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Advance Directives

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Common Problems in Acute Care Surgery

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Abstract

Acute care surgeons are working with patients at the end of their lives with greater and greater frequency. The elderly have been the most rapidly enlarging segment of the population over the last century due to the combined effects of the “baby boom,” the population growth during the 2 decades after World War II, and the increase in average life expectancy. This trend shows no signs of abating, and with the blessing of increased life span has come the burden of chronic disease and disability (Centers for Disease Control and Prevention, MMWR Morb Mortal Wkly Rep, 52(6): 101–104, 106, 2003). According to Medicare data, nearly one third of Americans underwent surgery during the last year of their life. Further, 18 % underwent procedures in the last month of life, and 8 % during the last week of life (Kwok et al., Lancet 378(9800): 1408–1413, 2011). Clearly it is important for the acute care surgeon to understand the issues surrounding end-of-life care. These include Advanced Directives and “Do Not Resuscitate” orders. In addition, we must have the skills needed to discuss end-of-life care with patients and their families with honesty and compassion.

This chapter will review the history of advance directives, the Do Not Resuscitate order, and the current forms these now take. Application of these orders in the operating room and the intensive care unit setting will be discussed. Attention will then be directed to working with patients and families.

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Authors and Affiliations

  1. Department of Surgery, New York University School of Medicine/Bellevue Hospital Center, 462 First Ave, NBV 15 S 14, New York, NY, 10016, USA

    Gary T. Marshall

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  1. Gary T. Marshall
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Correspondence to Gary T. Marshall .

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Editors and Affiliations

  1. Department of Surgery, The University of Texas McGovern Medical School - Houston, Houston, Texas, USA

    Laura J. Moore

  2. General Surgery and Trauma Ben Taub Hospital, Houston, Texas, USA

    S. Rob Todd

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Marshall, G.T. (2017). Advance Directives. In: Moore, L., Todd, S. (eds) Common Problems in Acute Care Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-42792-8_44

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  • DOI: https://doi.org/10.1007/978-3-319-42792-8_44

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