Talk:Advance healthcare directive

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 1 July 2019 and 23 August 2019. Further details are available on the course page. Student editor(s): Terry.vo.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 16:54, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): ALAlmond7288.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 13:28, 16 January 2022 (UTC)

Will To Live

This claim: "As the name suggests, the term "will to live", as opposed to the other terms, tends to emphasize the wish to live as long as possible rather than refusing treatment in the case of serious conditions" is at best misleading and more more likely false. 'Living' in 'living will' does not refer to the desires of the patient, but is meant to distinguish this type of advance directive from an ordinary will which is consulted after a person dies. 'Will' does not mean will in the sense of the patients desires and decisions, but refers to the document indicating the patient's wishes. One impetus for the living will movement was the occurrence of "natural death" acts which were expressly aimed towards allowing a patient refuse treatment even though this might cause their death. This claim should be removed. —Preceding unsigned comment added by Autoicon (talk • contribs) 17:52, 13 February 2008 (UTC)

Terri Schiavo

I took the section about Terri Schiavo's case causing an increased interest in living wills and placed it here in this article. I believe that it is valid to mention that in this article, that it caused more people to look at living wills.. Of course, please feel free to change or update the information. But I would at the same time respectfully request that wholesale deletions not be done because you believe that it doesn't belong here. Thank you.
JesseG 03:02, Mar 26, 2005 (UTC)

You might want to add the information that Living Wills address a TERMINAL condition (not Terri's condition which was profoundly disabled). There has been an awful lot of talk about living wills; If she had executed a living will, however, there would have been a need to find her condition "terminal." Lots of BAD information out there regarding living wills. A living will should be differentiated from a durable power of attorney for health care, which gives the power to another person, which a living will does not. An advance care directive is effectively the set in which living wills and durable powers of attorney for health care are subsets. An additional advance directive is a Do Not Resuscitate, which is often regulated by state form. In brief, the living will was popularized many years ago before so many medical advances were made. Its langauge is brief and you might want to link to it. It states wishes. The Durable Power of Attorney for Health Care is a creature of State Statute. The DNR is signed by the patient and will result in a DNR order.

I agree with this person - a living will is not the same thing as a durable power of attorney for healthcare. The living will governs solely end-of-life decisions, something which the attorney-in-fact of a durable power of attorney cannot do. Would someone like to make this distinction in the article itself, please? --TheTriumvir 16:04, 4 August 2006 (UTC)

It seems that people have different understandings of what a "Living Will" is. An Advanced Health Directive (AHD), seen by many as the same as a Living Will, should canvass many situations including persistent vegetative state, and is not purely for a terminal situation. AHD's usually also allow the person completing to appoint an attorney for personal/health matters.

Minor edit: Balancing documentation added. Now, don't everone start getting hysterical, like happens in all these edit wars. When there is not much "discussion," you gotta Be bold sometimes, and remember that this is a balancing addition, positive, it seems. Clarify, tweak, or add material to "balance the force," but don't go deleting willy-nilly without either consensus or very good reason. --GordonWattsDotCom_In_Florida 08:29, 16 May 2005 (UTC)

The Terry Shivaro section is unsourced original research and breaks WP:NOT "a how too" guide. Its given undue weight in this article. I'll be bold and remove it but happy to discuss if there remains a belief that we shold keep this. Spartaz ^Humbug! 16:40, 10 April 2007 (UTC)

living will vs. health care proxy

"An advance directive is a legal document in which you state how you want to be treated if you become very ill and there is no reasonable hope for your recovery. Although laws vary from state to state, there are basically two kinds of advance directives.

1. A living will is a legal document in which you state the kind of health care you want or don't want under certain circumstances.

2. A health care proxy (or durable health care power of attorney) is a legal document in which you name someone close to you to make decisions about your health care if you become incapacitated.

You can have both - a health care proxy naming a person to make the decisions, and a living will to help guide that person in making the decisions.

In order for your advance directive to be useful, it has to be available. After all, your advance directive won't do you any good if no one can find it." [1] -69.87.200.188 22:35, 26 July 2007 (UTC)

variations between states

"One state’s advance directive does not always work in another state. Some states do honor advance directives from another state; others will honor out-of-state advance directives as long as they are similar to the state's own law; and some states do not have an answer to this question. The best solution is if you spend a significant amount of time in more than one state, you should complete the advance directives for all the states you spend a significant amount of time in." [2] -69.87.200.188 22:35, 26 July 2007 (UTC)

Controversies

I've moved this section from th talk page:

Brother Fox Story - Brother Joseph Fox, age 83, lay in a hospital bed in a permanent vegetative coma in October 1979 following surgery to correct an inguinal hernia which he had sustained when he moved some large tubs of flowers on a roof top garden at Chaminade High School in Mineola, Long Island.

