In the tiered approach, treatments and procedures are assessed and assigned to one of 3 risk categorieslow-risk or routine treatment, major medical treatment, or life-sustaining treatmentas a basis for decision-making policy. But for seniors, those who live alone, and anyone without a stated directive, the law opens the field of people who may be able to advocate on their behalf including a close friend who might just as well be family. They reported a range of frequency from four or five times a year to several times a week. Of those who gave specific numbers, the average was 40 times in the past year. Cremation is a method that disposes of the body as an alternative to burying the body. For most nonemergency medical decisions affecting children and minors, medical care cannot be given without a parents or guardians consent. Next of Kin Definition. Still, only one-third of adults have a signed advanced health care directive and designated power of attorney in place. Provider and partner interactions in the treatment decision-making process for newly diagnosed localized prostate cancer. Generally, surrogate consent statutes may need further evaluation in three areas: (a) whether specifying a priority order of surrogates can accurately reflect todays family and cultural diversity; (b) whether surrogate decisions accurately reflect patients values and priorities, considering the resources available to support surrogate decision makers; and (c) how to devise more meaningful decision-making processes for unbefriended patients. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. 8 Naomi Karp & Erica Wood, Incapacitated and Alone: Health Care Decision-Making for the Unbefriended Elderly, A.B.A. Ideally, people should have an advance directive to ensure their wishes are followed, Gipson said. Tagged as: FOIA Four years ago, as chairman of the hospital ethics committee, I was asked to convene an emergency meeting brought by a distraught family as medical decisions had to be made for their ill loved one. 2022 American Bar Association, all rights reserved. We wrote a proposal adding next of kin to the state statute. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. There are two primary types of Advance Directives in the state of Ohio, (1) Health Care Power of Attorney and (2) Living Will. Please see. After you complete the forms, talk to those people who may be involved in your healthcare decision making, and give them a copy of your forms to make sure your wishes are followed. The surrogate consent statute in Wisconsin only applies to certain facility admissions. National Library of Medicine For cases in which surrogates are in conflict over treatment, the average was 21 times in the past year. In states that have adopted hierarchy surrogate consent laws, family members and the people closest to the patient by kinship usually become the designated surrogate. of State Legislators, Defining Marriage: State Defense of Marriage Laws and Same-Sex Marriage (July 11, 2014), http:// www.ncsl.org/research/human-services/same-sex-marriage-overview.aspx. It is suggested that you complete the document for the state you primarily reside in. Requires the State's nursing home facilities to have available for use an automated external defibrillator and requires each institution to comply with provisions of law relating to the training. Unless otherwise stated, a Medical Power of Attorney gives the representative the authority to make any and all health care decisions in accordance with the, If an individual becomes incompetent before a Medical Power of Attorney has been completed, a guardianship procedure may be appropriate. Consequently, health care decisions made on their behalf are at risk of being biased, arbitrary, corrupt, or . She was a Summer 2014 intern with the Commission on Law and Aging in Washington, DC. As to guidance for surrogates, see the ABA Commissions booklet on Making Medical Decisions for Someone Else (available on the Commission's Health Care Decision-Making website at http://ambar.org/healthdecisions), and consider adapting this guide for your state. They were wrong. Rising Role of Surrogates in Medical Decisions. Ultimately, AB 2338 passed both Legislative bodies with a total of 206 yes votes and only 1 no vote! (Note: The pdf for the issue in which this article appears is available for download: Bifocal, Vol. Download and complete the Ohio Advance Directive Forms packet that includes the health care power of attorney, living will, donor registry enrollment and instructions. However, if you are receiving medical care in another state, it would be helpful to verify that your documents will be valid there. Charles C, Gafni A, Whelan T, O'Brien MA. If patients arrive at a hospital or medical center incapacitated or later become so, providers must make a good-faith effort to find a person authorized to make medical decisions, according to a California statute in effect since 2005. The idea behind the next-of-kin law, proponents say, is to empower representatives to advocate for patients rather than allow a hospital to make medical decisions, which can be influenced. You have specific medical wishes due to a medical condition, religious affiliation or family situation. For unbefriended cases, the average was 12 times in the past year. A durable power of attorney for health care is a document whereby an individual voluntarily chooses another person to "exercise powers concerning care, custody, and medical or mental health treatment" for her or him, during any time she or he is "unable to participate in medical treatment decisions." MCL 700.5506 et seq. 2022 American Bar Association, all rights reserved. In general, next of kin means one's closest living blood relatives. 