Advance Directives Of To Any Physician Who Is Treating Me: Fill & Download for Free

Great question. I'll give you my perspective as an ICU physician.The biggest dilemma I encounter with advance directives is that they are rarely discussed with family, and that includes spouses and significant others (it's important to note that in the two states where I'm licensed to practice medicine, the significant other has no legal say in the management of the patient unless they are married or have a medical power of attorney). I often see a patient with and advance directive that doesn't want aggressive life-sustaining measures but hasn't discussed that with their family. What then ensues is shock that daddy or mamma wouldn't “want to live” or the accusation that I'm just trying to kill them because they don't have funding (just as an aside, I have never personally refused care to anyone based on lack of funding or any other inability to pay, and I treat every patient as if they were my family member). So inevitably, my patient ends up being put through the medical ringer, against their known and written wishes, only to have the family withdraw in a week or so. So Dr. Cantwell's rule #1 of advance directives is talk to your family about your wishes and make sure they understand and are agreeable with whatever you want.The next dilemma I encounter is that there is often no contingency plan for a medical power of attorney. If you as a patient are unable to make decisions for yourself, you should have someone names specifically who can (and is willing) to do that for you. What I see happen is that there is no named power of attorney, and the family who lives near the patient understands what the patient wants, but the family across the country has no idea and disagrees with everything being recommended by the near family. So our default is to do “"everything,” which is often against the patient's wishes and even inappropriate care (for example, the patient has a terminal disease, and we give “"life support” that is quite useless). Therefore, Dr. Cantwell's rule #2 of advance directives is name a medical power of attorney, and discuss your wishes and goals of care with them.Next would be specificity. Most of the advance directives that I see say something to the effect of “"if, in the opinion of two physicians, my condition is terminal and irreversible, blah blah blah….” Just so you know, that is useless verbage. You get everything whether you want it or not, up until the bitter end, appropriate or otherwise. And this is where disease specific concerns come into play: do you have metastatic cancer that has failed therapy two or three times? Do you have end-stage cirrhosis or COPD? Do you have end-stage dementia? These things should be discussed with your primary care doctor or specialist while you're still able; if you make it to me, it's unlikely you'll make the best decision as emotions tend to run high in the ICU. That brings us to Dr. Cantwell's rule #2 of advance directives: be specific and realistic, and get guidance from your PCP and specialists.Hope that helps!

It depends on the jurisdiction, the presence or absence of an advanced directive, the ability of the individual to make a competent decision, and the availability of law enforcement, physicians, and other resources.The most common situation in which the dying refuse treatment, or elect for only limited treatment, is those who have a known terminal condition and have obtained an advanced directive. (Often called a “Do Not Resuscitate” form or DNR.) To be binding, an advanced directive must be signed by the appropriate authority (usually a physician) as well as the individual or their representative, and a witness. (It will likely be different in different jurisdictions, but that is what I am familiar with.) In this case, I am bound by law to respect the wishes of the individual and to provide treatment only to the level of their expressed wishes.The second situation for consideration, which is extremely rare, is the case of an individual who refuses blood transfusions for religious reasons. Jehovah’s Witnesses have a strict prohibition against this practice, so once in a while it happens. I’ve never run into myself, since there are very, very few Jehovah’s Witnesses where I work, but I have spoken to people who have treated cases where this applied. However, I am not aware of any services that carry blood on their ambulances, and even those who refuse transfusion of blood are usually glad to accept other forms of life saving intervention. Their treatment under my care will be no different from anyone else, although they may die unnecessarily after arriving at the hospital as a consequence of their expressed wishes being respected.Other contingencies don’t fall as neatly into one pile or another.One example is the combative patient; these are the individuals who, due to injury, hypoxia (low oxygen levels), hypoglycemia (low blood sugar), stroke, drug intoxication, etc. are uncooperative and belligerent. “F*** you, I don’t need an ambulance! I’ll be fine, now go to hell!”.While it is clear that this individual doesn’t want care, it is unclear whether or not they are presently have the capacity to make an informed decision. If I can reasonably determine that they lack that capacity, I can get law enforcement or a physician to sign the appropriate paperwork and over-ride their right to refuse treatment, allowing me to legally treat them against their will.Of course if this person loses consciousness, or just becomes completely incoherent and stops responding appropriately, I can work from the position of implied consent. Implied consent is the idea that an individual who is found or becomes unconscious would reasonably be expected to want medical care, including life-saving measures.A different example, and not one I have ever had to face, is the patient who is obviously competent and cooperative who expresses the wish not to receive life-saving treatment, and then looses consciousness and requires CPR.Imagine an individual who appears to be having a heart attack, who is of advanced age and has a variety of medical conditions, and states plainly, “If I go this time, don’t bring me back”.I would want with all my heart to respect that individual’s choice. Lacking the proper documentation, doing so would be against the law. If there is no advance directive, and someone loses consciousness, I am obliged to work from the position of implied consent. That is one of the reasons that I often talk with people about their wishes and ask if they have had the opportunity to get an advance directive completed when I interact with them on less serious calls.

