types of advance health care
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The two types of advance health care directives are the living will and the health care proxy or surrogate. The living will provides spe- cific instructions about what medical treatment the client chooses to omit or refuse (e.g., ventilatory support) in the event that the client is unable to make those decisions.
The health care proxy, also referred to as a durable power of at- torney for health care, is a notarized or witnessed statement appointing someone else (e.g., a relative or trusted friend) to manage health care treatment decisions when the client is unable to do so. Figure 4–4 • shows an example of an advance health care directive that combines a living will declaration and a durable power of attorney for health care. A form specific to the state in which you live can be obtained from the National Hospice and Palliative Care Organization.
Nurses should learn the law regarding client self-determination for the state in which they practice, as well as the policies and pro- cedures for implementation in the institution where they work. The legally binding nature and specific requirements of advance medi- cal directives are determined by individual state legislation. In most states, advance directives must be witnessed by two people but do not require review by an attorney. Some states do not permit relatives, heirs, or primary care providers to witness advance directives. As a client advocate, it is important for the nurse to facilitate family discus- sion about end-of-life concerns and decisions.
AUTOPSY An autopsy or postmortem examination is an examination of the body after death. It is performed only in certain cases. The law de- scribes under what circumstances an autopsy must be performed, for example, when death is sudden or occurs within 48 hours of admis- sion to a hospital. The organs and tissues of the body are examined to establish the exact cause of death, to learn more about a disease, and to assist in the accumulation of statistical data.
The primary care provider or, in some instances, a designated individual in the hospital is responsible for obtaining consent for an autopsy. Consent must be given by the decedent (before death) or by the next of kin. Laws in many states and provinces prioritize the fam- ily members who can provide consent as follows: surviving spouse, adult children, parents, and siblings. After an autopsy, hospitals can- not retain any tissues or organs without the permission of the indi- vidual who consented to the autopsy.