Introdução As Diretivas Antecipadas de Vontade, também denominadas Testamento Vital constituem um documento com o registro expresso do desejo de um cidadão de recusar tratamento, caso venha a sofrer de alguma enfermidade terminal. Dessa forma, busca desconstruir uma cultura centrada no paternalismo que reduz o indivíduo doente a um paciente que deve aguardar, resignado e submissamente, que deliberações acerca de sua vida sejam tomadas por outros, sem que possa se manifestar ou decidir, autonomamente, como quer ser tratado ou que tipo de práticas de intervenção está disposto a aceitar. Objetivo - O presente trabalho objetivou conhecer a representação do Testamento Vital para os enfermeiros que atuam na assistência à pacientes em situação de terminalidade. Método - Trata-se de pesquisa de natureza qualitativa realizada com quinze enfermeiros que atuam na assistência à pacientes terminais, por meio de entrevistas norteadas pela seguinte questão Fale a respeito do Testamento Vital. Após a aprovação do Comitê de Ética em Pesquisa, houve a obtenção dos depoimentos que foram analisados de acordo com o método do Discurso do Sujeito Coletivo com fundamentação na Teoria das Representações Sociais de Serge Moscovici. Resultados - A pesquisa identificou três categorias que compõem o Discurso do Sujeito Coletivo: o enfermeiro frente às diretivas antecipadas de vontade; o enfermeiro frente à família contrária à vontade do paciente e o enfermeiro frente ao médico contrário à vontade do paciente. Conclusão - O testamento vital representa, na perspectiva dos enfermeiros, a autonomia e o direito do paciente pelas decisões nas situações de terminalidade que devem ser compartilhadas com seus familiares e profissionais de saúde. Não obstante, o enfermeiro pode vivenciar conflitos éticos nas situações em que o desejo manifestado por meio desse documento não é respeitado por familiares e/ou médicos. Diante dessa situação, o enfermeiro pode perceber a própria ação como limitada e sentir-se frustrado com a impossibidade de atender o desejo do paciente. / Introduction: Advance Directives also known as the Living Will Declaration constitute a manifestation of will by means of a document written by a person fully healthy of his mental faculties in order to dispose of the care, treatment and procedures that whether or not he or she wants to be submitted in case of a disease that is beyond therapeutic possibilities and incapable of manifesting his or her will freely. Objective - To know the representation of Living Will Declaration for nurses who work with terminally ill patients. Method - This is a qualitative research carried out with fifteen nurses who work in the care of terminal patients, through interviews guided by the following question \"Talk about the Living Will Declaration\". After the approval of the Committee of Ethics in Research, the interviews were obtained, which were analyzed according to the Collective Subject Discourse method based on Serge Moscovici\'s Theory of Social Representations. Results - The research identified three categories that make up the Discourse of the Collective Subject: \"the nurse in front of the advance directives \"; \"The nurse facing the family contrary to the will of the patient\" and \"the nurse facing the doctor contrary to the will of the patient\". Conclusion - The living will declaration represents, from the perspective of nurses, the autonomy and the right of the patient for decisions in terminal situations that should be shared with family members and health professionals. Nonetheless, nurses may experience ethical conflicts in situations where the desire expressed through this document is not respected by family members and / or doctors. Faced with this situation, the nurse can perceive the action as limited and feel frustrated with the impossibility of fulfilling the patient\'s desire.

Civil Liability in the Case of Disrespecting a Patient's Advance Directives The aim of this thesis is to analyse and describe the problematic of Civil Liability in the specific case of disrespecting a patient's advance directives by a medical. The institute of Advance Directives was first introduced in the Czech law by the Convention on Human Rights and Biomedicine in 2001 and later by the Law No. 372/2011 Coll., Act on Health Care Provision. Thought the Advance Directives cannot be considered as a new institute in the Czech law, it is hardly ever used in practice. There is no judicature and practical knowledge on the topic of civil liability in this case, and the insecurity causes that doctors do not feel like willing to respect the exceptionally occurring advance directives, because they fear the criminal liability they think that could arise if they did not provide the health care necessary for saving life of their patient. This thesis is trying to highline the importance of a patient's will. Meanwhile, it is pointing to the fact that even saving a patient's life can cause legal liability of a doctor. The thesis is primarily analysing and describing such liability within the general provisions on liability in the Czech Law and is also trying to give an insight to the problematic of potential...

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The purpose of this article is to synthesize the evidence on advance care planning (ACP), determine what is applicable to the home health (HH) setting, and find where gaps in knowledge may exist. An integrative review methodology was chosen. Although there is ample literature on the topic of ACP, most research has been conducted in the acute care, outpatient, and general community settings. There is limited literature regarding ACP with patients living with chronic cardiovascular and pulmonary illnesses, who comprise the majority of the HH population. Some literature has been published regarding the interprofessional team's role in ACP in the HH setting. A gap in knowledge exists regarding ACP in HH, and recommendations for future research are provided.

