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An advance healthcare directive is exclusively known as a living will in the United States.
Answer: False
Explanation: The term 'advance healthcare directive' is a broad category that includes documents like living wills, personal directives, and healthcare proxies. A living will is one specific type of advance directive, not the exclusive term for it.
In some countries outside the U.S., an advance healthcare directive is legally persuasive but not considered a formal legal document.
Answer: True
Explanation: The source material specifies that while an advance healthcare directive has legal status as a document in the United States, in some other countries it is considered legally persuasive rather than a formal legal document.
The Five Wishes document in the United States is an example of a combined advance directive that integrates various aspects of advance care planning.
Answer: True
Explanation: The source identifies the Five Wishes document as an example of a combined directive in the U.S. that integrates multiple aspects of advance care planning into a single form.
The legality of advance consent for advance healthcare directives is uniform across all jurisdictions.
Answer: False
Explanation: The legality of advance consent for these directives is not uniform; it depends on the specific jurisdiction.
A living will can only provide general instructions and cannot be used to refuse specific medical treatments.
Answer: False
Explanation: A living will can be very specific, forbidding the use of various kinds of burdensome medical treatments and expressing wishes on services like hydration, feeding, and ventilators.
A living will is activated only if the individual becomes unable to give informed consent or refusal due to incapacity.
Answer: True
Explanation: The source explicitly states that a living will is used only if the individual has become unable to give informed consent or refusal due to incapacity.
Living wills do not require regular updating as they reflect a permanent decision.
Answer: False
Explanation: Living wills reflect a person's wishes at a specific moment and may need regular updating to ensure they remain relevant to evolving medical situations.
Which of the following is NOT an alternative name for an advance healthcare directive mentioned in the source?
Answer: End-of-life testament
Explanation: The source identifies several alternative names for an advance healthcare directive, including living will, personal directive, medical directive, and advance decision. 'End-of-life testament' is not mentioned among these terms.
What is the legal status of an advance healthcare directive in the United States?
Answer: It has legal status as a document.
Explanation: The source explicitly states that in the United States, an advance healthcare directive has legal status as a document.
Why are individuals often encouraged to complete both a living will and a healthcare proxy?
Answer: To provide comprehensive guidance regarding their care.
Explanation: People are encouraged to complete both documents to provide comprehensive guidance, as a living will outlines specific wishes and a proxy appoints a person to make decisions.
Under what condition is a living will typically activated?
Answer: If the individual becomes unable to give informed consent or refusal due to incapacity.
Explanation: A living will is activated only if the individual becomes unable to give informed consent or refusal due to incapacity.
Advance directives were primarily created to address the rising costs of medical care for the dying.
Answer: False
Explanation: Advance directives were created in response to the increasing sophistication and prevalence of medical technology that could prolong life, not primarily to address costs.
The oldest form of advance directive is the healthcare proxy.
Answer: False
Explanation: The living will is identified as the oldest form of advance directive, predating the development of the healthcare proxy.
Luis Kutner, an Illinois attorney, first proposed the living will in a law journal in 1967.
Answer: False
Explanation: Luis Kutner first proposed the living will in a speech in 1967, but it was subsequently published in a law journal in 1969.
The U.S. Patient Self-Determination Act (PSDA) went into effect in December 1991, requiring healthcare providers to inform patients about their rights regarding advance directives.
Answer: True
Explanation: The PSDA became effective in December 1991, mandating that healthcare providers give patients information about their rights to make advance directives under state law.
What was the primary driver for the creation of advance directives?
Answer: The increasing sophistication and prevalence of medical technology.
Explanation: Advance directives were created in response to the increasing sophistication and prevalence of medical technology, which allowed for more interventions to prolong life.
Which form of advance directive is identified as the oldest?
Answer: The living will
Explanation: The source material identifies the living will as the oldest form of advance directive.
Who first proposed the concept of a living will?
Answer: Luis Kutner, an Illinois attorney.
Explanation: The living will was first proposed by Illinois attorney Luis Kutner in a 1967 speech to the Euthanasia Society of America.
When did the U.S. Patient Self-Determination Act (PSDA) go into effect?
Answer: December 1991
Explanation: The U.S. Patient Self-Determination Act (PSDA) went into effect in December 1991.
What was the first formal response to societal pressure for end-of-life planning in the U.S.?
Answer: The living will.
Explanation: The living will is identified as the first formal response to the societal pressure for ways to plan for end-of-life care in the U.S.
A healthcare proxy is a type of advance directive that provides specific instructions for medical treatment, similar to a living will.