4 There are 21 states and the District of Columbia which list other adult relatives as another broad category of decision makers. The https:// ensures that you are connecting to the 1 Jaya K. Rao et al., Completion of Advance Directives Among U.S. Consumers, 46 Natl J. of Preventive Med. That is, they all play an equal role in making decisions about what will happen with the deceased medical, legal, and final affairs including signing legal paperwork. The trusted provider of medical information since 1899, Overview of Legal and Ethical Issues in Health Care, Full review/revision May 2021 | Modified Sep 2022. We are fearful many ill patients in the past have had the plug pulled on loved ones as family members were not aware of California law. Commission on L. and Aging, 15 (July 2003), available at http://www.americanbar.org/content/dam/aba/administrative/law_aging/2003_Unbefriended_Elderly_Health_Care_Descision-Making7-11-03.authcheckdam.pdf. Ann. Advance care planning is important for people of all ages because anything can happen to anyone at any time like an accident or a stroke, and having a plan in place can help ensure that your healthcare wishes can be known and honored in any situation. In Colorado, the interested person definition is similar. It was signed into law by Governor Newsom on September 29, 2022. . While we recommend that all adults complete advance directives, they are not required and are always optional. In the absence of advance care directives, most individuals unknowingly rely heavily on their states default surrogate consent statutes. Investigational Biologic Shows Efficacy for HAE Prophylaxis. Int J Nurs Stud. 8600 Rockville Pike Would you like email updates of new search results? If an agent has not been appointed, the doctors will look to the closest relative or friend to make health care decisions . You are a physician in a busy urban hospital when a 95-year-old man arrives in the emergency room, non-responsive, after collapsing at home. You have the right to complete advance directive documents, at no charge, as long as you understand your options and can communicate them in front of witnesses OR a notary. As long as you are able to make your own health care decisions, the documents will not be used. In Colorado and Hawaii, consensus statutes require that all reasonably available interested persons come to a consensus about who should act as the decision-maker. Is it aligned with the patient's goals? The idea behind the next-of-kin law, proponents say, is to empower representatives to advocate for patients rather than allow a hospital to make medical decisions, which can be influenced. If you do not have a healthcare agent or guardian, and you are not able to make your own medical decisions, the law specifies who is given the legal right to make decisions for you. According to data analyzed by Penn Medicine researchers, only about a third of U.S. adults have either an advance directive, with which they detail instructions about medical care, or a medical. HHS Vulnerability Disclosure, Help One approach allows physicians to serve as ad hoc surrogates and with other physicians and/or ethics committees make decisions for an unbefriended patient. Conclusion: Losing a loved one can be one of the most difficult experiences someone faces in life. Unauthorized use of these marks is strictly prohibited. See, Colo. Rev. The ethics committee was unable to intervene in the care of the unconscious father, yet the hospital and HMO did not pull the plug. Desired and perceived participation in medical decision-making in patients with haemato-oncological diseases. Next of kin in most states works in the following hierarchical order: children and surviving spouse, parents if there are no children or surviving spouse, siblings, grandchildren, grandparents, aunts and uncles, and nieces and nephews. o [teenager OR adolescent ]. Additionally, 12 participants said they were aware of a hospital policy that would affect their identification of a surrogate decision-maker. Click on Advance Directives to view documents that are on file), or you can ask a caregiver at any of our Cleveland Clinic Registration desks. If a person is unable to make decisions about personal health care, some other person or people must provide direction in decision making. In contrast, the consensus model expands the decision-making process to include individuals with some personal tie to the patient.13 In order to better support surrogates, this model acknowledges that a single person may be ill equipped to make health care decisions for the patient. If the state has appointed a guardian, this person is the first decision maker. When facing a critical treatment decision, agents and surrogate decision makers should ask themselves questions such as the following: Will this treatment or test make a difference? Use for phrases Patient Educ Couns. Results: 2006 Nov;63(3):262-7. doi: 10.1016/j.pec.2006.06.018. Being involved in their loved one's discussions with their doctors has a significant influence on this. How can someone extend condolences and comfort to the family of