Advanced Directives

Advanced Directives

Advance directives are legal documents that allow control over decisions such as what care should be provided when capacity to make decisions is lost. There are two primary types. Firstly there is a Living Will and secondly a Durable Power of Attorney for health care. These are recognized and defined documents by statute with the aim of providing a legal tool by which people can express their wishes. However, they are not the exclusive means available to express wishes. Any authentic expression of a patient's wishes should be respected.

An advance directive cannot be completed after a patient becomes mentally incapacitated and it does not become effective until after incapacity has been determined. If an advance directive has been prepared, an authorized surrogate must be identified to make medical care decisions.

A living will expresses a patient's preferences for end-of-life medical care. State laws vary greatly regarding scope and applicability of living wills.

A living will allows people to express preferences for the amount and nature of their medical care, from no care to maximum care. Detailed treatment preferences are desirable because they provide more specific guidance to practitioners. A living will cannot compel health care practitioners to provide medical care that is medically or ethically unwarranted.

To be valid, a living will must comply with state law. The living wills should be written in a standardized way. It should be appropriately signed and witnessed. Living wills go into effect upon (1) the loss of ability to make health care decisions or (2) the existence of a medical condition specified in the directive—typically a terminal condition, permanent vegetative state, or the end-stage of a chronic condition. State law provides a process for confirming and documenting the loss of decisional capacity and the medical condition.

Durable power of attorney for health care is a document in which one person names another person to make decisions about health care and only health care.

While a living will states a person's specific preferences regarding medical treatment, a durable power of attorney for health care designates an agent to make health care decisions. People who have both a living will and a durable power of attorney for health care should stipulate which should be followed if the documents seem to conflict. Because predicting future circumstances in all of their complexity is virtually impossible and because the durable power of attorney for health care designates a decision maker who can respond to here-and-now circumstances, a durable power of attorney is far more practical and flexible than a living will. The agent is granted the power to discuss medical alternatives with the physicians and make decisions if an accident or illness incapacitates the person. In most states, a health care practitioner involved in the care of the patient cannot serve as agent for health care matters, unless the practitioner is a close relative. The durable power of attorney for health care can include a living will provision or any other specific instructions but, preferably, should do so only as guidance for the agent, rather than as a binding instruction.

The durable power of attorney for health care should name an alternate in case the first-named person is unable to proceed the role for certain reasons. Two or more people may be named to serve together or alone. The use of the durable power of attorney for health care is valuable for adults of all ages. It is especially critical for unmarried couples, same-sex partners, friends, or other individuals considered legally unrelated who wish to grant each other the legal authority to make health care decisions and to ensure rights of visitation and access to medical information.

Physicians should obtain a copy of a patient's living will and durable power of attorney for health care. The contents should be reviewed with the patient while the patient is still capable, and make it part of the medical record. A copy of the durable power of attorney for health care should also be given to the patient's appointed agent and another copy placed with important papers. The patient's attorney should hold a copy of all documents.

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Will New Proposals Pull the Plug on E-cigs?

E-cigs

It’s a typical scene in many UK bars and restaurants. While rain lashes down, smokers shiver outside under shelters or in doorways, indulging in a habit that’s illegal indoors.

Inside though, a group of people seem to be flouting the law. They are smoking what appear to be cigarettes, yet don’t have the smell of burning tobacco or ever need putting out.

They are smoking, or rather "vaping," electronic cigarettes - an innovation that’s not only regarded in some quarters as being much healthier than traditional cigarettes, but is inexpensive and legal to use indoors.

Most e-cigs consist of three parts – a battery, a chamber containing a heating element (referred to as an atomiser) and a cartridge containing a filter soaked in liquid, usually made up of nicotine extract, flavourings and propylene glycol, a chemical used in many foodstuffs. It is this that, when heated, produces the "‘smoke’" or vapour.

For smokers or anyone trying to quit, this all sounds too good to be true. And perhaps it is, due to a proposed change in the law which could soon see manufacturers of electronic cigarettes, or e-cigs as they are more commonly known, come under close scrutiny.

Proposals For Regulation Of E-cigs

This month, the Medicines and Healthcare Products Regulatory Agency (MHRA), announced proposals to regulate e-cigs, which are currently classed as an unlicensed nicotine containing product, so that they are classed as a medicine. This would mean that any manufacturer/supplier of these products would have to apply to the MHRA for a medicines marketing authorisation, something that at a reported cost of 1.4 million pounds, could prove far too costly for many companies.
As a result, many manufacturers and users of e-cigs are concerned that the pharmaceutical industries could move in and effectively monopolise the market, marketing these products in the same way as nicotine patches, gum and inhalers.