Answer: False
Explanation: A healthcare proxy appoints a person to make real-time decisions, whereas a living will provides pre-written instructions for hypothetical situations.
Despite their popularity, living wills were found to have limitations, often failing to fully address presenting problems and needs.
Answer: True
Explanation: The source notes that as living wills became better recognized, key deficits were discovered, as they tended to be limited in scope and often failed to fully address presenting problems.
Early power of attorney documents in the U.S. were primarily used to allow individuals to name someone to act in their stead regarding property affairs.
Answer: True
Explanation: The source states that early powers of attorney, based on common law, allowed an individual to name someone to act in their stead, which was later adapted for healthcare decisions.
A healthcare proxy is authorized to make real-time decisions in actual circumstances, unlike advance decisions in a living will.
Answer: True
Explanation: A key distinction is that a healthcare proxy makes real-time decisions in actual circumstances, whereas a living will contains advance decisions framed in hypothetical situations.
A study found that next-of-kin surrogates accurately predicted an incapacitated person's treatment preferences 90% of the time.
Answer: False
Explanation: A study found that next-of-kin surrogates chose correctly only 68% of the time, highlighting the difficulty in predicting another person's wishes without explicit guidance.
A values history advance directive focuses on specific treatments and medical procedures rather than patient values.
Answer: False
Explanation: The goal of a values history is to shift the focus away from specific treatments and toward a patient's broader values and personal goals.
A medical directive describes six case scenarios for advance medical decision-making, each linked to a roster of medical procedures.
Answer: True
Explanation: The source describes the medical directive as a document with six case scenarios, each associated with a list of medical procedures, allowing individuals to specify their choices in advance.
What was a key deficit discovered about living wills as they became better recognized?
Answer: They tended to be limited in scope and often failed to fully address presenting problems.
Explanation: A key deficit of living wills was that they were often limited in scope and failed to fully address the specific problems and needs that arose in medical situations.
What is the primary function of a healthcare proxy document?
Answer: To appoint a person, the proxy, who can make healthcare decisions on behalf of the granting individual in the event of incapacity.
Explanation: A healthcare proxy document's main purpose is to appoint a person (the proxy) to make healthcare decisions for the individual if they become incapacitated.
What is a 'values history' in the context of advance directives?
Answer: A two-part instrument eliciting patient values about terminal medical care and therapy-specific directives.
Explanation: A values history is a two-part advance directive that elicits a patient's values regarding terminal care and provides therapy-specific directives, serving as an alternative to a conventional proxy.
What is the primary goal of a values history advance directive?
Answer: To move away from a focus on specific treatments to a focus on patient values and personal goals.
Explanation: The goal of a values history is to shift the focus from specific medical treatments to the patient's broader values and personal goals.
Psychiatric advance directives (PADs) are legal documents used by individuals to declare preferences for future mental health treatment.
Answer: True
Explanation: PADs are legal documents for individuals with legal capacity to declare their preferences for future mental health treatment in the event they are later unable to make decisions for themselves.
All 50 U.S. states have passed legislation establishing authority for Psychiatric Advance Directives (PADs).
Answer: False
Explanation: The source states that in the decade prior to its publication, 25 states had passed legislation establishing authority for PADs, not all 50.
A Duke University study found that creating a PAD with a trained facilitator decreases therapeutic alliance with clinicians.
Answer: False
Explanation: The study found the opposite: creating a PAD with a trained facilitator increases the therapeutic alliance with clinicians.
National surveys in the U.S. indicate that most people targeted by coercive psychiatry laws have completed a PAD.
Answer: False
Explanation: National surveys show a large discrepancy: while about 70% would want a PAD, less than 10% have actually completed one.
The more clinicians knew about PAD laws, the less favorable their attitudes were toward these practices.
Answer: False
Explanation: A survey showed a positive correlation: the more clinicians knew about PAD laws, the more favorable their attitudes were toward these practices.
What is a Psychiatric Advance Directive (PAD)?
Answer: A written document describing what a person wants to happen if they are judged to have a mental disorder and are unable to decide for themselves.
Explanation: A PAD is a written document outlining a person's preferences for mental health treatment in the event they are later deemed unable to decide for themselves.
How many U.S. states had passed legislation establishing authority for Psychiatric Advance Directives (PADs) in the decade prior to the source's information?
Answer: 25 states
Explanation: In the decade preceding the source's information, 25 U.S. states had passed legislation establishing authority for PADs.
