ADVANCED DIRECTIVES AND END OF LIFE
Category: EMS Operations
Topic: Medical/Legal and Ethics
Next Unit: Confidentiality
4 minute read
ADVANCED DIRECTIVES: defined as a written statement of a person’s wishes regarding medical treatment. Often including a living will, these statements are made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.
Do Not Attempt Resuscitation (DNR) Order: a type of advanced directive that is usually present when a patient has a terminal disease that is associated with medical futility.
DNR’s are hospital, EMS, and facility specific.
It is an order written by a doctor, has a time limit, and does not eliminate non-resuscitative treatment.
MEDICAL FUTILITY: interventions that are unlikely to produce any significant benefit for the patient and which are categorized into two distinguishable categories:
- QUANTITATIVE FUTILITY: where the likelihood that an intervention benefitting the patient is extremely poor.
- QUALITATIVE FUTILITY: the quality of benefit that an intervention will produce is extremely poor.
Quantitative = benefit of an intervention (example: positive physiologic response from a medication is a benefit)
Qualitative = the quality of benefit an intervention will produce (example: will it improve their condition or worsen it)
LIVING WILL: a type of advanced directive indicating a patient’s wishes that may not address the emergency medical response in your state.
Surrogate decision-makers have a durable power of attorney for health care and follow a healthcare proxy or legal document wherein a patient appoints an agent to legally make healthcare decisions on behalf of him/her for when he or she is incapable of doing so. Oftentimes the next of kin is the surrogate decision-maker.