扬州大学：《医学伦理学》课程教学课件（PPT讲稿）Chapter 3 Advance Directives

CHAPTER3ADVANCEDIRECTIVES

CHAPTER 3 ADVANCE DIRECTIVES

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6:32/7:39AdvanceDirectives:HealthCareDecisionsHospiceoftheValley

ADVANCEDIRECTIVES:THELIVING WILLANDTHEPOWEROFATTORNEYFORHEALTHCARE“"AdvanceDirective"”istheDirectivesAdvanceterm used to refer to anyLivingdocument that makes theWillwishes ofacapablepatientclearforatimeinthefutureDonorHealthcareRegistryPowerofEnrollmentwhenthepatientis noAttorneyFormDo Notlonger able to make orResuscitateOrder(DNR)communicate healthcaredecisions

ADVANCE DIRECTIVES: THE LIVING WILL AND THE POWER OF ATTORNEY FOR HEALTH CARE “Advance Directive” is the term used to refer to any document that makes the wishes of a capable patient clear for a time in the future when the patient is no longer able to make or communicate health care decisions

Advance Care PlanningSChinicsCRE

Cleveland Clini0:04/5:24HealthcarePowerof Attorney

SUMMITMEDICALGROUPTypes of Advance DirectivesHealthCareProxy·Instruction DirectiveDirective/Powerof("Living Will")Attorney.Providesspecificinstructionsforhow.Allowsyoutochooseyourrepresentativewhowillmakeshould makedecisions onyourdecisionsbehalfifyoubecomeincapacitated

TheNEWENGLANDJOURNALofMEDICINEHOMEISSUESFORAUTHORSARTICLES&MULTIMEDIASPECIALTIES&TOPICSCORRESPONDENCEAnUnconsciousPatientwithaDNRTattooinitially decided notNEnglJMed2017:377:2192-2193|November30.2017|DOl:10.1056/NEJMc1713344to honor the tattooan ethicsconsultation wasrequested-DNRthe social workdepartmentDO NOT RESUSCITATEobtained a copy ofhis FloridaDepartment ofHealth"out-of-hospital"DNRorder

• initially decided not to honor the tattoo • an ethics consultation was requested – DNR • the social work department obtained a copy of his Florida Department of Health “out-of￾hospital” DNR order

Henry C.is an84-year-old male with severeAlzheimer's disease.WhenHenryhad hadonly early signs of mild cognitive impairment,hehad completed legal paperworkto assigna health care agent -a neighbor and friend,Jean H

Henry C. is an 84-year-old male with severe Alzheimer’s disease. When Henry had had only early signs of mild cognitive impairment, he had completed legal paperwork to assign a health care agent –a neighbor and friend, Jean H

Day zeroHenry was diagnosed withsevere pneumonia and mildJean had not beenrenal failuresuccessfullycontactedDay oneDay twoJean said -- "too old"Day threeto come to theHenry's condition worsenedhospital to visitand transferred to theHenry and to “justmedical intensive care unitkeep doing what(MICU)you're doing

Day zero Henry was diagnosed with severe pneumonia and mild renal failure Day three Henry’s condition worsened and transferred to the medical intensive care unit (MICU) Day one Day two Jean had not been successfully contacted Jean said - “too old” to come to the hospital to visit Henry and to “just keep doing what you’re doing