Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Your Surrogate… 1. Can begin making decisions for you only when your doctor determines that you are no longer able to make health care decisions for yourself. 2. May make any and all health care decisions for you within the boundaries of reasonableness, including treatments for physical and mental conditions and decisions regarding life-sustaining procedures…UNLESS you limit the power of your surrogate. 3. Subject to certain exceptions in the law, will have power to authorize the withholding or withdrawal of life-prolonging treatment and decisions about the artificial provision of nutrition and hydration (feeding tubes). 4. Is protected from legal liability when acting in good faith. 5. Must make a decision based on your expressed wishes and values or your “best interests”; this will take precedence over other decisions, regardless of family relationships. 6. May have his or her decision challenged if your family, health care provider or close friend believes the surrogate is acting in bad faith or is not acting in accord with your wishes and religious/moral beliefs. SCN Meetings/Table 6/Continuity Group/8-05 What Health Care Providers Should Expect of Surrogates Basic comprehension of the surrogate’s role Availability for discussion Prompt response to requests for decision making Willingness to discuss overall goals of care Willingness to collaborate in care planning Willingness to make use of available community resources including ethics committees and ombudsmen when necessary. SCN Meetings/Table 4/Continuity Group/8-05 What Surrogates Should Expect From Health Care Providers Accessibility Communication about diagnosis, prognosis, available treatment options and life expectancy Description of the benefits and burdens of each treatment Recommendations for treatment and discussion of the reasoning underlying the recommendations Access to pertinent written education materials or journal articles Written communication of recommendations about treatment and their justification, when requested Access to ethics committees Emotional support SCN Meetings/Table 3/Continuity Group/8-05 A Framework for Assessing Capacity to Make Medical Decisions Can the person make and express personal preferences at all? Can the person give reasons for the alternatives selected? Are the supporting reasons rational in the sense that the person begins with a plausible idea and reasons logically from that premise to a result? Can the person comprehend the personal implications, namely the probable risks and benefits, of the various choices presented and selected? SCN Meetings/Table 1/Continuity Group/8-05 Hierarchy of Medical Decision-Making for Incapacitated Patients Advance Directives specified by the patient before (s)he became incapacitated prevail, even over the contrary wishes of guardians and other surrogate decision-makers. The decisions of the guardian or of a surrogate designated in an Advance Directive prevail over all others except in the presence of a written Advance Directive. Decisions of surrogates, including guardians, should be guided by: Substituted judgment (if the incapacitated person’s wishes were known but not formalized in an Advance Directive) Best interest of the patient, based on clinical evidence, prognosis, life expectancy, risk and benefit of proposed treatments, comfort and dignity Family members and friends take precedence next, usually in the following order: Spouse Adult children Siblings Other family members Friend Health care providers follow, in the absence of other decisionmakers (not optimal) SCN Meetings/Table 2/Continuity Group/8-05 Definition of “Life-Support Treatment” Life-support treatment means any medical procedure, device or medication to keep me alive. Life-support treatment includes: Medical devices put in me to help me breathe Food and water supplied artificially by medical device (tube feeding) Cardiopulmonary resuscitation (CPR) Major surgery Blood transfusions Dialysis Antibiotics SCN Meetings/Life Support/Continuity Group/8-05 My Wish for the Kind of Medical Treatment I Want or Don’t Want I believe that my life is precious and I deserve to be treated with dignity. When the time comes that I am very sick and am not able to speak for myself, I want the following wishes, and any other instructions I have given to my Health Care Agent, to be respected and followed. The instructions that I am including in this section are to let my family, my doctors and other health care providers, my friends and all others know the kind of medical treatment that I want or don’t want. A. General Instructions I do not want to be in pain. I want my doctor to give me enough medicine to relieve my pain; even if that means that I will be drowsy or sleep more that I would otherwise. I do not want anything done or omitted by my doctors or nurses with the intention of taking my life. I want to be offered food and fluids by mouth, and kept clean and warm. B. Meaning of “Life-Support Treatment” Life-support treatment means any medical procedure, device or medication to keep me alive. Life-support treatment includes: medical devices put in me to help me breathe; food and water supplied artificially by medical device (tube feeding); cardiopulmonary resuscitation (CPR); major surgery; blood transfusions; dialysis; and antibiotics. If I wish to limit the meaning of life support treatment, I write this limitation in the space below: C. If I am close to death: If my doctor and another health care professional both decide that I am likely to die within a short period of time, and life-support treatment would only postpone the moment of my death (choose one of the following): I want to have life-support treatment. I do not want life-support treatment. If it has been started, I want it stopped. I want to have life-support treatment if my doctor believes it could help, but I want my doctor to stop giving me life-support treatment if it is not helping my health condition or symptoms. SCN Meetings/My Wish/Continuity Group/8-05