What does the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) require of behavioral health facilities regarding PADs?
Answer: To ask patients if they have PADs.
Explanation: The JCAHO requires behavioral health facilities to ask patients if they have a Psychiatric Advance Directive.
According to a Duke University study, what is a clinical benefit of creating a PAD with a trained facilitator?
Answer: Increased therapeutic alliance with clinicians.
Explanation: A Duke University study demonstrated that creating a PAD with a trained facilitator increases the therapeutic alliance between patients and their clinicians.
Tasmania, Australia, has specific legislation concerning advance healthcare directives.
Answer: False
Explanation: The source explicitly states that Tasmania has no specific legislation concerning advance healthcare directives.
In Canada, only about 13% of Canadians have actually had a conversation with a loved one about end-of-life planning or created an advance care plan.
Answer: True
Explanation: Polling data indicates that despite 96% of Canadians believing such conversations are important, only about 13% have actually created an advance care plan or had the discussion.
In the UK, emergency care and treatment plans (ECTPs) are always formed with direct patient or family involvement.
Answer: False
Explanation: Research has found that the involvement of patients or their families in forming ECTP recommendations is variable, and in some situations, professionals may not explore patient preferences.
In England and Wales, an advance refusal of life-prolonging treatment must be recorded in writing and witnessed to be legally binding.
Answer: True
Explanation: For an advance decision refusing life-prolonging treatment to be legally binding in England and Wales, it must be recorded in writing and witnessed.
Germany's law on advance directives, passed in 2009, is based on the principle of the right of self-determination.
Answer: True
Explanation: The German law on advance directives, which became applicable in September 2009, is explicitly based on the principle of the right of self-determination.
The Italian Senate officially approved a law on advance healthcare directives in 2006, following the Piergiorgio Welby case.
Answer: False
Explanation: While the Piergiorgio Welby case occurred in 2006, the Italian Senate did not approve the law on advance healthcare directives until December 14, 2017.
Advance healthcare directives are legally recognized in Japan, with a high percentage of the population having prepared them.
Answer: False
Explanation: Advance healthcare directives are not legally recognized in Japan, and a 2017 survey showed that only 8.1% of individuals had prepared one.
In Nigeria, advance healthcare directives are legally recognized and widely used due to strong traditional influences.
Answer: False
Explanation: Advance healthcare directives have not yet been legalized in Nigeria, where tradition, rather than written directives, still dominates in determining patient preferences.
In Israel, the right to refuse care through advance directives is recognized only if the patient's life expectancy is less than six months.
Answer: True
Explanation: Israel's law on advance care directives recognizes the right to refuse care only when the patient is considered terminally ill with a life expectancy of less than six months.
Switzerland's 2013 law on advance healthcare directives allows adults to designate a natural person to make medical decisions on their behalf.
Answer: True
Explanation: The 2013 Swiss law allows individuals to designate a natural person to discuss medical procedures and make decisions on their behalf if they are no longer capable of judgment.
What percentage of Canadians, according to polls, think that having a conversation with a loved one about planning for the end of life is important?
Answer: 96%
Explanation: Polling indicates that an overwhelming majority, 96% of Canadians, believe it is important to have a conversation with a loved one about end-of-life planning.
What did a 2014 Ipsos Reid Survey find about Canadian primary care professionals' comfort with end-of-life discussions?
Answer: Only about a third felt comfortable.
Explanation: A 2014 survey revealed that only about one-third of Canadian doctors and nurses in primary care felt comfortable discussing end-of-life issues with their patients.
Under what legal framework can individuals in England and Wales make advance directives or appoint a proxy?
Answer: The Mental Capacity Act 2005.
Explanation: In England and Wales, individuals can make an advance directive or appoint a proxy under the provisions of the Mental Capacity Act 2005.
What is required for an advance refusal of life-prolonging treatment to be legally binding in England and Wales?
Answer: It must be recorded in writing and witnessed.
Explanation: For an advance decision refusing life-prolonging treatment to be legally binding in England and Wales, it must be recorded in writing and witnessed.
When did Germany pass its law on advance directives?
Answer: June 2009
Explanation: On June 18, 2009, the German Bundestag passed a law on advance directives, which became applicable on September 1, 2009.
What event sparked controversy over end-of-life care in Italy in 2006?
Answer: Piergiorgio Welby's petition for respirator removal.
Explanation: Controversy over end-of-life care in Italy was sparked in 2006 when Piergiorgio Welby, a terminally ill patient, petitioned the courts for the removal of his respirator.
