This study examined the relationship between demographics, attitudes, and subjective norms (influences) on Virginia adults over 50 with at least one adult child and the presence of estate planning documents. The Theory of Reasoned Action (Azjen & Fishbein, 1980) was applied using a secondary data set of 189 participants. Regression analyses examined paths from external variables (demographics), attitudes toward the behavior, and subjective norms to the intention and behavior. Intention and behavior were defined as the possession, intention to possess, and non-intention to possess estate planning documents. Asset-focused documents included Will, Living Trust, Durable Power of Attorney for Financial Issues, and the Letter of Instruction. Health care-focused documents included Living Will and the Durable Power of Attorney for Health Care. An analysis was also conducted on the possession of a complete set of estate planning documents. Older persons were more likely to possess all documents except the Letter of Instruction. Respondents with higher assets were more likely to possess a Will. Respondents who were more educated were more inclined to possess a Living Will. Respondents that had informally promised property to their children were more likely to possess a Living Trust. Younger respondents were more likely to intend to possess a Will, the Durable Power of Attorney for Health Care, and the Living Will. Persons with lower assets were more likely to intend to possess a Will, and those with a goal for privacy in financial affairs and who believed they should help their adult children financially were more likely to intend to possess a Living Trust. Participants who intended to possess a Letter of Instruction were more educated, male, owned homes, and had a goal for privacy in financial affairs. Age (younger) was an indirect influence to the Letter of Instruction, mediated through the goal to leave family financial security. Participants with lower assets and in good emotional health did not have intention to possess a Living Trust. Male gender and owning a home were influences on not intending to possess a Durable Power of Attorney for Financial Issues. Males were less likely to have a Letter of Instruction. Respondents with the goal to leave an inheritance were more likely to have non-intention to possess the Durable Power of Attorney for Health Care and Durable Power of Attorney for Financial Issues. More education, lower income, and residing with a relative were mediated influences to the Durable Powers of Attorney for Health Care and for Financial Issues through the goal to leave inheritance. Respondents that were older, had more assets, owned homes, had a goal to leave an inheritance, and that had informally promised their property were more likely to possess more estate documents. Indirect paths to having a set of estate planning documents were more education, lower income, and residing with a relative, which were mediated through the goal to leave inheritance. The low number of estate planning documents respondents had and the lack of intention to obtain estate planning documents indicate a need for further education in the areas of estate planning. The occurrence of older age as an influence, particularly with health care-focused documents, indicates a need for more awareness in younger adults of their vulnerability, at any age, to illness or injury and that medical directives should be in place. / Ph. D.

Criminal law issues related to Advance directives Abstract The aim of this thesis is to describe the recent institute of Advance directives in the Czech legal system and to analyze criminal law issues related with it's aplication. The focus is on medical workers which can get into jeopardy of criminal liability by respecting the Advance directives. Furthermore in this thesis are compared the legislations of Czech republic and the Australian state Queensland conserning Advance directives. Also, key rullings of Australian courts and other common law courts related to the aplicaton of Advance directives are described in this thesis. Descreption methods were aplied to describe each institute and terms close to it, analyzing methods to analyze liability of medical workers and comparative methods to compare the Czech and Queensland legislations. The thesis is divided into seven chapters and many subchapters. The first chapter is dedicated to the institute of Advance directives, to it's definition, history and to the legislations it is based in. The second chapter describes fundamental human rights related to Advance directives. These are the Right to Life, Right to dignity and the Right to self- determination. Every one of these rights is closely described and a subchapter deals with their collisions. The third...

A dignidade da pessoa humana e a autonomia privada espraiam-se pela experiência da vida, alcançando a doença e a morte. As diretivas antecipadas, gênero dos quais são espécies o testamento vital e o mandato duradouro, constituem negócio jurídico de caráter existencial que têm por objetivo assegurar a realização da dignidade da pessoa e o cumprimento dos atos de autonomia nas situações em que a pessoa estiver incapacitada para manifestar sua vontade. As diretivas representam instrumento de autodeterminação através do qual a pessoa disciplina os tratamentos médicos que aceita ou não ser submetida, autoriza doação de órgão, estipula se tem interesse em conhecer seu estado clínico e/ou nomeia terceira pessoa para tomar estas decisões em seu lugar. As três primeiras hipóteses constituem o que usualmente se qualifica como testamento vital, enquanto a última situação descrita configura o mandato duradouro. O objeto de estudo abrange a evolução das diretivas antecipadas, a disciplina existente em países que já regulamentaram o tema, a legitimação no sistema jurídico brasileiro (o que autoriza a conclusão favorável a sua utilização independentemente de lei expressa) e a sistematização deste negócio jurídico perante o ordenamento jurídico. / Human dignity and autonomy get extended through life, reaching illness and death. The advanced directives, which species are the living will and durable power of attorney, represent an existential act aimed to fulfill human dignity and to preserve ones autonomy when lacking the ability of transmitting ones desire personally (disability). The advance directives are an instrument of self-determination that may contain clauses to withheld or withdraw medical treatment, authorize organ donation, discipline the right to know ones medical condition and to indicate an attorney for health care, to whom will be delegate those decisions. The object of study covers the evolution of the advance directives, their discipline in the countries that already legislate about it, the source of legitimation in brazilian Law system (what includes a positive understanding on its usage even though without a specific law) and the guide lines of the act, such as form and legitimacy.

