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  • Canadian Journal on Aging / La Revue canadienne du vieillissement, Volume 17, Issue 1
  • January 1998, pp. 24-39

A New Health Care Directive for Long-Term Care Elderly based on Personal Values of Life

  • Najmi Nazerali (a1), Bernadette Ska (a2) and Yvette Lajeunesse (a3)
  • DOI:
  • Published online: 01 January 1998

Determining the appropriate intensity of investigation and treatment for individual elderly patients in long-term care settings can present a significant challenge to physicians, especially when patients are incompetent to decide for themselves. However, respecting established intervention levels may represent an even greater challenge, given the realities of coverage by on-call physicians. This paper describes a new Intervention Level Scale for competent as well as incompetent long-term care elderly, and its validation as a communication tool between attending and on-call physicians. Specifically studied were (a) concordance of interventions, (b) whether prior knowledge of an intervention level by an on-call physician was considered useful, (c) applicability of the scale in different institutions and (d) necessity of physician training for optimal use. The scale's uniqueness resides in the fact that it is based on personal values of life, rather than institutional resources, and it incorporates directives on family contact.


Déterminer le niveau adéquat d'investigation et de traitement médical pour les patients en soins de longue durée constitue un défi, particulièrement quand les patients sont incapables de décider eux-mêmes. Appliquer ce niveau d'intervention présente un autre défi pour les médecins de garde. Une nouvelle échelle de niveaux d'intervention destinée à des patients aptes et inaptes, en soins de longue durée, est proposée ainsi que son évaluation comme moyen de communication entre médecins traitants et médecins de garde. Les aspects étudiés sont la concordance entre leurs interventions, l'utilité de la connaissance du niveau d'intervention préétabli, l'applicabilité de l'échelle dans des institutions différentes, et la nécessité d'un entraînement pour une utilisation optimale. L'originalité de l'échelle réside dans le fait qu'elle est basée sur des valeurs personnelles plutôt que sur les ressources de l'institution et qu'elle tient compte à la fois des désirs du patient et des directives de la famille.

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American Heart Association. Emergency Cardiac Care Committee and Subcommittees. (1992). Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Part VIII — Ethical considerations in resuscitation. Journal of the American Medical Association, 268, 22822288.

R. Besdine (1983). Decisions to withhold treatment from nursing home residents. Journal of the American Geriatrics Society, 31, 602606.

M. Danis , L.I. Southerland , J.M. Garrett , J.L. Smith , F. Hielema , C.G. Pickard , D.M. Egner , & D.L. Patrick (1991). A prospective study of advance directives for life-sustaining care. New England Journal of Medicine, 324(13), 882888.

L.L. Emanuel , & E.J. Emanuel (1989). The medical directive. A new comprehensive advance care document. Journal of the American Medical Association, 261, 32883293.

L.L. Emanuel , M.J. Barry , J.D. Stoeckle , L.M. Ettelson , & E.J. Emanuel (1991). Advance directives for medical care — A case for greater use. New England Journal of Medicine, 324, 889895.

M. Gordon , & M. Cheung (1993). Poor outcomes of on-site CPR in a multi-level geriatric facility: three and a half years experience at the Baycrest Center for Geriatric Care. Journal of the American Geriatrics Society, 41, 163166.

D.C. Hayley , C.K. Cassel , L. Snyder , & M.A. Rudberg (1996). Ethical and legal issues in nursing home care. Archives of Internal Medicine, 156(3), 249256.

L. Kass (1980). Ethical dilemmas in the care of the ill. What is the patient's good? Journal of the American Medical Association, 244, 19461949.

S.A. Levenson , N.D. List , & B. Zaw-Win (1981). Ethical considerations on critical and terminal illness in the elderly. Journal of the American Geriatrics Society, 29, 563567.

Report of the Council on Scientific Affairs (1990). American Medical Association White Paper on elderly health. Archives of Internal Medicine, 150, 24592472.

S. Wanzer , S. Adelstein , & R. Cranford (1984). The physician's responsibility toward hopelessly ill patients. New England Journal of Medicine, 310, 955959.

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Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
  • URL: /core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement
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