Brother Fox’s heart resumed beating, but due to the interruption of oxygen caused by the cardiac arrest, he experienced substantial brain damage. He slipped into a coma and was placed on a respirator, a mechanical breathing device, which is regarded as extraordinary or heroic medical treatment. His higher brain functions, the so-called cognitive and sapient functions—the ability to feel, see, think, sense, communicate and feel emotions—were lost with no chance of returning.

In order to obtain court permission to withdraw Brother Fox’s respirator, a legal proceeding was initiated which quickly went through the court system and reached the highest court in New York, but not before Brother Fox had died of congestive heart failure while still on the respirator.

The highest court decided that Brother Fox had a common law right to bodily self-determination which included the right to refuse extraordinary, life-sustaining medical treatment. The court further found that Brother Fox had, in fact, exercised this right before the onset of his illness and affirmed the order granted by the lower courts to withdraw his respirator.

This case has paved the way for the use of living wills in New York. Moreover, since New York is not one of the states that has passed legislation authorizing living wills, the case of Brother Fox is the legal precedent in the area.

Karen Ann Quinlan - In 1976, when the Karen Ann Quinlan case was in the news, members of Brother Fox’s religious community held extended discussions about its significance. The Quinlan case involved New Jersey parents who had requested removal of the respirator attached to their permanently comatose 19-year-old daughter.

It was noted that the Pope had stated that Catholic principles permitted the discontinuance of extraordinary life-sustaining treatment when there is no reasonable hope for the patient’s recovery. Brother Fox said at these discussions that he, “would not want any of this extraordinary business to be done to him.”

While it seems illustrative but inappropriately presented. I'm also concerned about sourcing and neutrality. Are these cases considered pivotal in the evolution of advanced directives? And if so can we find better sources? A link to http://wanglawoffices.com/Documents/What%20is%20a%20Living%20Will%20Brother%20Fox's%20Story.doc was included in the external links section, but this seems to be basically an advertisement promoting advance directives rather than a considered analysis of the case. I don't think it can really be considered appropriate sourcing. Anyone have ideas for how to better present this information (assuming it should be). -- SiobhanHansa 18:01, 20 February 2008 (UTC)

Is the following article on the the topic of advance health care directives worthwhile?

"Why You Need A Living Will" Short article illustrates a terrible scenario that spells-out exactly why everyone should have a living will + link to FREE state-by-state living will forms from NHPCO (a 501(c)(3) non-profit). If you believe it is, and have no affiliation with the site it's located on, please please post it as an edit to the Living Will page [3]. If you think it's worthless, please say so in the space below. —Preceding unsigned comment added by 24.225.129.220 (talk) 17:27, 27 February 2008 (UTC)

It seems very low value. The "FREE state-bystate living will forms" link is already included in our external links list so that's no benefit either. Since the link has previously been spammed and it adds next to nothing I've removed it again. -- SiobhanHansa 20:27, 14 May 2008 (UTC)

I disagree entirely with SiobhanHansa that "It seems very low value" - The scenario posed in the brief article illustrates the entire issue of why advance health care diectives are so important:

"What would you want if something like what happened to Terri Schiavo happened to you?

Suppose you have not completed your advance health care directives and suppose something happened to you tonight. Who are the people in the world you love more than anything? Gather them all together in your head for a moment, then divide them into two groups. The first group believes with all its heart that the right thing to do is keep you alive at all costs, even if brain dead with virtually no hope of recovery. The second group believes with equal passion and conviction that you would never want to be kept alive by artificial means under such circumstances. Would you want the people in each group to channel their grief and saddness into hatred toward the others and spend their entire life savings on legal fees, fighting to do what they guess you would have wanted?"

If 1 out of 40 readers of the article has a better understanding of the issue and is motivated to complete their directives, this is VERY valuable.

I wrote the article and originally posted it prior to understanding the details of the posting policy (others can post the link, but I can't personally), so I followed the spirit and letter of the rules and posted the link in the discussion section and believed someone else would see the article's value and post it. Eventually someone did, and SiobhanHansa just has a bad attitude about it and deleted it again.

Would some outside person please review the article and post it with affiming comments if they too believe it's valuable. —Preceding unsigned comment added by 98.221.26.251 (talk) 17:44, 26 May 2008 (UTC)

More on external links

I recently removed several links that point to pages providing help with producing advanced health care directives for specific jurisdictions. But was reverted with the comment "I think that while the concept is international, it is helpful to provide US-specific links." The reverting editor did not say why we should taqrget US readers as being desrving of this type of focus.

