Advance healthcare directive: Difference between revisions - Wikipedia

Line 46:

===Psychiatric advance directives===

A '''psychiatric advance directive''' (PAD), also known as a mental health advance directive, is a written document that describes what a person wants to happen if at some time in the future they are judged to be suffering fromhave a [[mental disorder]] in such a way that they are deemed unable to decide for themselves or to communicate effectively.<ref>{{cite web |title=About PADs |url=https://nrc-pad.org/ |website=NRC•PAD |publisher=National Resource Center on Psychiatric Advance Directives |access-date=22 November 2021}}</ref>

A PAD can inform others about what treatment they want or don't want from [[psychiatrists]] or other [[mental health professionals]], and it can identify a person to whom they have given the authority to make decisions on their behalf. A mental health advance directive is one kind of [[advance health care directive]].

Line 66:

National surveys in the United States indicate that although approximately 70% of people targeted by coercive psychiatry laws would want a PAD if offered assistance in completing one, less than 10% have actually completed a PAD.<ref>"Psychiatric Advance Directives Among Public Mental Health Consumers in Five U.S. Cities: Prevalence, Demand, and Correlates" Jeffrey W. Swanson, Marvin S. Swartz, Joelle Feron, Eric B. Elbogen, and Richard Van Dorn. The Journal of the American Academy of Psychiatry and the Law, Volume 34, Number 1, 2006</ref>

In a survey conducted of 600 [[psychiatrists]], [[psychologists]], and [[social workers]] showed that the vast majority thought advance care planning for crises would help improve patients’patients' overall mental health care.<ref>"Clinical Decision Making and Views About Psychiatric Advance Directives" Eric B. Elbogen, Marvin S. Swartz, Richard Van Dorn, Jeffrey W. Swanson, Mimi Kim, and Anna Scheyett Psychiatric Services, Volume 57, Number 3: 350-355, March 2006</ref> Further, the more clinicians knew about PAD laws, the more favorable were their attitudes toward these practices. For instance, while most [[psychiatrists]], [[social workers]], and [[psychologists]] surveyed believed PADs would be helpful to people detained and targeted for forced drugging and electroshock when labeled with severe [[mental illnesses]], clinicians with more legal knowledge about PAD laws were more likely to endorse PADs as a beneficial part of patients’patients' treatment planning.

Many clinicians reported not knowing enough about how PADs work and specifically indicated they lacked resources to readily help patients fill out PADs or to help their clients develop crisis plans.

Line 121:

Aggressive medical intervention leaves nearly two million Americans confined to nursing homes,<ref>Wilkkes, JL. Nursing Home Nightmares. ''USAToday.'' August 20, 1996. 11A.</ref> and over 1.4 million Americans remain so [[medically frail]] as to survive only through the use of feeding tubes.<ref name="US Congress 1987">US Congress, Office of Technology Assessment. ''Life-Sustaining Technologies and the Elderly.'' OTA-BA-306. Washington, DC: US Gov't Printing Office. July, 1987.</ref> Of U.S. deaths, about a third occur in health care facilities.<ref>{{cite news |author=<!--Staff writer(s)/no by-line.--> |title=A third of Americans die in hospitals, study finds |url=https://www.reuters.com/article/us-death-usa/a-third-of-americans-die-in-hospitals-study-finds-idUSTRE5A34N220091104 |work=Reuters |date=4 November 2009 |access-date=10 March 2021}}</ref> As many as 30,000 persons are kept alive in comatose and permanently vegetative states.<ref name="US Congress 1987"/><ref>{{cite journal | author = American | year = 1995 | title = Practice Parameters: Assessment and Management of Patients in the Persistent Vegetative State: Summary Statement | journal = Neurology | volume = 45 | issue = 5| pages = 1015–1018 | doi = 10.1212/wnl.45.5.1015 | pmid = 7746375 | doi-access = free }}</ref>

Cost burdens to individuals and families are considerable. A national study found that: “In"In 20% of cases, a family member had to quit work;”" 31% lost “all"all or most savings”savings" (even though 96% had insurance); and “20"20% reported loss of [their] major source of income.”"<ref>Covinsky, KE; Goldman, L; Cook, EF; etal. The impact of serious illness on patient's families. ''Journal of the American Medical Association.'' 1994;272(23):1839-1844.</ref> Yet, studies indicate that 70-95% of people would rather refuse aggressive medical treatment than have their lives medically prolonged in incompetent or other poor prognosis states.<ref>Heap, MJ; etal. Elderly patients' preferences concerning life support treatment. ''Anaesthesia.'' 1993;48:1027-1033.</ref><ref>Patrick, DL; etal. Measuring preferences for health states worse than death. ''Medical Decision-Making.'' 1994;14:9-19.</ref>

As more and more Americans experienced the burdens and diminishing benefits of invasive and aggressive medical treatment in poor prognosis states – either directly (themselves) or through a loved one – pressure began to mount to devise ways to avoid the suffering and costs associated with treatments one did not want in personally untenable situations.<ref name="ReferenceA"/> The first formal response was the living will.

Line 135:

===India===

[[Supreme Court of India]] on March 9, 2018, permitted living wills and passive euthanasia. The country's apex court held that the right to a dignified life extends up to the point of having a dignified death.<ref>{{cite news|url=http://www.thehindu.com/opinion/editorial/death-with-dignity/article23009854.ece|title=Death with dignity: on SC's verdict on euthanasia and living wills|date=10 March 2018|via=www.thehindu.com|newspaper=The Hindu}}</ref>

==See also==