myself (and won’t get better), or
____ 4. The likely risks and burdens of treatment would outweigh the expected benefits. (For example: I will be in pain, or I will be unable to do things for myself, or the costs of caring for me will be beyond my willingness to pay.)
____ 5. If it is possible that I might recover with treatment and more time is needed to determine if I can get better or not, I wish my medical team to start the necessary treatments to keep me alive. If, over time, these treatments do not improve my chances of living or my physical condition, I wish to have life-sustaining treatment stopped.
____ 6. If I have initialed or checked any of the situations above and am also unable to swallow enough food and water to stay alive, I do want food and water to be given to me by vein or by feeding tube.
____ 7. If I have initialed or checked situations 1-5, I do not want food and water to be given to me by vein or feeding tube, but I will accept medication for pain and agitation through an intravenous line.
____ 8. Other specific instructions are as follows:______ B. My Choice is to Sustain Life - I want to be kept alive as long as possible through any means possible regardless of my condition or awareness.
People wishing to see the entire new draft form should visit our website: www.vtethicsnetwork.org or call the VEN office at (802) 828-2909 and we will mail you a copy along with a feedback card to record you reactions and comments.
Mark your calendars now for a special Monday conference in Montpelier entitled:
Advance Directives and the Changing Landscape of Medical Decisions