As an international encyclopedia it's problematic to provide links that only apply to readers in one country or area - and if we try to balance with links for other areas we end up with a directory. These types of links are also generally out of keeping with our guidelines because they're not really providing further information on the topic for the general reader but are rather providing a service to produce a directive. As such these links are only relevant to some of our readers and are more appropriate for a how-to guide. I suggest all these links should go and we should stick to providing encyclopedic information. People always have access to Google to find help specific to their own regions. -- SiobhanHansa 18:16, 15 August 2008 (UTC)

If there are no objections to this reasoning I'll go ahead and remove the links again tomorrow. -- SiobhanHansa 20:26, 17 August 2008 (UTC)

I agree. Remove the links. --Vince (talk) 08:21, 18 August 2008 (UTC)

SiobhanHansa--After reading your reasoning, I now agree with you. Thanks. --Dizzydaveman (talk) 12:22, 18 August 2008 (UTC)

Thanks - I've removed the links. -- SiobhanHansa 13:02, 18 August 2008 (UTC)

Psychiatric advance directives

Looks like Psychiatric advance directives could be merged into here? EverSince (talk) 15:33, 26 August 2008 (UTC)

If the PAD article was amended I think it could continue to stand alone as there are specific issues relating to psychiatric advance directives that make them distinct. Perhaps merge for now? --Vince (talk) 09:31, 27 August 2008 (UTC)

Yeah you're right. It's quite long too. I'll maybe add a brief summary of it to here, and make that article link to here. By the way there's also Advanced Medical Directive - seems to be covering the same issue as here? EverSince (talk) 15:17, 2 September 2008 (UTC)

Well spotted. I think we should merge the information from Advanced Medical Directive into here and set up a redirect. I am happy to do this at some point if nobody objects. --Vince (talk) 16:50, 2 September 2008 (UTC)

Merged material

I have merged in material from Advanced Medical Directive and set up a redirect. I have edited the material to improve flow and iron out some inconsistencies in terminology. The material still needs substantial referencing. I also plan to write a summary of psychiatric advance directives and include it here. --Vince (talk) 10:43, 4 September 2008 (UTC)

POV in intro and Background, Wikify

It seems to me that the introduction and Background sections of this article have a particular bias in favor of establishing an advance care directive (or, from another perspective, against the current state of practiced medicine). Examples include the word choice in statements such as:

• "critical deficits in the medical care of the dying"
• The inclusion of the mid-sentence hyphenated statement, "where 80% of all deaths occur"
• "the burdens and diminishing benefits of invasive and aggressive medical treatment in poor prognosis states"

Other such statements occur within the page, the majority being near the top of the page. It is as if an editor were "making a case" for an advance care directive, rather than explaining the concept. I have flagged this as Template:POV-check as a result.

Furthermore, some of the content does not conform to Wikipedia's standards of formatting (e.g. the second-to-last paragraph of Living Will, reading "For instance, you can now establish a living will for your pet (see, for example, www.PetLivingWills.com)" ). As such, I have also flagged this as Template:Wikify. Devmage (talk) 20:56, 30 July 2009 (UTC)

UK links

I've no current plans to expand this article but having been asked to find UK websites I came up with the links below. Note a Health Care Proxy is a human in the UK and appears to be a form in the USA!

Definition of a living will.

BBC Living wills I note the reference to Medical Power of Attorney but its absence in the HMG website suggests it is not in place in the UK.

UK Government website

Age UK living wills

JRPG (talk) 21:22, 9 January 2011 (UTC)

Criticism & NPOV

I'm removing the 'Criticism' section, the content of which was previously (and quite inappropriately) located in the lede. Instead of providing a NPOV overview of critical debate in an encyclopaedic manner (as would be appropriate for WP), it reads like campaign literature in support of the views of Dr Van Scoy. MistyMorn (talk) 23:58, 2 January 2012 (UTC)

Merger proposal

Advance Health Directive seems to be about an Australian version of an advance health care directive. We currently have no information about Australia here, and Advance Health Directive is a long-standing stub and orphan. So merging it here seems the best option. PWilkinson (talk) 22:25, 1 June 2012 (UTC)

Merge. Littledogboy (talk) 01:59, 15 May 2013 (UTC)

I have completed this merge.LT90001 (talk) 13:43, 26 August 2013 (UTC)

Stability of preference

Those who are less ill may change their mind: doi:10.1001/jamainternmed.2014.1183 JFW | T@lk 06:11, 8 July 2014 (UTC)

Source

This might be a useful source:

Olick, Robert S. (2012-01-01). "Defining features of advance directives in law and clinical practice". Chest. 141 (1): 232–238. doi:10.1378/chest.11-1520. ISSN 1931-3543. PMID 22215831.

WhatamIdoing (talk) 22:27, 28 November 2015 (UTC)

References

Reference 57 link is dead - 404 - [4] E Hassen (talk) 01:26, 12 December 2015 (UTC)

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Merger proposal (Psychiatric advance directive)

I propose merging Psychiatric advance directive into Advance healthcare directive. The psychiatric advance directive is a form of healthcare directive, the separate article is poorly maintained and in need of substantial revision, and it should be possible to sufficiently address the topic within the advance healthcare directive within the space of a few paragraphs. Arllaw (talk) 14:33, 14 November 2021 (UTC)