The Self-determination act requires health care facilities that receive Medicare funding to inform patients their right to make their own advance directives. Research has shown that family members experience far less stress when a dying patient has a living will or has a medical power of attorney however, fewer than one in five adults has executed an advance directive.

Since nurses are also patient advocates, they play a vital role in encouraging patients to prepare such documents before they become terminally ill. In order to be an effective patient advocate on these cases one needs to have an understanding of advance directives and what role they play on it.

Since the terms may vary from one state to another, a document in which an individual specifies his or her wishes not to be maintained on artificial life support if there is no hope of a meaningful recovery, for example—is generally known as a living will. But no written statement can cover every eventuality, so a patient should discuss his preferences with a loved one, then sign a document—typically known as a medical power of attorney— authorizing that person to make medical decisions in the event that the patient becomes unable to make them himself. A copy of a living will or medical power of attorney, or both, should be placed in the patient’s medical record.

If family members disagree about following the expressed wishes of an incapacitated patient or a conflict over end-of-life care arises, you should notify the primary care provider and recommend a consultation with your facility’s ethics team. As a nurse for this patient your role being a patient advocate is essential in making sure that your patient’s’ treatment wishes are observed and followed.