MANAGING CARE( continued)
Mental Health Treatment Preference
This type of directive asks you to state whether you would allow electroconvulsive treatment( ECT) or psychotropic medicine if you have a mental illness and are unable, at the time, to make these decisions for yourself. In addition, you can express whether you will accept admission to a mental health facility for up to a certain number of days( for example, 17 days). You can name someone to speak for you. These orders are written and have an expiration( such as, three years from signature date). They require witnesses. Mental health treatment directives can be canceled in writing as long as you are not receiving mental health treatment at the time of cancellation.
It is important to note that not all states have a mental health treatment advance directive, and requirements may vary by state.
Guardianship
A guardian is a legally responsible individual who is court-appointed— on a limited-time or full-time basis— when an individual is not able to make their own decisions and there are no advance directives and designated healthcare proxy, or no next of kin( commonly referred to as surrogates). Other instances that might necessitate a court-appointed guardian include families in which multiple first-degree relatives cannot agree— even with mediation, or where a next of kin is clearly acting in their own self-interest and not that of the patient. Fortunately, formal guardianship is rarely required.
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Points Pertinent to PSP and Related Diseases
Patients and family members often put off what they view as the morbid discussion of whether artificial nutrition and hydration( ANH, or tube feeding) should be used if swallowing problems or advanced dementia keep the patient from eating and drinking normally. Without the discussion, however, a crisis situation can develop. If the person with PSP is unable to make their wishes known, then it is left to the Durable Power of Attorney for Health Care to decide whether or not to place a feeding tube.
If the person with PSP is competent and able to make care decisions, then the question of whether to accept ANH can be made based on individual circumstances and beliefs. But what if the patient is no longer able to make personal decisions and has not previously completed a Durable Power of Attorney for Health Care? The person acting as the health decision surrogate( spouse, partner, adult child, sibling, close friend) may struggle with the ANH decision and not have much time to think about it. The following information may be of help.
If ANH is being suggested because the patient is at risk for aspirating or has had a bout of aspiration pneumonia, it is important to know that the feeding tube will not prevent bacteria-laden saliva and nasal secretions from getting into the lungs and causing infection. In other words, patients could still die of pneumonia.
Placing a feeding tube in a severely demented person can result in the patient trying to pull the tube out and needing to be physically restrained. This can worsen any agitation the person might have and may lead to the use of sedative medications. In the Cochrane review done in London, doctors searched for evidence that tube feeding improved the quality of life for people with advanced dementia— but could not find any. They, in fact, found some evidence that tube feeding increased mortality and morbidity, and reduced quality of life.