What would be the impact if a patient had signed an advanced directive?
According to Morrison (2009) family members who are making choices for their loved ones “often have a sizable stake in how treatment decisions go, and their interests influence the decisions making, the orthodoxy regards the process as morally contaminated” (p. 203). In other words, family members may tend to make decisions about their loved ones life saving measures based on how it would benefit them and not based on the benefit of the patient. One issue that a health care provider would want to make sure of is that the person in charge of a patient’s health care decisions is a competent and knowledgeable person. Another issue that a health care provider would want to address is making sure that the person who is making decisions on behalf of the patient has the priority to do so. For example, Morrison (2009) states that when it comes to making decisions on behalf of a patient there is a “descending order of priority: spouse, adult children, parents, siblings, and so on” (p. 208). A health care provider must make sure that the person determining the health care treatment for the patient indeed has the authority to do so, and if that person is not present, the health care provider must do everything in their power to reach this “priority” family member. If the patient had signed an advanced directive then the health care facility would have to honor the wishes of the patient and not those of the family. For example, according to Giger, Davidhizar, and Fordham (2006) “advanced directives outline requirements that healthcare agencies are expected to meet” (p. 4).
2. Research the law in Oregon and other countries which allow physician assisted suicide. Discuss fully one are of concern you have with the law as written.
Morrison (2009) lists seven “safeguards and guidelines for a policy on assisted death” (p. 225). These guidelines must be met in order for patients in Oregon to be allowed to process with ending their life. It is my opinion that if a person is diagnosed with an incurable disease that people may be able to manipulate that individual into taking his or her own life. For example, a person who has been diagnosed with an incurable disease who is competent, and who has given up on the will to live with the disease could be convinced by family members, physicians, or friends to consider physician-assisted suicide. The guidelines only focus on the patient and the physician; they do not involve interviewing family members to make sure that the idea of pursuing physician-assisted suicide was the sole idea of the patient and not the coercion of family members. In addition, the guidelines say nothing about the patient’s family even being aware of their family members deciding to embark on such a decision. For example, what if the patient was a young mother with HIV/AIDS and she decided she did not want to live with the disease any longer; the guidelines for physician-assisted suicide do not take into account people ending their lives and leaving helpless children behind. According to Volker (2007), there are several risks involved if physician-assisted suicide is legalized in other states which include:
1) vulnerability and devaluation of socially marginalized and disabled people; 2) sense that suicide is an acceptable, if not obligatory, response to terminal illness; 3) financial pressure to accept assisted suicide as a less-expensive approach to care; 4) difficulty regulating the practice to terminally ill people only and creating safeguards against abuse” (p. 160).
4. Describe the pros and cons of signing an advanced directive.
Rick Stone is a 48-year-old male who is diagnosed with rapidly advancing Lou Gehrig’s (ALS) disease. Explore the ethical issues that Rick and Rick’s family may face in the future. As a healthcare provider, how might you advise Rick and his family concerning the decisions that may need to be made?
There are many issues a health care provider encounters when a patient family requests life support. Forms and legal documents are a priority. The patient may or may not have a living will, advance directive, or power of attorney. If this is the case then a next of kin is questioned on end of life care. You always hope that their loved one has expressed what they want in a medical situation. If it were to be that an unforeseen accident or illness was to occur. Unfortunately, this happens with young or old.
I have read that many Americans don’t have are without an advance directive. This form would state what end of live support the patient would want. The costs of care are a consideration for a family when thinking of life support. I say this in knowing that many Americans have no health insurance. I listened to President Obama speech last week on this matter. He states that we must continue to help with the insurance problem of our country.
With this fact of growing medical cost, we keep end of life issues in mind. For some it doesn’t matter the cost. I still think for many it does. I also have seen that some let their family know that they don’t want them to be on life support because of the cost. Families go bankrupt over medical bills. It is to each to decide what is in their best interest. However, at moments there may be conflict when a family member disagrees with their loved ones decision on their end of life care.
As a medical health care provider we are there to give information, and not judgmental. We also give support, and empathy. We help the family with spiritual care if needed. Many facilities have a team that is there to help patients and their families with end of life care. The impact when a patient has an advance directive is to follow the advance directive, and speak with the family on this matter. Some may need counseling or help with what it all entails.
Research the case of Terri Schiavo. As a health care administrator, what is your role in such a case? Should there be a difference between the role of a health care administrator and provider?
I remember seeing several television clips on Terri Schiavo. I remember seeing the parents and the husband of Terri. I heard and read their views, and how they felt on Terri’s wishes. She was only twenty six years old when her brain lost oxygen. It led to her medical diagnosis of being unresponsive. With feeding tube and no change in her condition the husband question how long should she be kept alive? The parents hoped for one day Terri would heal and be able to function somewhat normal again. They didn’t want to give up hope.
I being a parent myself can understand reasoning. On the other hand, you have the husband who didn’t want Terri to stay on tube feeding. He felt that the feeding was only thing keeping her alive. He stated she had no response in movement or brain function. As a health care administrator your role is to follow the legal and policies of your facility. As a health care provider you also follow the same legal matters stated by what the court has deemed to do in such a case. Terri’s case was a legal matter, and from what I read there was money from a court settlement that was placed for her medical care.
There are differences in a health care administrator and provider. The health care administrator has the role of keeping paperwork, and data entry filed correctly following court legal matter as well as the facility guidelines. The provider gives the medical care. I read in chapter ten a paragraph that stated many part’s that dealt with this issue. There it seemed as though we were confronting the issues for the very first time without any precedent to guide us. And when dealing with a case that had finally exhausted our medically capacity to remedy, some tried literally to will a remedy out of conviction, regardless of credible clinical evidence to the contrary (Morrison,2009,p.210)
My heart goes out to these families that have to deal with unfortunate end of live medical issues.
Describe the pros and cons of signing and advance directive.
In describing pros and cons of an advance directive there are more pros then cons I see. The respect of autonomy is to treat someone as an adult, to expect him or her to act responsibly, and to acknowledge and support his or her
There are several pros to signing an advanced directive. First, the advanced directive allows an individual to “make healthcare decision-making plans in advance of future incapacity, including terminal illness” (Morrison, 2009, p. 125). Secondly, the advance directive is legally binding in the state in which a patient lives and takes priority over the patient’s spouse, children, and other family members. The cons for advanced directives include “patients cannot predict accurately their future incapacity and death; patients might change their minds; an agent might turn out to be a poor choice as a surrogate decision maker, and that the documents or agents might specify treatments that the provider has sincere conscientious objections of using” (Morrison, 2009, p. 125-126). In addition to the listed cons, advanced directives differ from state to state; therefore, if the patient becomes incapacitated in another state their advance directive may not be honored. Overall, there is still much work that must be done in the area of advanced directives. For example, “each state must develop a written description of the law of the state whether in statute or case law concerning advanced directives and distribute the document to local healthcare providers” (Morrison, 2009, p. 124). In addition, “the PSDA, then, is to call to states and health care providers to educate professionals and the public about local laws concerning healthcare decision-making rights and advanced directives” (Morrison, 2009, p. 124).
References
Giger, J. N., Davidhizar, R. E., Fordham, P. (2006). Multi-cultural and multi-ethnic considerations and advanced directives: Developing cultural competency. Nursing & Allied Health Source, 13(1), 3-9.
Morrison, E.E. (2009). Health care ethics: critical issues for the 21st century. Sudbury, MA: Jones and Bartlett Publishing.
Volker, D. L. (2007). The Oregon experience with assisted suicide. Journal of Nursing Law, 13, 152-162.