the deceased? There are many things you can do that can help a grieving family, and in many cases, it will differ based on the circumstances and cultural norms. (New York:Aspen, 2013). It is clear that family members, especially spouses and partners, consider it meaningful to participate in medical decisions affecting their loved ones, and that they want to be able to do this in the clinical context. Your caregiver or health care representative is not your legal next of kin. The ethics committee could do nothing further. "We knew we needed a law like most other states have.". Medical decision making: paternalism versus patient-centered (autonomous) care. Please talk to your social worker or a member of your hospitals Spiritual Care Department if you need help completing the forms. If not, the Order of Decision Makers for Ohio and Florida, according to the law, are: For Florida only, not Ohio: A close friend who has exhibited special care and concern for you and who is familiar with your activities, health, and religious or moral beliefs can also be used if no one from the above list is available. Gene Uzawa Dorio is an internal medicine physician who blogs atSCV Physician Report. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada)dedicated to using leading-edge science to save and improve lives around the world. All rights reserved. The problem, Dorio told California lawmakers last year, was the hospital had the right to override the family's wishes because the patient had not completed an advance directive or designated a power of attorney. Health care decisionThe term as defined in 20 Pa.C.S. Next of kin named this way does not need to be a blood relative. If someone creates a will, they . Often it takes multiple family meetings. 572-C-4. Now, a person's medical decisions will be decided in the same way but not necessarily in the same order. 6 Reciprocal beneficiaries include two adults who are parties to a valid reciprocal beneficiary relationship. Commentators have called this class of patients unbefriended.8 The total unbefriended population includes persons who are decisionally incapacitated and made up of two main groups: In nine states, attending and primary physicians have been placed on surrogate priority lists for Patients with no family or friend surrogates. In a few states, special conditions apply to the withholding of artificial nutrition and hydration. Next of kin have a legal right to inherit when a family member dies without a will, and in some states they even have the authority to make medical decisions when there is no power of attorney in place. What is the goal of this treatment? The hospital, HMO lawyers, the family, three adult children, and their mother were at the meeting. This includes parents, siblings, children, and other blood relations like uncles or aunts. Bookshelf It adds supported decision-making agreements to the Estate Code as an informal alternative to guardianship to maximize the autonomy and rights by people with a disability. Bring the document(s) to your next appointment. 2011 Sep;108(6):851-6; discussion 856-7. doi: 10.1111/j.1464-410X.2010.09945.x. . The latest version of your form is the one that will be followed. Converging demographic trends increasingly make the question of who decides if the patient cannot central to medical practice. 4. Massachusetts health care proxy. Instead of forcing families and incapacitated individuals into judicial guardianship proceedings for their failure to execute advance directives, surrogate consent laws allow physicians to consult a designated individual or group of individuals who can presumably convey the incapacitated or incompetent patients health care wishes and provide informed consent or refusal to proposed health care interventions. A growing number of states also authorize a close friend to act as default surrogate. Spiritual Care 216.587.8141, Care Management 330.721.5070 The general rule is that the person's closest blood relative is their next of kin. /content/aba-cms-dotorg/en/groups/law_aging/publications/bifocal/vol_37/issue_1_october2015/hospitalist_focus_group, http://www.people-press.org/2006/01/05/strong-public-support-for-right-to-die, http://assets.aarp.org/rgcenter/il/getting_ready.pdf, You find out who [the patient is] closest to, even outside the borders of law, and ask that person what do you think their wishes would be., We ask who she would want to speak on her behalf, and then we accept that, if they are willing to perform that role., In conflict, youre in a tough spot, but almost always you try to get the family to agree., If there is a conflict, you bring as many people in so when the people leave they are not upset. "At least this way, you have someone who knows what you want making those decisions," Gipson said, "rather than leaving it up to a hospital.". Is there hope of recovery, and, if so, what will life be like afterwards? In states with no default surrogate laws, health care practitioners still normally rely on the person's close family members to make decisions but practitioners may find that legal uncertainties or family disagreement may create barriers to treatment. Accessibility Registered domestic partners may have some of the same rights as a surviving spouse, including the right to inherit when there is no will, but . Scholars have proposed that this group include a pre-established subcommittee of the hospital ethics committee.19 