Living will question

[combinate]

I wrote an alternative answer to a question from Potter and Perry to try and clarify and help me to understand the principle of the living will:

The nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline the nurse will follow?

answer

: A living will is invoked only when the patient has a terminal

condition or is in a persistent vegetative state.

A living will is invoked only when the patient has a terminal condition and is no longer cognitively capable to direct their care (e.g. is in a persistent vegetative state).

Does the second answer make more sense? It seems like the first answer creates the possibility of a patient's document coming into conflict with their conscious desires.

[loving2024, BSN, RN]

The first answer states that a living is activated only when the patient is terminal OR in a persistent vegetative state

The second states that the living will is activated only when the patient is terminal AND in a persistent vegetative state or not cognitive capable.

The answer is the first one because living will be invoked whether in a terminal situations or in a persistent vegetative state.

[KelRN215, BSN, RN]

The first answer states that a living is activated only when the patient is terminal OR in a persistent vegetative state

The second states that the living will is activated only when the patient is terminal AND in a persistent vegetative state or not cognitive capable.

The answer is the first one because living will be invoked whether in a terminal situations or in a persistent vegetative state.

I disagree. Someone may have a terminal condition and still be cognizant enough to make their wishes known and current wishes may conflict with those in the living will.

Say, for example, someone writes a living will just because they do not want their family to use heroic measures if there is no hope. Said person is then diagnosed with grade IV Glioblastoma Multiforme. This is a terminal diagnosis. It's terminal from the day of diagnosis. Median survival is just over 14 months. But if you have a patient in front of you whose cognizant and making his wishes known, you don't go to his chart looking for his living will and say "Sorry, Sir, we will not give you a central line because you have a living will saying you do not want xyz." Living wills, health care proxies, etc. only apply when the patient can no longer make decisions for himself and having a terminal diagnosis in and of itself does not render a patient incapable of doing that.

[Loo17]

Just because a patient is terminal it does not mean they are no longer able to make decisions for themselves. Imagine telling Mr Smith "I'm sorry you are dehydrated because the chemo is causing you to vomit. You wrote in your living will that if you had a terminal illness that you didn't want IV fluids. So even though you say you want it now, we have invoked your living will so it doesn't matter."

[loving2024, BSN, RN]

Which statement represents the best description of an advance directive guideline the nurse will follow?

Patient has the right to change his/her living will at anytime as far as s/he is cognitively capable.

However, to answer this question, the best option is terminally ill or not capable. It is either one of them or both of them.

The reason I didnt choose the second answer is that it says the patient has to be terminally ill and not cognitively capable which is not correct according to potter and perry

According to potter and perry "Living wills represent written documents that direct treatment in accordance with a patient’s wishes in the event of a terminal illness or condition."

[Loo17]

Which statement represents the best description of an advance directive guideline the nurse will follow?

Patient has the right to change his/her living will at anytime as far as s/he is cognitively capable.

However, to answer this question, the best option is terminally ill or not capable. It is either one of them or both of them.

The reason I didnt choose the second answer is that it says the patient has to be terminally ill and not cognitively capable which is not correct according to potter and perry

According to potter and perry "Living wills represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition."

I don't know who Potter and Perry are (maybe leaders of the NCLEX world) but that's not how it works in the real world. :-)

A living will only comes in to play when a person has a terminal condition AND is unable to make decisions on their own.

liv-ing will

noun

a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent.

[KelRN215, BSN, RN]

Which statement represents the best description of an advance directive guideline the nurse will follow?

Patient has the right to change his/her living will at anytime as far as s/he is cognitively capable.

However, to answer this question, the best option is terminally ill or not capable. It is either one of them or both of them.

The reason I didnt choose the second answer is that it says the patient has to be terminally ill and not cognitively capable which is not correct according to potter and perry

According to potter and perry "Living wills represent written documents that direct treatment in accordance with a patient’s wishes in the event of a terminal illness or condition."

Well that is a bad definition of a living will and factually/legally untrue. It's not either or. Living wills and other forms of Advanced Directives ONLY apply in the event that the patient is not able to make decisions for himself. A terminal diagnosis alone is insufficient for these documents to be invoked. If Grandma gets diagnosed with cancer, again, the MD can't just go running to her daughter to ask what she wants done when Grandma is cognizant and competent, even if her daughter is the Health Care Proxy. It doesn't apply until Grandma is unable to make decisions for herself.

What is a Living Will? - AllLaw.com

A living will does not become effective unless you are incapacitated; until then you'll be able to say what treatments you do or don't want.

[loving2024, BSN, RN]

And the clear cut is terminally ill or not capable to make the decision.

However, terminally ill patient has the right to refuse fluid and food and it has to be stated in the living will.

Potter and perry are the authors of fundamentals of nursing(8th edition)

[Loo17]

And the clear cut is terminally ill or not capable to make the decision.

However, terminally ill patient has the right to refuse fluid and food and it has to be stated in the living will.

Potter and perry are the authors of fundamentals of nursing(8th edition)

No. Terminally ill AND unable to make decisions.

[Loo17]

No. Terminally ill AND unable to make decisions.

For example a living will would not come in to play if the patient simply has a UTI or a fever and is confused from that. The patient is expected to return to health. They are not terminal and the living will would not be brought in to play unless the UTI gets worse, patient goes septic and ends up intubated and declining.

[loving2024, BSN, RN]

Well that is a bad definition of a living will and factually/legally untrue. It's not either or. Living wills and other forms of Advanced Directives ONLY apply in the event that the patient is not able to make decisions for himself. A terminal diagnosis alone is insufficient for these documents to be invoked. If Grandma gets diagnosed with cancer, again, the MD can't just go running to her daughter to ask what she wants done when Grandma is cognizant and competent, even if her daughter is the Health Care Proxy. It doesn't apply until Grandma is unable to make decisions for herself.

What is a Living Will? - AllLaw.com

Well I know thats true but nlcex/Nursing school stuff is different from the real world nursing.

In other for students to get the grades they deserve, they have to know the textbook content but believe me I know for a fact that it has to be both not just either or.

Again, these are some of the people that create nclex questions

[Loo17]

And the clear cut is terminally ill or not capable to make the decision.

However, terminally ill patient has the right to refuse fluid and food and it has to be stated in the living will.

Potter and perry are the authors of fundamentals of nursing(8th edition)

I was joking when I asked who potter and perry were. A terminally ill patient that is alert and oriented has the right to refuse fluids regardless if it is in their living will.

I know you want to be right here and maybe according to potter and perry you are but potter and perry are wrong. If you answered that way on the nclex or in the real world it would be incorrect.