I am sick to death of the number of pretenders giving medical advice in various streams of media. Ivor Cummins is the most recent one who has been shown to me. Australia’s Pete Evans is another.These people arise out of the frustrations societies feel with actual expertise. Real experts aren’t perfect. Real experts change their minds as evidence accumulates. Real experts actually work in the fields they comment on.In contrast, there are a million panhandlers with various vague backgrounds who (especially in the COVID Pandemic) are suddenly sages. I have an advanced science degree majoring in biochemistry. Why ‘advanced’? Because it literally contained more challenging units than the regular BSc. Do I comment on molecular biology, bioinformatics, cellular behaviour and immunology to the point of directing punters how to live their lives in books I profit from? Hell no. I don’t want that responsibility! I’m not an expert. I am qualified to a pre-doctoral level in basic sciences. There is NO WAY that I can claim to have sufficient insight into whole fields just from reading other people’s work! That’s what undergraduates do, and that’s all I ever amounted to fifteen years ago in those areas.Then I got a medical degree. Does that make me an expert? Hardly. My internal medicine and surgical skills remain at the level of a competent Hospital Resident. I’m a General Practitioner - and as such my role in primary care is literally defined by the limitations of the scope of my knowledge and practice. I have some amateur interests in neuroscience and cellular biology still, but I’m not an expert. I have interests.However, I know SO MUCH MORE than many of these irresponsible idiots garnering adoring attention because of their sensationalism. It’s for that reason that I keep my mouth shut on topics like epidemiology and public health these days apart from passing on what actual experts determine. That’s because I don’t kid myself that my meagre knowledge of virology and immunology is sufficient. I don’t publish in those fields, I don’t go to conferences, I don’t teach postgrad students. I read other people’s articles in journals. That’s it.Hence, I cannot claim expertise because I do not contribute to the state of the art in any active fields. Many of my friends do. They give years to PhDs, then postdoc fellowships, then research appointments. They slog and grind, doing the real, dirty, difficult, frustrating, changeable, flawed work that produces the charts and conclusions that arrogant children then claim as if they understood. Charlatans, thieves and frauds - that’s what they are. Where are Ivor Cummins’ publications in cardiology and vascular journals? Where are Pete Evan’s contributions to Osteoporosis research?Empty. Vacuous, pretentious pantomimes that play with people’s lives. That’s what these people produce. Where’s their responsibility? They’re not registered, they’re not liable - they are literally protected from the law because they’re unqualified. Yet these fools talk about ‘knowing more than your doctor’. Well, if they do then they can run a clinic. They can publish. They can do some goddamn work instead of defecating on the discipline and determination of the unsung men and women who actually produced the evidence they toy with so arrogantly.These people need to be held to account. They are hiding behind the fact that they don’t have any responsibility. It’s not given to them because they haven’t earned it. If they had, they would feel the weight of their words much more keenly, and speak less of them.Listen to the people who actually contribute more than a youtube channel and a coffee-table book. Shame on them.A physician who treats himself has a fool for a patient..