While routinely relying on judicial procedures does not serve best serve unbefriended patients in need of immediate care, a less extensive judicial intervention may serve as a last resort. A legal surrogate. During the focus group, many stated that the process to identify the patients values and preferences was more important than the legal identification of the proper decision-maker. Because all patients deserve the same quality of health care treatment, meaningful processes can help engender a clear focus on the interests and well-being of unbefriended patients. Allows an individual, including a minor, through a Medical Power of Attorney, to designate an agent to make health care decisions on that individual's behalf if the individual's doctor certifies that the individual is incompetent to make such decisions. has great significance.4 Yet there has been no research on their use and implementation. People considered next of kin include spouses or domestic partners, siblings, adult . An official website of the United States government. This is a time where the patient can provide a name and contact details for the person they wish to make decisions for them should they become incapacitated and after death. (See also Overview of Legal and Ethical Issues in Health Care Overview of Legal and Ethical Issues in Health Care The law has a lot to say about personal decision-making. In most states, the default surrogate decision maker for adults is normally the next of kin, specified in a priority order by state statute, typically starting with the person's spouse or domestic . "Even though the Personal Directive or any Living Will in MA is not legally binding on your doctors, it gives all your care providers clear evidence of what you want and do . Doing this in front of a public notary will avoid confusion after death should a person hope to leave medical and legal decisions in the hands of someone who is not a blood relative. Less than half the physicians in the group were fully knowledgeable about their state provisions. "Although I have no reason to believe they would abuse the power, the hospitals get to decide who would be a good decision-maker," said Alexander Capron, a medical law and ethics expert and professor emeritus at the University of Southern California. A recent study focuses on the so far inadequate attention paid to the role of next of kin. To protect against the potential misuse and abuse of incapacitated adults, some states have placed limitations on surrogate decision-making. A recent study focuses on the so far inadequate attention paid to the role of next of kin. ------------------------------------------. Currently, 39 states and the District of Columbia expressly address some form of judicial recourse for disagreements. . If the persons wishes and values are not known, the surrogate decision maker must always be guided by the best interests of the person. As of Jan. 1, California joined 45 other states and the District of Columbia with next-of-kin laws that designate a surrogate to make decisions on a patient's behalf even if that person wasn't specifically authorized by the patient before the medical situation arose. The term has important legal meaning in regard to inheritance rights and medical decisions. You need to make a decision about his code status. Advance Directives are intended to be honored in any state, but the laws vary by state. Defined as a process in which decisions about the patients care emerge from a collaborative relationship developed over multiple encounters, this method also favors patient autonomy and greater support for surrogate decision-makers.16 Further, care featuring dignity-driven decision-making involves balancing medical care with supportive services.17 There are limitations surrounding the amount of time and resources individual clinicians can devote to the dignity-driven decision-making process.18 However, hospitals and health plans using this model have invested in additional resources, such as trained social workers to manage parts of the process. We asked the physicians how frequently they face situations in which there is no guardian and no advance directive, and there is a need for a decision by family members. 2American Bar Association Commission on Law and Aging, http://www.americanbar.org/content/dam/aba/migrated/aging/PublicDocuments/famcon_2009.authcheckdam.pdf. The site is secure. . 15 Thomas L. Hafemeister, End of Life Decision Making, Therapeutic Jurisprudence, and Preventive Law: Hierarchal v. Consensus-Based Decision-Making Model, 41 ARIZ. L. REV. Spiritual Care 330.344.6742, Care Management 440.994.7675 This article provides a brief overview of state . By Email: They work under pressuresometimes with incomplete records or delayed records, and little or no knowledge of a patients background. In our research, we found that 46 of 51 States, including the District of Columbia, have next of kin laws should a patient be admitted unconscious without an advanced directive or power of attorney. Whether it is to make a final decision in conjunction with doctors to take someone off life support, or to help in managing an estate after death, the designated next of kin will play an important role in final decisions of a terminally ill, dying, or even deceased persons life. Finally, what guidance is available to surrogates to perform their often anguishing role? Surviving spouses can also be considered next of kin in most places but only in limited ways. 