... | |Flaws in Advance Directives, Living Wills, and Power of Attorney | Introduction A Living Will is a form of an advance directive that is a “legal document that describes those treatments an individual wishes or does not wish to receive should he or she becomes incapacitated and unable to make medical decisions” (Pazgar, 2007, p. 378). Normally in a Living Will an individual would also indicate another individual as his or her power of attorney in the legal document; however, it is not necessary for a living will to be created with a power of attorney or a power of attorney to be created with a living will though it is highly recommended to do so. This is due to the fact that each has its flaws and each could compensate for one another though in reality it could create more conflicts too. For a physician or any other healthcare provider to go against a patient’s autonomy means that there are many legal problems these physicians may face because they went against the patient’s desires, especially because of such allegations as criminal assault and battery. Advance directives have been created to preserve an individual’s autonomy and protect a physician from having...
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... In the case study, the nurse is facing ethical as well as professional dilemma regarding the patient’s rights. The nurse’s role in this case study is to, work according to the Maryland state regulations and nursing standards; But as per Maryland nursing standards, she is not working as an advocate for her patient, Mr. E at this situation (Code of Ethics - the Division of State Documents, 10.27.19.02). The patient already signed advanced directive against life saving measures almost seven years ago, at the time of admission to a nursing home, with the help of patient advocate; but Dr G. is planning patient care in opposition to Mr.E’s active advance directive and his expressed objections to the medical care. There are numerous issues to consider in this case study. The nurse has to review her professional role according to code of ethics and nursing standards in relation to advance directives and medical power of attorney. The nurse also has to consider the patient’s right to privacy and confidentiality according to HIPPA Policy. The issues in contemporary healthcare facilities are sometimes the statues can be vague, and issues can be in conflict with own personal beliefs in most areas. A) State Regulations and Nursing Standards of practice There are specific Maryland state regulations and nursing standards regarding patient rights in this case study. However, the most relevant regulation is that, the nurse...
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...their personal beliefs and listen and respect the beliefs and traditions of others. Legally Nursing implications require nurses to maintain licensure, obey state and federal laws and to remain within their scope of practice. Within these legal and ethical issues the American Association Code of Nursing ethics, personal and societal values, legal aspects and legal responsibilities all affect decisions. Two different cases will be discussed and explored; an advance directive case involving a woman by the name of Marianne, and a malpractice case involving a nurse and the involved healthcare organization. The American Nurses Association Code of Nursing Ethics can influence the final decision made in the case study involving Marianne’s family by designating a surrogate. According to "American Nurses Association" (2011), “The nurse supports patients self-determination by participating in discussions with surrogates, providing guidance, referral to other resources as necessary, and identifying and addressing problems in the decision-making process” (1.4). In the case study involving malpractice, the nurse being called upon as a witness, has a duty and responsibility to report the incidents to the employer. The "American Nurses Association" (2011) website further states,” all nurses have a responsibility to assist those who identify potentially questionable practice” (3.5). If the hospital fails to correct the actions, the...
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...The primary aim of my assignment is to look at the issue of end of life care in dialysis satellite units, as these areas tend to be nurse led units. My interest in palliative and end of life care has arisen from the growing number of poorly patients we continue to dialyse, this has proved distressing especially for the patient, who often has unmanaged symptoms and for their families, it is also upsetting for the staff involved in their care, as it is felt nobody is acting as the patients’ advocate and helping the decision to facilitate the withdrawal of what is now an ineffective and unnecessary treatment. One of the latest developments by the Government and Department of health is the concept of Advance Care Planning. I have looked at this from various perspectives and would like to be involved in introducing the process to Sheffield Kidney Institute. In 2004, the number of patients receiving renal replacement therapy in England, Scotland and Wales was 33,511, this figure is sourced from data which has been made available to them from participating renal units throughout the country, the number of patients receiving dialysis since 2000 has risen by 7% (Ansell et al 2005) with it projected to rise by a further 10 percent over the next 5 years (Ansell et al 2005). About 15-29 percent of deaths of patients with end stage renal disease results from a decision to discontinue dialysis (Davison 2006). Importantly we need to explore which patients especially those reaching...
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...ethical issues in health care which we must firmly know the difference between right and wrong. However, in health care, there are many circumstances which health care professionals do not always make the correct ethical decisions. Theses ethical decisions affect society and the next generation to come. Therefore, the Patient Self-Determination Act is the main issue which affects our society. Generally speaking, the Patient Self Determination Act (PSDA) in most hospitals, nursing homes, home health agencies, and HMO’s routinely provide information on advance directives at the time of admission. They are required to do this by federal law. The PSDA simply requires that most health care institutions do the following: give you at the time of admission a written summary of your health care decisions-making rights, the facility’s policies with respect to recognizing advance directives, and ask you if you have an advance directive, and document that fact in your medication record. On the contrary, many physicians were not in favor of a policy for patient self determination because they felt that this would decrease their authority regarding medicine, interfere with the patient-physician relationship, and be one more legal regulation (General Accounting Office (GAO) Letter Report, 1995). However, the American Medical Association supported the policy. Some hospitals were concerned about the execution of the policy as they believed that it was appropriate to give medical advice but...
