Senior Sunrise

Advance directives began to be developed in the United States in the late 1960.

The First Living Wills:

In 1967, the first living will was suggested to facilitate “the rights of dying people to control decisions about their own medical care.”

In 1968, the first living will legislation was presented to a state legislature. It was introduced, and defeated twice in Florida.

In 1974 it was introduced  in California and defeated.

Introduced again in 1976, and CA became the first state in the nation to legally sanction living wills.

The States:

By 1977, forty-three states had considered living will legislation and seven states had passed bills.

Advance directive legislation has subsequently progressed on a state- by-state basis.

By 1992, all fifty states, as well as the District of Columbia, had passed legislation to legalize some form of advance directive.

 NJ 1976 - The first court decision to validate advance directives was at the state level. Patients have the right to refuse treatment even if this refusal might lead to death.

If patients are mentally unable to make treatment decisions, someone else may exercise their right for them.

Decisions that can lead to the death of a mentally incompetent patient are better made not by courts but by families, with the input of their doctors.

Decisions about end-of-life care should take into consideration both the invasiveness of the treatment involved and the patient’s likelihood of recovery.

The case in which Judge Hughes ruled was the request by Joe Quinlan to make legally binding health care decisions for his daughter, Karen Ann Quinlan. As a result of the case, Karen Ann Quinlan was gradually weaned from mechanical ventilation. (NJ 1976)

The Federal Government:

The U.S. federal government has shown its interest in advance directives through two of its bodies, the Congress and the Supreme Court.

The U.S. House of Representatives in 1991 enacted the Patient Self- Determination Act. The Act stipulates that all hospitals receiving Medicaid or Medicare reimbursement must ascertain whether patients have or wish to have advance directives.

The Patient Self- Determination Act does not create or legalize advance directives; rather it validates their existence in each of the states.

Today:
In the United States, four out of every five adults has no advance directive.

In 1950, about half of Americans who died did so at home.

Now, about 85% of Americans die in a health care setting: a hospital, a nursing home or a rehabilitation center.

At least 12% die in an intensive care unit.

As seen by the stats above the idea of a medical directive, and living wills has taken time to evolve. They are timely subjects, and upon their completion they offer both the family, and the requestor a sense of calm that he/she will be cared for as he/she intended.  Take time to think and research your choices for living wills and medical directives.