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An advance health care directive, also known as living will, personal directive, advance directive, or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. In the U.S. it has a legal status in itself, whereas in some countries it is legally persuasive without being a legal document. A living will is one form of advance directive, leaving instructions for treatment. Another form is a specific type of power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf when they are incapacitated. People are often encouraged to complete both documents to provide comprehensive guidance regarding their care.〔(【引用サイトリンク】title=Living Wills and Powers of Attorney for Health Care: An Overview )〕 An example of combination documents includes the Five Wishes in the United States. The term ''living will'' is also the commonly recognised vernacular in many countries, especially the U.K.〔Docker, C. ''Advance Directives/Living Wills'' in: McLean S.A.M., "Contemporary Issues in Law, Medicine and Ethics," Dartmouth 1996〕 ==Background== Advance directives were created in response to the increasing sophistication and prevalence of medical technology.〔Childress, J. Dying Patients. Who's in Control? ''Law, Medicine & Health Care.'' 1989;17(3):227-228.〕〔Choice in Dying (now: Partnership in Caring). ''Choice in Dying: an historical perspective.'' CID 1035-30th Street, N.W. Washington, DC. 2007〕 Of U.S. deaths, 25%-55% occur in health care facilities.〔Current TV: News Video Clips & Current News Articles ("A Third of Americans Die in Hospitals, Study Finds" ) September 24, 2010.〕 Numerous studies have documented critical deficits in the medical care of the dying; it has been found to be unnecessarily prolonged,〔Callahan, D. ''Setting Limits'' Simon & Schuster. 1983〕 painful,〔SUPPORT Investigators. A controlled trial to improve care for seriously ill hospitalized patients: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). ''Journal of the American Medical Association.'' 1995;274(20):1591-1598.〕 expensive,〔Lubitz, J; Riley, GF. Trends in Medicare payments in the last year of life. ''New England Journal of Medicine.'' 1993;328:1092-1096.〕〔Scitovsky, A.A. The High Cost of Dying, Revisited. ''Milbank Quarterly.'' 1994;72(4):561-591.〕 and emotionally burdensome to both patients and their families.〔American Medical Association. Guidelines for the Appropriate Use of Do-Not-Resuscitate Orders. Council on Ethical and Judicial Affairs. ''Journal of the American Medical Association.'' 1991;265(14):1868-1871.〕〔McGrath, RB. In-house Cardiopulmonary resuscitation -- after a quarter of a century. ''Annals of Emergency Medicine.'' 1987;16:1365-1368.〕 Aggressive medical intervention leaves nearly two million Americans confined to nursing homes,〔Wilkkes, JL. Nursing Home Nightmares. ''USAToday.'' August 20, 1996. 11A.〕 and over 1.4 million Americans remain so medically frail as to survive only through the use of feeding tubes.〔US Congress, Office of Technology Assessment. ''Life-Sustaining Technologies and the Elderly.'' OTA-BA-306. Washington, DC: US Gov't Printing Office. July, 1987.〕 As many as 30,000 persons are kept alive in comatose and permanently vegetative states.〔〔American Academy of Neurology. Practice Parameters: Assessment and Management of Patients in the Persistent Vegetative State: Summary Statement. ''Neurology.'' 1995;45(5):1015-1018.〕 Cost burdens to individuals and families are considerable. A national study found that: “In 20% of cases, a family member had to quit work;” 31% lost “all or most savings” (even though 96% had insurance); and “20% reported loss of () major source of income.”〔Covinsky, KE; Goldman, L; Cook, EF; etal. The impact of serious illness on patient's families. ''Journal of the American Medical Association.'' 1994;272(23):1839-1844.〕 Yet, studies indicate that 70-95% of people would rather refuse aggressive medical treatment than have their lives medically prolonged in incompetent or other poor prognosis states.〔Heap, MJ; etal. Elderly patients' preferences concerning life support treatment. ''Anaesthesia.'' 1993;48:1027-1033.〕〔Patrick, DL; etal. Measuring preferences for health states worse than death. ''Medical Decision-Making.'' 1994;14:9-19.〕 As more and more Americans experienced the burdens and diminishing benefits of invasive and aggressive medical treatment in poor prognosis states – either directly (themselves) or through a loved one – pressure began to mount to devise ways to avoid the suffering and costs associated with treatments one did not want in personally untenable situations.〔 The first formal response was the living will. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Advance health care directive」の詳細全文を読む スポンサード リンク
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