Report immediately if a proxy directs care that contradicts the patient's documented living will.
Before you read
Test yourself first: 5 questions
Question 1 of 5
An advance directive that designates another person to make health care decisions if the client becomes unable to do so is known as a:
Answer: B. A durable power of attorney for health care, also called a health care proxy, designates a specific person, the agent, to make medical decisions if the client loses decision-making capacity. A living will states the client's wishes about treatments but does not name a decision maker.
Question 2 of 5
A durable power of attorney for healthcare allows a designated person to:
Answer: B. A healthcare proxy/DPOA makes medical decisions for the client ONLY when the client is unable to do so themselves. While the client is competent, the client decides.
Question 3 of 5
A client states, "I have a living will, but I am awake and able to make my own decisions today. I want to change my mind about a treatment." How should the nurse respond?
Answer: B. Advance directives such as a living will take effect only when the client loses decision-making capacity. As long as the client is competent and able to communicate, the client's current expressed wishes govern care and may differ from the document. The nurse honors the client's present decision and notifies the provider.
Question 4 of 5
When a client has a valid living will/advance directive, the nurse ensures:
Answer: B. Honor the client's documented wishes, ensure the directive is in the chart and communicated to the team, and clarify if conflicts arise. The nurse does not override a valid directive.
Question 5 of 5
A document in which a competent client states specific wishes about life-sustaining treatment to be followed if the client becomes incapacitated is called a:
Answer: A. A living will is a type of advance directive in which the client specifies which life-sustaining treatments are wanted or refused if the client becomes unable to communicate, such as mechanical ventilation or artificial nutrition. It guides care but does not appoint a surrogate decision maker.
Keep the streak going with more questions like these, each with a full rationale.
What is living will and power of attorney?
A durable power of attorney for healthcare names a person (proxy/agent) to make medical decisions on the patient's behalf. Together these advance directives ensure the patient's wishes are honored when they cannot speak for themselves.
Key points to remember
- A living will specifies desired and unwanted treatments (such as ventilation or tube feeding) for end-of-life situations.
- A durable power of attorney for healthcare names a proxy who decides only when the patient loses capacity.
- The healthcare proxy must base decisions on the patient's known wishes, not their own preferences.
- A durable financial power of attorney handles money matters and is separate from the healthcare proxy.
- A competent patient always speaks for themselves; the proxy acts only after capacity is lost.
- Both documents can be revoked or changed by the patient at any time while competent.
Nursing priorities
- Confirm which advance directive documents the patient has and place copies in the chart.
- Identify the named healthcare proxy and document their contact information.
- Activate the proxy's authority only after the provider documents loss of decision-making capacity.
- Ensure the care team follows the living will's stated treatment preferences.
- Communicate the patient's documented wishes during care planning and handoffs.
Patient teaching
- A living will writes down your treatment wishes; a healthcare proxy names someone to decide for you.
- Choose a proxy who understands and will honor your wishes, and talk with them in advance.
- You remain in charge of your own decisions for as long as you are able.
Red flags: report now
- Report immediately if a proxy directs care that contradicts the patient's documented living will.
- Never let the proxy override a patient who still has decision-making capacity.
- Do not act on a power of attorney for healthcare until capacity loss is documented.
References
Clinical references for this topic
