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2 - Advance directives

from Section IV - Ethical issues

Published online by Cambridge University Press:  08 January 2010

Ian Maddocks
Affiliation:
University of New South Wales, Sydney
Bruce Brew
Affiliation:
University of New South Wales, Sydney
Heather Waddy
Affiliation:
Wakefield Hospital Specialist Centre, Adelaide
Ian Williams
Affiliation:
Walton Centre for Neurology & Neurosurgery
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Summary

The advance health care directive (or ‘anticipatory direction’) is an important component of the preparation by any individual for a time when some deterioration in individual competence is regarded as possible. It has been recommended as an important component of a routine medical examination at (say) the age of 75 years, or at the time of admission to an aged care facility. It becomes particularly relevant when the diagnosis of a potentially fatal condition has been made, and death and dying are a prospect requiring consideration. It provides an opportunity to clarify the range of possible outcomes and to indicate preferences for care. It can relieve family members and physicians of some of the burden of difficult decision-making.

An advance directive can rarely be both comprehensive and specific, because it is usually not possible to predict with any certainty the timing and nature of the final course of a terminal condition. Probably the most valuable aspect of raising the opportunity to write an advance directive is in the discussion that it arouses, and the permission that can follow to discuss difficult realities, and the options for facing them.

However, it may prove possible to indicate some particular wishes in response to the invitation: ‘If you should become so ill that you are unable to speak for yourself, will you want to indicate the medical care you wish to receive?’

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Chapter
Information
Palliative Neurology , pp. 205 - 206
Publisher: Cambridge University Press
Print publication year: 2005

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