Course Summary

A person may sustain an unexpected medical event, or acquire a progressive disease that causes a decline in the person’s health or function. These events may limit a person’s cognition to the point that he or she can no longer make healthcare decisions. An advance directive may be created in advance of these medical events so that a person’s preferences regarding medical care can be known ahead of time, and implemented even though the patient can no longer state his or her wishes. There are different types of advance directives, each having its particular function, as well as potential advantages and disadvantages. Health clinicians need to know how each of these directives are created and how they work. Health clinicians also need to know how each of these directives function when the time comes to use them. It is not always simple to implement a patient’s advance directive since conflicts may arise when a coworker or family member disagrees on the application of a patient’s advance directive or the medical care that should be given to the patient. These conflicts may be resolved by bringing together family and health team members into the decision process for carrying out the patient’s wishes.

Course Format

Homestudy

Course Syllabus

• Introduction
• Prevalence of Advance Directives
• Scenarios Involving the Use of Advance Directives
  • Scenario 1: Elderly Man with Cancer
  • Scenario 2: Elderly Woman with Advanced Dementia
  • Scenario 3: Elderly Woman with a Stroke
  • Scenario 4: An Oncology Patient
• Common Types of Advance Directives
  • Do-Not-Resuscitate Orders (DNR)
  • Living Will
  • Medical Power of Attorney
  • Physician Orders for Life-sustaining Treatment (POLST)
  • Instructional Directive
  • Consulting an Attorney
• Choosing a Health Care Agent
• Using an Advance Directive
  • Communicating the Advance Directive to Others
  • When an Advance Directive is Activated
• Changes to Advance Directives
• Medical Treatments to Consider
  • Resuscitation
  • Mechanical Ventilation
  • Nutrition and Hydration
  • Hemodialysis
  • Comfort Care
  • Organ Donation
• Barriers to End-Of-Life Care
• Advance Directives and Resolving Conflicts
• Case Study 1
  • Discussion
• Case Study 2
• Conversations About Patient Goals and General Preferences
• Future Directions of Advance Directive and DNR Policy
• New Directions During COVID-19 Pandemic
• Summary

Authors

Noah H. Carpenter, MD

Dr. Noah Carpenter is a Thoracic and Peripheral Vascular Surgeon. He completed his Bachelor of Science in chemistry and medical school and training at the University of Manitoba. Dr. Carpenter completed surgical residency and fellowship at the University of Edmonton and Affiliated Hospitals in Edmonton, Alberta, and an additional Adult Cardiovascular and Thoracic Surgery fellowship at the University of Edinburgh, Scotland. He has specialized in microsurgical techniques, vascular endoscopy, laser and laparoscopic surgery in Brandon, Manitoba and Vancouver, British Columbia, Canada and in Colorado, Texas, and California. Dr. Carpenter has an Honorary Doctorate of Law from the University of Calgary, and was appointed a Citizen Ambassador to China, and has served as a member of the Indigenous Physicians Association of Canada, the Canadian College of Health Service Executives, the Science Institute of the Northwest Territories, Canada Science Council, and the International Society of Endovascular Surgeons, among others. He has been an inspiration to youth, motivating them to understand the importance of achieving higher education.