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Nursing Advance Directive

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Advance Directive

An advance directive, more commonly known as a living will, is a legal instrument where a dying person appoints another person to direct the former’s health care decisions should he no longer be able to do so. It may contain specific instructions regarding the health care of the dying person (including a do not resuscitate clause). It may state the types of treatment allowed or forbidden by the individual being treated. In some countries even, the advance directive may even contain a euthanasia directive — instructions on how euthanasia will be conducted. (Wikipedia, 2006)

Common understanding

The common understanding of an advance directive is that it is a do not resuscitate document which instructs the health care professionals to allow the illness to take its natural course. It forbids the caretakers from reviving or resuscitating a patient who suffers a cardiac or respiratory arrest. This common understanding is inaccurate because in some jurisdictions, a do not resuscitate order may come from the physician and not the patient himself.

On the other hand, an advance directive or living will must always come from the patient. Additionally, an advance directive is much broader; it practically covers anything and everything that the patient wants to be followed regarding his treatment. It could either be an order to stop his treatment at a certain point in time or upon the happening of certain conditions or it could be an order to continue his treatment to the fullest extent possible.

Why is it important?

            A living will is important because it allows the patient to direct his own fate. It allows him to make difficult end-of-life decisions so that his loved ones do not have to. Making these decisions for another person can be very stressful. It could lead to heated debates between family members that would only take away what little time they have with the dying patient.

And after everything, the person who made the decision will never be sure if that was what the patient truly wanted. Ideally, every terminally ill patient should provide for an advance directive. However, this might be quite impossible in cases of sudden illness or accidents which incapacitate the patient from speaking, writing or otherwise expressing his wishes. In these cases, it becomes the full responsibility of the patient’s loved ones to direct his end-of-life care.

How would you help a family in conflict about what to do at end of life?

            Health care professionals must be cautious in giving unsolicited advice to the family of the dying patient. Conflicts between family members and loved ones could escalate even further if other persons begin to take sides. However, in the event that the family actively seeks for advice, the health care professional may give his opinion but he must be very sensitive to issues even beyond his medical expertise like the legal implications of the action or the religious beliefs of the dying patient.

            There are certain guide questions that might help the family in making a decision:

  1. Did the patient say anything in the recent past regarding his end-of-life treatment?
  2. Will the treatment or its absence cause more suffering to the patient?
  3. Is the treatment or absence of the treatment consistent with the patient’s religious or moral beliefs?
  4. Will the treatment improve the condition of the dying patient?
  5. Is there still a probability of recovery for the patient?

There can be many factors to consider when making these decisions. Many families will worry about the financial aspect of the problem. Extended treatment can cause medical bills to soar way above the financial capacity of the family. This is the most common source of disagreement. In this matter, the loved ones must be left to their own consciences to make these difficult decisions.

In the end, we must remember that the role of health professionals is not to mingle in the affairs of the patient and his family but to give care and support. Impending death is already a difficult time as it is. We must not be there to add to be burden but to lighten the load. Our job is to ease the pain, both physical and emotional. We are not there to judge but to respect the decisions of those who are most close to the patient. Our job is to heal, not to cause more pain.


Wikipedia. (2006). Living will. Wikimedia Foundation. Retrieved May 30, 2006, from


Wikipedia. (2006, May 17). Do not resuscitate. Wikimedia Foundation. Retrieved May 30, 2006,

from http://en.wikipedia.org/wiki/Do_not_resuscitate

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