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Planning for Decisional Incapacity
Author(s) -
High Dallas M.
Publication year - 1987
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1987.tb06361.x
Subject(s) - proxy (statistics) , delegation , medicine , health care , plan (archaeology) , medical decision making , advance care planning , nursing , family medicine , law , computer science , archaeology , machine learning , political science , history , palliative care
Practitioners and elderly patients share a common interest in advance planning for future health care decision‐making in the event of decisional incapacity. It is argued that advance directives can: 1) assist the elderly person in maximizing self‐determination; and 2) help physicians in caring for the elderly and their families by removing conflict potential. Furthermore, the author compares the legal and medical understandings of patient self‐determination and the uses of best interest and substituted judgment standards. It is argued that medicine and law differ on the important issues only in degree of emphasis, not in principle. To clarify the issues, a systematic classification of the multiple levels of instruction directives and agent‐proxy decision‐making models is developed. Finally, it is recommended that health care decision‐making for the elderly can be enhanced by encouraging patients to: 1) create as much evidence as possible to affirm their preferences and values; and 2) plan the delegation of decisions by appointing a proxy.