Advance Care Planning by Proxy for Residents of Long-Term Care Facilities Who Lack Decision-Making Capacity

Authors: Volicer, Ladislav¹; Cantor, Michael D.²; Derse, Arthur R.³; Edwards, Denise Murray⁴; Prudhomme, Angela M.⁵; Gregory, Dorothy C. Rasinski⁶; Reagan, James E.²; Tulsky, James A.⁷; Fox, Ellen²; the National Ethics Committee of the Veterans Health Administration,

Source: Journal of the American Geriatrics Society, Volume 50, Number 4, April 2002 , pp. 761-767(7)

Publisher: Wiley-Blackwell

Abstract:

J Am Geriatr Soc 50:761-767, 2002.

This report examines whether long-term care facilities should implement policies and procedures to support advance care planning by proxy for residents who lack decision-making capacity. The report focuses on advance care planning in the Department of Veterans Affairs. After reviewing clinical, legal, and ethical perspectives, the authors conclude that advance proxy planning is ethically sound and can improve patient care. However, because experience with advance proxy planning is still fairly limited, the authors do not recommend that a particular standardized approach be mandated at the national level. Instead, local facilities are advised to develop their own policies and then evaluate their effect. The report contains specific recommendations for the advance proxy planning process.

Keywords: advance directives; proxy; long-term care; mental competency; ethics

Document Type: Research article

DOI: http://dx.doi.org/10.1046/j.1532-5415.2002.50175.x

Affiliations: 1: Geriatric Research, Education and Clinical Center, Dementia Study Unit, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts; 2: The National Center for Ethics of the Veterans Health Administration, Washington, DC; 3: Center for the Study of Bioethics and the Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; 4: The Center for Health and Well-Being, West Des Moines, Iowa; 5: Office of the General Counsel of the Department of Veterans Affairs, Washington, DC; 6: Retired VA 7: The Center for Health Services Research in Primary Care, Durham Veterans Administration Medical Center, Durham, North Carolina.

Publication date: 2002-04-01

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• In this Subject: Internal Medicine
• By this author: Volicer, Ladislav ;  Cantor, Michael D. ;  Derse, Arthur R. ;  Edwards, Denise Murray ;  Prudhomme, Angela M. ;  Gregory, Dorothy C. Rasinski ;  Reagan, James E. ;  Tulsky, James A. ;  Fox, Ellen ;  the National Ethics Committee of the Veterans Health Administration,

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