What was the outcome for the physician who honored Piergiorgio Welby's wishes to remove his respirator?
Answer: He was initially charged but later cleared.
Explanation: The physician who honored Welby's wishes was initially charged for violating laws against euthanasia but was ultimately cleared of the charges.
What was the duration of Eluana Englaro's coma before her death?
Answer: 17 years
Explanation: Eluana Englaro had been in a coma for 17 years following a car accident before her feeding tubes were withdrawn.
Are advance healthcare directives legally recognized in Japan?
Answer: No, they are not legally recognized.
Explanation: The source states that advance healthcare directives are not legally recognized in Japan.
When did advance healthcare directives become legally recognized in Korea?
Answer: 2016
Explanation: Advance healthcare directives became legally recognized in Korea in 2016 with the implementation of the Act on Decisions on Life-Sustaining Treatment.
In Nigeria, what factor primarily determines patient preferences regarding healthcare decisions?
Answer: Tradition.
Explanation: In Nigeria and most African countries, tradition, rather than written directives, still dominates in determining patient preferences.
When did the Knesset, Israel's parliament, pass a law allowing people to write advance care directives?
Answer: 2005
Explanation: In 2005, Israel's parliament, the Knesset, passed a law allowing people to write advance care directives.
When did the Supreme Court of India permit living wills and the withdrawal of life-sustaining treatments?
Answer: March 9, 2018
Explanation: On March 9, 2018, the Supreme Court of India permitted living wills and the withdrawal of life-sustaining treatments.
What principle did the Supreme Court of India establish regarding the right to a dignified life?
Answer: The right to a dignified life extends up to the point of having a dignified death.
Explanation: India's Supreme Court held that the right to a dignified life extends up to the point of having a dignified death, thereby linking it to end-of-life decision-making.
Studies have consistently shown that medical care for the dying is often unnecessarily prolonged, painful, and expensive.
Answer: True
Explanation: The source confirms that numerous studies have documented critical deficits in the medical care of the dying, finding it to be unnecessarily prolonged, painful, expensive, and emotionally burdensome.
Adults are more likely to complete advance directive documents if they are highly technical and focus on specific medical treatments.
Answer: False
Explanation: Studies indicate that adults are more likely to complete advance directive documents if they are written in everyday language and are less focused on technical treatments.
By 2007, less than 10% of Americans had completed a living will.
Answer: False
Explanation: By 2007, the adoption rate was significantly higher; 41% of Americans had completed a living will.
All U.S. states recognize the term 'living will' officially in their state law.
Answer: False
Explanation: While all states recognize some form of advance directive, not all use the official term 'living will.' For example, California law does not officially recognize the term.
Pennsylvania's Act 169 of 2006 provides a comprehensive statutory framework for advance healthcare directives.
Answer: True
Explanation: In 2006, Pennsylvania's Act 169 was signed into law, providing a comprehensive statutory framework for advance healthcare directives and decision-making for incompetent patients.
Some U.S. state living will registries have been closed due to high enrollment and sufficient funding.
Answer: False
Explanation: Some state living will registries have been closed due to low enrollment and a lack of funds, not high enrollment and sufficient funding.
What was the adoption rate of living wills among Americans by 2007?
Answer: 41%
Explanation: By 2007, living wills had become very popular, with 41% of Americans having completed one.
What proportion of U.S. deaths occur in healthcare facilities?
Answer: About a third
Explanation: The source states that about a third of U.S. deaths occur in healthcare facilities.
How many people in the U.S. are kept alive in comatose or permanently vegetative states, according to the source?
Answer: As many as 30,000
Explanation: The source estimates that as many as 30,000 people are kept alive in comatose and permanently vegetative states in the U.S.
What percentage of people, according to studies, would rather refuse aggressive medical treatment than have their lives medically prolonged in poor prognosis states?
Answer: 70-95%
Explanation: Studies indicate that a large majority, between 70% and 95% of people, would prefer to refuse aggressive medical treatment rather than have their lives prolonged in poor prognosis states.
Which U.S. President was the first to publicly announce having a living will and encourage others to do so?
Answer: Barack Obama
Explanation: On July 28, 2009, Barack Obama became the first U.S. President to publicly announce that he had a living will.
What was the controversy preceding President Obama's announcement about living wills?
Answer: Language in proposed healthcare legislation permitting payment to doctors for counseling patients on living wills.
Explanation: President Obama's announcement followed a controversy over proposed healthcare legislation that would have permitted Medicare to pay doctors for counseling patients about living wills.