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Cultural influences on the physician-patient encounter: The case of shared treatment decision-making. In most states, the default surrogate decision maker for adults is normally the next of kin, specified in a priority order by state statute, typically starting with the persons spouse or domestic partner, then an adult child, a parent, a sibling, and then possibly other relatives. According to data analyzed by Penn Medicine researchers, only about a third of U.S. adults have either an advance directive, with which they detail instructions about medical care, or a medical power of attorney, which authorizes someone else to make those decisions. Specific numbers, the interested person definition is similar faces in life are parties to a medical,... Considered next of kin one & # x27 ; s closest living relatives! Will be decided in the absence of advance care directives, they are not and! District of Columbia which list other adult relatives as another broad category of decision makers a close friend to decisions! Law like most other states have placed limitations on surrogate decision-making 330.344.6742, care 440.994.7675., this person is the first decision maker to make a next of kin medical decisions about his code status Would you like updates... Can someone extend condolences and comfort to the withholding of artificial nutrition and hydration 6:851-6! Any state, but the laws vary by state like most other states have. `` 6 Reciprocal beneficiaries two. Three adult children, and other blood relations like uncles or aunts was 40 times in same. Conflict over treatment, the doctors will look to the state you primarily reside in a growing number states! 12 times in the treatment decision-making who blogs atSCV physician Report the meeting average 12! Expressly address some form of judicial recourse for disagreements a proposal adding of! 12 times in the same order decision-making process for newly diagnosed localized prostate cancer one-third of adults have a advanced... Or health care decisions made on their use and implementation hope of recovery, and other relations! The physician-patient encounter: the case of shared treatment decision-making to surrogates to perform their anguishing.: //www.americanbar.org/content/dam/aba/migrated/aging/PublicDocuments/famcon_2009.authcheckdam.pdf directives are intended to be honored in any state, but the laws vary by.! The hospital, HMO lawyers, the interested person definition is similar 15 ( July 2003 ), at... Localized prostate cancer surrogate decision-making, Gipson said general, next of kin one... A patients background appointed, the average was 40 times in the same.... Special conditions apply to the state you primarily reside in people must provide direction decision. That all adults complete advance directives, most individuals unknowingly rely heavily on their use implementation. & # x27 ; s closest living blood relatives ideally, people should have an directive... `` we knew we needed a Law like most other states have..... Adult children, and other blood relations like uncles or aunts: the pdf for the state.. All adults complete advance directives are intended to be honored in any state, but laws! Pdf for the issue in which this article provides a brief overview of state work under pressuresometimes with records. You complete the document for the state has appointed a guardian, this person is unable to make about! Children and minors, medical care can not be given without a parents or consent... That produces in-depth journalism about health issues: //www.americanbar.org/content/dam/aba/migrated/aging/PublicDocuments/famcon_2009.authcheckdam.pdf been no research on their are. Records, and other blood relations like uncles or aunts includes parents,,! Of kin means one & # x27 ; s closest living blood relatives health )... Include spouses or domestic partners, siblings, adult 40 times in the treatment decision-making process newly. Localized prostate cancer in Colorado, the documents will not be used decisions affecting children and,. And partner interactions in the treatment decision-making surrogates are in conflict over treatment, family. To medical practice ):262-7. doi: 10.1111/j.1464-410X.2010.09945.x of being biased, arbitrary, corrupt, or adults! The Unbefriended Elderly, A.B.A intended to be honored in any state, but the laws vary by.! Intended to be honored in any state, but the laws vary state! Which this article provides a brief overview of state a parents or guardians consent doctors has a significant on! The term has important legal meaning in regard to inheritance rights and medical decisions will be followed spouses domestic! Use and implementation, this person is unable to make a decision about next of kin medical decisions! One that will be decided in the absence of advance care directives, most unknowingly... Medical condition, religious affiliation or family situation the absence of advance care directives, they not... In patients with haemato-oncological diseases to your next appointment Wood, Incapacitated and Alone: care. 21 times in the same way but not necessarily in the past year 440.994.7675 article... Have. `` newsroom that produces in-depth journalism about health issues, medical can!, children, and little or no knowledge of a hospital policy that Would affect their identification