A dignidade da pessoa humana e a autonomia privada espraiam-se pela experiência da vida, alcançando a doença e a morte. As diretivas antecipadas, gênero dos quais são espécies o testamento vital e o mandato duradouro, constituem negócio jurídico de caráter existencial que têm por objetivo assegurar a realização da dignidade da pessoa e o cumprimento dos atos de autonomia nas situações em que a pessoa estiver incapacitada para manifestar sua vontade. As diretivas representam instrumento de autodeterminação através do qual a pessoa disciplina os tratamentos médicos que aceita ou não ser submetida, autoriza doação de órgão, estipula se tem interesse em conhecer seu estado clínico e/ou nomeia terceira pessoa para tomar estas decisões em seu lugar. As três primeiras hipóteses constituem o que usualmente se qualifica como testamento vital, enquanto a última situação descrita configura o mandato duradouro. O objeto de estudo abrange a evolução das diretivas antecipadas, a disciplina existente em países que já regulamentaram o tema, a legitimação no sistema jurídico brasileiro (o que autoriza a conclusão favorável a sua utilização independentemente de lei expressa) e a sistematização deste negócio jurídico perante o ordenamento jurídico. / Human dignity and autonomy get extended through life, reaching illness and death. The advanced directives, which species are the living will and durable power of attorney, represent an existential act aimed to fulfill human dignity and to preserve ones autonomy when lacking the ability of transmitting ones desire personally (disability). The advance directives are an instrument of self-determination that may contain clauses to withheld or withdraw medical treatment, authorize organ donation, discipline the right to know ones medical condition and to indicate an attorney for health care, to whom will be delegate those decisions. The object of study covers the evolution of the advance directives, their discipline in the countries that already legislate about it, the source of legitimation in brazilian Law system (what includes a positive understanding on its usage even though without a specific law) and the guide lines of the act, such as form and legitimacy.

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.

隨著醫學科技的進步，越來越多病患無法自主進行醫療決定的情況發生。西方國家受病人自主權的概念啟發，發展出預立醫囑(living will)及醫療代理人制度(durable power of attorney for health care)。醫療代理人制度提供個人預先指定醫療代理人，當事人無法自主做出醫療決定時，可由醫療代理人代替當事人作出醫療決定，以補足無預立醫囑或預立醫囑的不足。 我國同志伴侶於目前仍缺乏法律上的實質身分保障，伴侶相關的醫療權利正迫切且無預警的影響許多打算共組家庭而無法受法律上的婚姻制度保障的同志伴侶。雖有論者認為，可適用醫療法上「關係人」以及安寧緩和醫療條例之「醫療委任代理人」，即可滿足同志伴侶於醫療上的需求。然由於關係人的定義模糊，且實務上為避免醫療糾紛，往往要求病患的親屬到場，而不接受其他不具配偶、親屬身分關係者進行醫療行為的同意，「關係人」一詞於實務上難以適用。 本文試圖從醫療代理人制度的角度，期能另闢蹊徑，除強化並保障病人自主權外，提供同志伴侶在與生死攸關的醫療議題上更可能且直接的保障，也為不論是同志或其他愛的關係尋求更多可能，提供在婚姻以外的選擇能有更多彈性。本文除了介紹西方的醫療代理人制度並借鏡美國同志伴侶使用醫療代理人制度的經驗外，也探討醫療代理人制度對於我國家庭觀念、傳統醫療上家屬父權主義以及家庭中心式的醫療決策文化的影響與衝擊。同時更深入討論，同志伴侶必須面臨來自醫療院所、醫護人員對於同志是否友善；以及來自病患原生家庭對於醫療代理人及同志身分的壓力。 / With the advances in medical technology, the situation that patients couldn't determine their medical decisions increasingly occurs in our society. Inspired by the concept of patient autonomy, Western countries developed living will and durable power of attorney for health care, which is as known as health care proxy. Individuals can appoint a trustworthy person as their health care proxy. When the patient is incompetent, the health care proxy can make medical decisions for the patient to complete the inadequacy of living will. Same-sex couples can’t make medical decisions for their same-sex partners because same-sex marriage is currently illegal in Taiwan. Moreover, family members play an important role in the process of medical decision in Taiwan. Therefore, this article introduces the development of durable power of attorney for health care in Western countries, tries to address the medical issue of Taiwanese same-sex couples, and discusses the impact of durable power attorney for health care on Chinese traditional family values and family-centered medical decision making. While as a health care proxy, same-sex partner has to face the medical staff’s attitude toward homosexual, also has to confront the pressure from the patient’s family-of-origin.