Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Advance directives: The term "advance directives"
refers to treatment preferences and the designation of a surrogate decision-maker in the event that a person should become unable to make medical decisions
on her or his own behalf.
Advance directives generally fall into three categories: living
will, power of attorney, and health-care proxy.
Living will: This is a written document that specifies what types of
medical treatment are desired should the individual become incapacitated. A
living will can be general or very specific. The most common statement in a
living will is to the effect that
if I suffer an incurable, irreversible illness, disease, or
condition and my attending physician determines that my condition is
terminal, I direct that life-sustaining measures that would serve
only to prolong my dying be withheld or discontinued.
More specific living wills may include information regarding an individual's
desire for such services such as
artificial (intravenous or IV) hydration,
artificial feeding (feeding tube),
life-support equipment including ventilators (breathing machines),
do not resuscitate (DNR).
Health-care proxy: This is a legal document in which an
individual designates another person to make health-care decisions if
he or she is rendered incapable of making their wishes known. The
health-care proxy has, in essence, the same rights to request or
refuse treatment that the individual would have if capable of making
and communicating decisions.
Durable power of attorney (DPOA): Through this type of advance
directive, an individual executes legal documents that provide the
power of attorney to others in the case of an incapacitating medical
condition. The durable power of attorney allows an individual to
make bank transactions, sign social security checks, apply for
disability, or simply write checks to pay the utility bill while an
individual is medically incapacitated.
DPOA can also specifically designate different individuals to act on a person's behalf for specific affairs. For example, one person can be designated the DPOA of health-care or medical power of attorney, similar to the
health-care proxy, while another individual can be made the legal DPOA.
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 10/5/2011