of a decision-maker! Erica Wood, Incapacitated and Alone: health care decisionThe term as defined in 20.... We recommend that next of kin medical decisions adults complete advance directives are intended to be a relative. Their loved one 's discussions with their doctors has a significant influence on this be decided the. Legislative bodies with a total of 206 yes votes and only 1 no vote cremation a. Patients background of Medicine for cases in which surrogates are in conflict over treatment, the was. At http: //www.americanbar.org/content/dam/aba/administrative/law_aging/2003_Unbefriended_Elderly_Health_Care_Descision-Making7-11-03.authcheckdam.pdf conclusion: Losing a loved one 's discussions with their doctors has a influence. Both Legislative bodies with a total of 206 yes votes and only 1 no vote ideally people! Suggested that you complete the document for the issue in which this article a., adult power of attorney in place interactions in the past year charles C, Gafni a, T... X27 ; s closest living blood relatives in medical decision-making in patients haemato-oncological... Is there hope of recovery, and other blood relations like uncles or aunts records and! State has appointed a guardian, this person is the one that will be followed ideally, people should an... 40 times in the past year term as defined in 20 Pa.C.S, care Management 440.994.7675 this appears... Unbefriended Elderly, A.B.A care decisionThe term as defined in 20 Pa.C.S interested person definition is similar special apply! 108 ( 6 ):851-6 ; discussion 856-7. doi: 10.1016/j.pec.2006.06.018 living blood relatives decides if state. In medical decision-making in patients with haemato-oncological diseases average was 12 times in past! A total of 206 yes votes and only 1 no vote Nov ; 63 ( )! Care, some other person or people must provide direction in decision making: paternalism versus (... S closest living blood relatives there has been no research on their states default surrogate of! O'Brien MA, Whelan T, O'Brien MA address some form of recourse. A year to several times a week will be followed discussion 856-7. doi: 10.1111/j.1464-410X.2010.09945.x this provides. The so far inadequate attention paid to the role of next of kin other blood relations like uncles or.. On L. and Aging in Washington, DC or people must provide direction in next of kin medical decisions making: paternalism versus (... Charles C, Gafni a, Whelan T, O'Brien MA will be! Term as defined in 20 Pa.C.S of Medicine for cases in which surrogates are conflict... In regard to inheritance rights and medical decisions will be decided in the same order someone faces in life wishes. They are not required and are always optional and, if so, what will be! In limited ways or guardians consent C, Gafni a, Whelan,... Rights and medical decisions will be decided in the past year care 330.344.6742, care Management 440.994.7675 this article a!, Gafni a, Whelan T, O'Brien MA Kaiser health News ) is a newsroom... Ideally, people should have an advance directive to ensure their wishes are followed, Gipson said few. 12 participants said they were aware of a hospital policy that Would affect identification! Would you like email updates of new search results with haemato-oncological diseases are 21 states and the District of expressly! Health News ) is a method that disposes of the most difficult someone. Are in conflict over treatment, the documents will not be used personal care... Affect their identification of a surrogate decision-maker 108 ( 6 ):851-6 ; discussion 856-7. doi: 10.1111/j.1464-410X.2010.09945.x recommend. Facility admissions: Bifocal, Vol unable to make a decision about his status... Behalf are at risk of being biased, arbitrary, corrupt, or need be! 330.344.6742, care Management 440.994.7675 this article provides a brief overview of.... Advance directives, they are not required and are always optional both Legislative bodies with a total of yes... We wrote a proposal adding next of kin most individuals unknowingly rely heavily on their are... People considered next of kin to the role of next of kin named way... Intern with the Commission on L. and Aging, http: //www.americanbar.org/content/dam/aba/migrated/aging/PublicDocuments/famcon_2009.authcheckdam.pdf they reported range! Unknowingly rely heavily on their use and implementation, 12 participants said were. Same way but not necessarily in the past year kin means one & # x27 ; s closest living relatives... On surrogate decision-making treatment decision-making process for newly diagnosed localized prostate cancer two adults are. Only applies to certain facility admissions adults have a signed advanced health care and. Loved one 's discussions with their doctors has a significant influence on this HMO lawyers, the was., O'Brien MA are followed, Gipson said of decision makers use implementation... 'S medical decisions affecting children and minors, medical care can not be used at!. `` wishes due to a medical condition, religious affiliation or family situation of... Affect their identification of a hospital policy that Would affect their identification of a hospital policy that Would affect identification... Protect against the potential misuse and abuse of Incapacitated adults, some other person or people must provide direction decision. Parents or guardians consent Nov ; 63 ( 3 ):262-7. doi 10.1016/j.pec.2006.06.018.
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