Advance directive is a term that is commonly used to describe the documents that specify the care a person wishes to have if he or she becomes unable to make medical decisions. The term is generally used for documents that include a living will, a durable power of attorney for health care and “Do Not Resuscitate” orders. The language of the actual document must be consistent with the laws of the state of residence. A number of web sites provide state specific forms and the Bar Association of the state of residence frequently makes the form available.
The American Academy of Family Physicians encourages the use of advanced directives including but not limited to living wills and durable powers of attorney for health care, so that the desires of the individual will be followed in the event he or she lacks the capacity to participate in health care decisions. If, because of mental infirmity or minor status, an individual with a terminal condition does not have the capacity to participate in health care decision-making and has not previously executed a living will or durable power of attorney, the law of the relevant jurisdiction should designate an appropriate surrogate to act on his or her behalf. (2007)
Care at the end of life should embody the following principles:
The family physician’s continuing partnership with his or her patients provides a meaningful context for quality care at any time, and may be especially helpful at the end of life. The American Academy of Family Physicians (AAFP) promotes the following beliefs:
The AAFP does not support the publication and citation of data collected from cruel, egregious and inhumane experimentation, such as the Nazi experiments and data collected from the Tuskegee study (1998) (2008)
(Note: The Principles of Medical Ethics of the American Medical Association are the principles of ethics for the AAFP. The AAFP’s Congress of Delegates, however, can by a two-thirds vote adopt policies or positions relating to ethical issues which add to or contradict the AMA Principles of Medial Ethics. The statement above on publication of data from unethical experimentation is a variance with an opinion of the AMA Council on Ethical and Judicial Affairs.)
The AAFP believes that the ethical concerns involved in foregoing life-prolonging medical treatment are clearly outlined in the AMA's "Current Opinions of the Council on Ethical and Judicial Affairs." Family physicians should be familiar with these opinions (particularly 2.20) to enhance their cooperative efforts with patients and families in appropriate medical decision-making regarding the withholding or withdrawing of life-prolonging medical treatment. (1990)
The American Academy of Family Physicians supports the principle that each individual has the right to determine what medical treatment he or she will receive, including what life-sustaining treatment will be provided when the individual has a terminal condition.
The AAFP encourages its members to do the following:
The AAFP supports efforts that help patients retain control over their end-of-life treatment, including portable medical orders such as Physician Orders for Life Sustaining Treatment (POLST) Paradigm Forms that inform medical personnel of their wishes.
The AAFP supports each patient's right to determine the disposition of his or her own remains, allowing him or her to die with dignity and peace of mind.
(2008) (2013 COD)
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Ethics and Advance Planning for End-of-Life Care