The number of individuals aged more than 65 years in the United States and their life expectancy has been increasing in the past decades. In spite of the presence of federal and accreditation policies recommending completion of advance directive documents by patients admitted to health care settings, advance directive completion rates are low in most health care organizations. The purpose of this study was to determine the level of advance directive completion among home health patients. The health belief model provided the theoretical framework that guided this study. A retrospective chart review was carried out in a home health agency with about 51 patients. Demographic details, including age, gender, ethnicity, nature of illness and type of health insurance were collected. Descriptive statistics were used to determine the percentage of home health patients with existing advance directives and those who do not have an advance directive. The study revealed that only 25% of the patients in the home health care agency had a completed advance directive. The finding indicate a disconnect between the recommended and the actual practice with regards to end of life issues. There is a pressing need for more complete documentation of the patient's desires and wishes regarding end of life care at home health care facilities. Documenting the patient's end of life preferences and wishes may potentially ease the decision-making process, making the end of life days less stressful for the patients and their families at the same time promoting the provision of personalized health care at the end of life.

Individuals who are facing death today are doing so in an environment that is significantly different than it was in the past. Medical technology is increasingly able to keep people alive even with multiple complex chronic conditions. While these advances in medicine are beneficial to many, it can also unnecessarily prolong inevitable deaths. Concerns over the ability to have a death that is in alignment with personal values has increased the interest in the use of formal end-of-life planning including writing an advance instructional directive and assigning a durable power of attorney for health care. Although research has indicated that the use of these formal planning strategies is beneficial, not everyone completes them. Using a current nationally representative sample, the three specific aims of this study were to examine whether there are racial and ethnic differences in formal end-of-life planning done by older African American, Hispanic, and White adults; to examine socioeconomic factors including education and income in formal end-of-life planning as well as assess the contribution of these factors in explaining racial and ethnic differences in formal end-of-life planning; and to examine the role of religiosity in formal end-of-life planning and to assess its influence on racial and ethnic differences in explaining formal end-of-life planning. Logistic regression was run on data from the Health and Retirement Study (HRS) in order to analyze the completion of formal end-of-life plans by African American, Hispanic, and White decedents. Exit interviews conducted with knowledgeable proxies in 2008 or 2010 were combined with data from earlier waves of the HRS survey in order to analyze the completion of formal end-of-life plans, race and ethnicity, socioeconomic status, and religion. Both Blacks and Hispanics were less likely to complete a written advance directive, assign a proxy, or complete both forms of formal planning than were Whites. Group differences remained after controlling for region of death and cause of death. Both Blacks and Hispanics were less likely to complete any form of formal planning than Whites. Group differences remained after additionally controlling for gender, age, marital status, whether the decedent had children, income, education, religious preference, importance of religion, and frequency of attending religious services. Higher levels of income and education both increased the odds that formal advance planning would take place. Religious preference was not significant, but decedents who had stated that religion was very important were less likely to plan while those that attended services frequently were more likely to plan. I speculate that the role of cultural capital may partially explain the persistent racial and ethnic disparities and the importance of income and education. Additionally the dominant religious doctrines of Christianity may have a greater influence than the different religious teachings of Protestant and Catholics around end-of-life medical care. Contrary to expected findings, reference groups of those who attend religious services frequently may assist in formal planning. These finding may help guide interventions that can diminish disparities in the end-of-life experience. Understanding who are completing formal plans can help ensure end-of-life care that is in alignment with personal beliefs and values.

The purpose of this article is to synthesize the evidence on advance care planning (ACP), determine what is applicable to the home health (HH) setting, and find where gaps in knowledge may exist. An integrative review methodology was chosen. Although there is ample literature on the topic of ACP, most research has been conducted in the acute care, outpatient, and general community settings. There is limited literature regarding ACP with patients living with chronic cardiovascular and pulmonary illnesses, who comprise the majority of the HH population. Some literature has been published regarding the interprofessional team's role in ACP in the HH setting. A gap in knowledge exists regarding ACP in HH, and recommendations for future research are provided.

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Psychiatric advance directives (PADs) are legal documents allowing competent individuals to declare their treatment preferences in advance of a mental health crisis. The objective of this thesis is to examine psychosocial perceptions of legal and mental health professionals in Ontario and Quebec regarding their knowledge and willingness to implement PADs. Two hundred professionals---psychiatrists, psychologists, lawyers and administrative tribunal members---participated in an Web-survey measuring psychosocial perceptions of clinical, ethical, legal and implementation factors of PADs. Results indicate Quebec professionals are more willing to begin using PADs than Ontario professionals. Mental health professionals reported more concern than legal professionals for medical malpractice lawsuits for overriding PADs. Advantages of PADs most commonly reported are patients' ability to declare their clear wishes ahead of time, respect for autonomous choice, and establishing a collaborative treatment plan with physicians. Disadvantages included patients' lack of awareness, treatment refusal, and being self-bound to an earlier decision.

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