Either way, this leaves consumers in an uncertain position, especially as many have found that e-cigs helped them quit where other methods have failed.

One such person is Jackie, an e-cig user from Hull, who says: “I was a 20 a day smoker for 20 years - I'd tried various methods of quitting then heard about e-cigs and out of pure curiosity bought one. I had an open mind about it - I wasn't really expecting to quit. However, I immediately went from 20 cigarettes a day to three or four, then quit completely. That was nearly five months ago and I'm still amazed at how easy it was for me.”

She’s not alone. A quick look online at one of the many e-cig forums reveals a worldwide network of contented ex-smokers who have finally managed to quit for good. Many report that their health has improved.

But, despite their testimonials, doubts remain in the eyes of some as to the safety of e-cigs and it is this concern which lies at the heart of the MHRA's proposal. Since its development in 2004, there has been little research into the e-cig, largely due to the cost of commissioning scientific tests.

Are E-cigs Safer Than Traditional Cigarettes?

Tests that have been carried out, however, suggest that this is a much safer product than traditional cigarettes, with Dr Joel Nitzkin, chair of the Tobacco Control Task Force for the American Association of public health physicians, saying: “We have every reason to believe that the hazard posed by e-cigarettes would be much lower than one percent. So, if the nicotine in e-cigarettes is the same as in prescription nicotine replacement therapy products, we can assume that the hazard posed by e-cigarettes would be much lower than that posed by regular cigarettes."

His views are echoed by some other healthcare experts. Indeed, while the MHRA raises its concerns, one UK-based e-cig company, Intellicig, has recently seen its product made available at every pharmacy in Greece.

The MHRA report states the need for some form of regulation to ensure that e-cigs are a safe product, saying: "We know from work done by the Food and Drug Administration (FDA) in the United States that laboratory analyses of e-cigarette samples were found to contain carcinogens and toxic chemicals, against which general product safety legislation could not protect. Bringing all current unlicensed NCPs into regulation would eliminate these issues and ensure that smokers had products of the requisite quality, efficacy and safety to eliminate or reduce the harm from smoking."

Choosing The Right E-cig For You

Naturally, there is a bewildering range of e-cigs on the market, many varying wildly in quality and price, so it would seem to be logical that consumers are protected. However, some e-cig manufacturers claim that customer choice would be greatly limited if the product were only available from pharmacies and/or on prescription.

So, with a wide range of products at present to choose from, which one should someone wishing to try e-cigs go for?

For anyone who wants something that looks and feels almost exactly like a cigarette, try the EVOlution from Intellicig, a leading UK manufacturer. Alternatively, for products which take the concept of e-cigs to a more space age level, try the Jantystick (a small silver box) or eGo – a black e-cig resembling a 21st century cigar.

E-cig users are being invited to have their say on the MHRA proposals via its website.
Ultimately, whether e-cigs become an accepted NRT product or not remains to be seen, but many ex-smokers would strongly argue that e-cigs have helped them quit for good where other methods have seen their attempts to kick the habit go up in smoke.

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What is Poison Ivy and How to Treat It

Poison Ivy

Poison ivy is known as toxicodendron radicans. It is a plant the grows on a vine or shrub. Poison ivy grows in nearly every state in the United States and in some Canadian provinces. Some people are highly allergic to poison ivy. Here are some tips on what to look for and how to treat it.

What Poison Ivy Looks Like

Poison ivy either grows down low on the ground or in a hairy climbing vine attached to something like a tree. It is a plant that grows in leaves of three from a stem. The leaves are light to dark green and in the fall turn a reddish color.

When a person touches a poison ivy plant, the oil from the plant called urushiol sticks to the skin. Within a couple of days of contact with the ivy, a person will start to get red rash and it will be swollen. A few days after the rash starts, blisters will start popping up and will be itchy. Do not scratch it. It could become infected.

How to Treat Poison Ivy

When a person knows they have come in contact with poison ivy, they should wash the area with plain cool water as soon as possible. Do not use soap to wash the exposed area. Since urushiol is an oil, the soap will make it move around on the body. After washing with just plain cool water, they can then take a shower with soap and warmer water. The key is to get the oil off of the body as soon as possible. Wash any clothing or shoes that have come in contact with the poison ivy as well.

Some people are highly allergic to the plant and have to get medical treatment for it. If the person starts to run a fever, has a rash on the face or around the genitals, or the rash does not go away, it is a good time to see the doctor. With others, it is just a matter of weeks before the rash will go away on its own.

Just remember that the poison ivy oils can be carried on the family pet, clothes, shoes and any other thing that can come in contact with the plant. If someone is burning the ivy plant, do not breath in the smoke. as this can cause a rash as well.

For more information about poison ivy read treating poison ivy organically and poison ivy.

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