Use of Advance Directives in Long-term Care Populations

An advance directive (AD) allows a patient to communicate health care preferences in the event that he or she is no longer able to make these decisions (1). Many view advance care planning (ACP)—a process that includes discussing values and goals of care among the patient, family, and physician, and determining or executing treatment directives—as a way to help ensure that wishes about end-of-life care are honored (2). Ideally, ADs are part of the ACP process.  Research indicates that the preference for having an AD can be influenced by individual attitudes, cultural beliefs, health conditions, and trust in health care professionals. This report, from the National Center for Health Statistics (U.S.), presents the latest national data on ADs in three long-term care populations—those receiving home health care or hospice care and those residing in nursing homes.


http://www.cdc.gov/nchs/data/databriefs/db54.pdf

Advance Care Planning National Guidelines

These guidelines were released February 2009, and are published by the Royal College of Physicians (UK) in collaboration with The National Council for Palliative Care, British Society of Rehabilitation Medicine, Alzheimer's Society, Royal College of Nursing, RC College of Psychiatrists, Help the Aged, and the Royal College of General Practitioners.

http://www.rcplondon.ac.uk/clinical-standards/organisation/Guidelines/concise-guidelines/Pages/RCP_ConciseGuideline_AdvancedCarePlanning.aspx

Advance Care Planning in Care Homes for Older People

This UK based survey describes current ACP practice in care homes for older people; to what extent this is currently undertaken, how this is done and to highlight good practice already in use within the sector in order to develop a good practice guide.

http://www.counselandcare.org.uk/assets/library/documents/ACP_in_care_homes_a_survey_of_current_practice_2008.pdf

Withholding and Withdrawing Life Sustaining Treatment

Three resources on this controversial issue recently making headlines in the news.

The College of Physicians and Surgeons of Manitoba.
Withholding and withdrawing life-sustaining treatment
This statement was issued by The College on January 30, 2008.
http://www.cpsm.mb.ca/statements/1602.pdf

Strauss, Sharon. Whose life is it anyway? Capacity and consent in Canada. Canadian Medical Association Journal, November 20, 2007; 177 (11).
This editorial appeared in the Canadian Medical Association Journal in November, 2007.
http://www.cmaj.ca/cgi/content/full/177/11/1329

The End of Life Project, Health Law Institute, Dalhousie University
The Dalhousie Health Law Institute End of Life Project was originally an educational research project involving members of the Health Law Institute at Dalhousie University and their colleagues across the country. The project was funded by the Max Bell Foundation and the Nova Scotia Health Research Foundation. The primary objective of this project was to facilitate informed public policy debate regarding the provision of potentially life-shortening palliative treatment and the withholding and withdrawal of potentially life-sustaining treatment.
http://as01.ucis.dal.ca/dhli/cmp_ww/default.cfm