Advance Care Planning Flashcards
How is advance directives different in children and adults?
Why?
Children: focuses on beneficence rather than personal autonomy.
Leads to prima facie bias towards curative rather than palliative
Why: parental obligation to protect. Societal predisposition to favour life.
What are a few reasons why advance care planning is good?
Two way communication is improved
Details of date are clarified
Goals of care are aligned with the planned course of treatment
What is the problem with DNR?
There is confusion whether these directives are limited to CPR or include interventions beyond resuscitation like antibiotics and surgery.
What are some principles of palliative care?
Relief of suffering
Focus on quality of life and dying rather than limited to end of life care
Bereavement support
Withholding life sustaining treatment should be to hasten death?
No. It should not be to hasten death but to optimise quality of life.
Why might parents not bring up advance directives and palliative care?
Feeling that they are ‘giving up’
May not be overtly aware of the potential to die
What are the ethical principles that underlying advance care planning ?
Respect for autonomy, beneficence and non-malificence
What are the three categories of decision making capacity?
Developing capacity
Incapable of capacity
Fully capable of capacity
What Ian instructional directive?
What is a proxy directive?
Instructional directives indicate what actions should be taken in the case of anticipated health crises,
proxy directives indicate who should be consulted to decide in the case of patient incapacity
Can minors create advance directives?
Most jurisdictions in Canada do not have legislation granting legal validity to advance directives made by nature minors.
In some provinces, the age is 16
Is there an age at which it is legal to be a substitute decision maker?
This varies between provinces
What is the problem with physician drafted advance directives, with the input of parents?
There are concerns about the variable acceptance of these advance directives by third parties such as schools and emergency medical services
What does the COS recommend re advance directives?
Advance care planning should be part of standard of care for kids with chronic illness.
We should initiate the discussions and encourage children to make their opinions known.
