What is a durable power of attorney for healthcare?Ī durable power of attorney for healthcare is a document that legally gives authority to a surrogate, or healthcare proxy, to make healthcare decisions for a person who is mentally incompetent or physically incapacitated. And in the absence any advance directive, medical personnel will turn to next of kin-usually spouse first, then adult children-for healthcare decisions. In the absence of a healthcare proxy, medical personnel should take guidance about the patient's wishes as expressed in a legally executed advance directive called a living will. If the patient is not mentally competent or is physically incapacitated so that communication is not possible, then the decision about treatment may be made by a surrogate, known as a healthcare proxy, who has been assigned by an advance directive known as a durable power of attorney for health care. If the patient is mentally competent, then he or she makes medical treatment decisions-usually in consultation with medical personnel, counselors or spiritual advisors and family members. Who decides on the medical treatment of an ill patient? The goal of hospice care is to ensure that the physical, spiritual and emotional needs of patients are all met so that they may live well while dying. The hospice patient is attended by a team of caregivers including medical personnel, counselors, clergy and family members. Hospice care is "comfort care," which can occur in either a hospice facility or in a patient's home. A hospice is for patients who have a terminal illness, who have suspended curative efforts and who want to die in a homelike setting. Based on these findings, concern about hastening death does not justify withholding opioid therapy.What is the difference between a hospital and a hospice?Ī hospital is for patients seeking medical treatment to cure their illness or injury. In a hospice population, survival is influenced by complex factors, many of which may not be measurable. This analysis revealed that opioid dosing was associated with time till death, but this factor would explain very little of the variation in survival. Analyses of subsamples did not reveal additional effects of dose. Multivariate models demonstrated a significant association between shorter survival and higher opioid dose, a cancer diagnosis, unresponsiveness, and pain of 10% of the variance in time till death. The mean+/-SD number of days between final dose change and death was 12.46+/-23.11. Multivariate least squares regression analyses determined associations between survival and other variables, including those significant in bivariate analyses. Spearman rank correlations examined bivariate associations between survival after final dose change and other variables, including dose in morphine equivalent mg and percentage dose increase. Subsamples based on maximum opioid dose compared patients receiving usual doses with those receiving high-dose therapy. Of 1,306 patients, 725 received opioids and underwent at least one dose change before death. To determine whether survival after last opioid dose change is associated with opioid dosing characteristics and other factors, data from the National Hospice Outcomes Project, a large prospective cohort study involving 13 U.S. Studies that assess the true risks are needed. Concern that opioids hasten death may be among the reasons that pain is treated inadequately in populations with advanced illness.
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