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...Legal Case Study This study is about a 41 year old woman whose name is Terri Schiavo. She was in a persistent vegetative state for 15 years with a brain injury before she died on March 31, 2005. This paper discusses her 15 year ordeal, the effects of it on her husband and family, Terri’s right to die, and the importance of end of life choices. We discuss the ethical and legal issues involved in the decision making of this case. Her husband and family disagreed on how to handle her situation, whether or not to remove her feeding tube. Even though their Terri was in both of their best interest, they could not agree on, would removing the feeding tube be killing her or letting her die? Ethical Importance Terri had left no written instructions as to what her wishes might be if she were no longer able to make her own medical decisions. The only thing that the court and her family had to go on was what her husband and family remembered her saying in conversation over the years. The memories of her husband and family were very different. In the beginning of this ordeal they both agreed that everything should be done for Terri’s survival because at that time there was hope. After a while, when Terri did not appear to be changing, or getting better, her husband believed that the quality of life that Terri had was not the quality that she would have wanted had she been able to voice her opinion. “Michael Schiavo said his wife had said that she would never want to be...
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...Respecting Patient End-of-Life Care Wishes Introduction As a citizen in today’s fast paced and medically advanced society, it is imperative to have knowledge and understanding of Advance Directives and what role they play in patient care. In the scenario presented we find Mr. E who is a 67 year old male who lives in a nursing home and has presented to the ER with lung congestion. Mr. E. has a history of diabetes, poor vision, and hypertension, impaired hearing, and is delayed developmentally. After an initial assessment, the physician, Dr. K. has diagnosed the patient with pneumonia secondary to aspiration. Mr. E. has a fever and his oxygen saturation level is 88% on room air. Dr. K has admitted Mr. E to the ICU and has determined that he needs to be placed on a ventilator. When the doctor explains the situation, Mr. E. vehemently states that he does not want a ventilator. Mr. E. has an advance directive that outlines his wishes. Body As a nurse in the state of Indiana, it is a responsibility and standard to advocate for the patient while providing competent care according to the patient’s wishes. Indiana law upholds a patient’s written or spoken advance directive in the event that the patient is unable to make decisions regarding their healthcare. In the scenario, Mr. E.’s advance directive was disregarded by the healthcare personnel because he was deemed incompetent of understanding the seriousness of the situation. Thus, the physician and the nurse involved violated Indiana...
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...As you are dying the last thing you want to do is have to make decisions of what is going to happen to you, so let’s make the decisions before we get to this point. Physicians should make it routine to talk to their adult patients about the options of end of life care and advance directives. These end of life care and advance directive involve: living will, a medical power of attorney (or healthcare proxy), palliative care and hospice care. Allowing these patients to know all the options they have, it could make the end of life care process easier for families when deciding what should be done. I believe physicians and nurses should talk about end of life care and advance directives because everybody should know their options before they get...
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...left her paralyzed and her awareness is uncertain because she communicates by nodding her head. The patient’s physician Dr. Bob Pritchard, who is in charge of Lydia’s care, is not very confident about her recovery. Lydia’s husband, Mr. Bevin, says his wife would not want to be kept alive in this fashion and does not know the location of her advance directives. Unfortunately, Lydia’s mother, Eileen Redfield, believes in miracles and end of life is not an option for her. The battle of emotions between mother and husband has Dr. Pritchard in the middle. Mr. Bevin states that before their marriage Lydia had written an advance directive but he was unable to locate the document. Without knowing her advance directives, it became the responsibility of her love ones to make the final decision about continued care or termination. For someone as critical as Lydia, end of the life decisions are not an option for Lydia’s mom. On the other hand, her husband thinks that Lydia should not have to suffer in this way and agrees to end life. It is not easy for anyone involved and having to make an ethical decision to end life. The end-of-life critical care cases tend to experience the most emotional turmoil, and are the most difficult. The CEO of the hospital, Felicia Larue, has asked for a briefing on the status of the patient and alternative methods to protect the patient’s rights and minimize the hospital’s risk. When the patient is unable to speak for him or herself, it becomes the responsibility...
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...Abstract Research into trends concerning medical futility reveal that aggressive treatment at the end of life is not equating to better outcomes (Colello 2008). In fact, not only is it providing no benefit, all too often it imposes unnecessary pain and suffering. In the case of patients who lack decision making capacity and do not have an advance directive, families are often approached by nursing staff and asked “Do you want us to do everything?” or if they would prefer a Do Not Resuscitate status (DNR), meaning CPR will not be initiated if breathing or the patient’s heart were to stop. This sends a confusing message to families, that there is something worthy of offering their loved ones; when the reality is, there is nothing worthwhile left to offer. More often than not, despite a grim prognosis for the patient and the possibility of being in a persistent vegetative state (PSV), families routinely choose this option, largely because an informative conversation has never taken place as to the implications of these decisions. This is an issue which can no longer be overlooked. It is costing our nation dearly, both ethically and fiscally. As Americans, it is high time that we come to terms with our mortality and accept the reality that death awaits us all. Denial will not make it less likely to occur. As such, in an effort to promote awareness of this issue and the detrimental impact it has on patients and society as a whole, the following will define and explain the various...
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...care practices" (State of Tennessee, 2011). There are a number of arguments in this case study that incompetent health care practices are being performed, from the decision to place a patient on a ventilator for an oxygen saturation of 88%, circumventing the patient’s written and verbal advanced directives, utilizing an unauthorized family member to get consent for a medical procedure, and discussing confidential medical information in a public location and with and unauthorized family member. The nurse clearly violated this rule because the nurse did not take any action at any point to stop the physician from taking these incompetent actions. Implications Rule # 1000-01-.13-1r applies because, as mentioned above, the nurse failed to take any action to prevent the physician from performing a number of incompetent acts related to the healthcare of the patient. First and foremost, the patient likely does not even need to be placed on the ventilator. The physician’s decision to place the patient on the ventilator is based on an oxygen saturation of 88%. Although the patient’s oxygen saturation does need to be increased, the physician could consider BiPAP to adequately ventilate the patient without violating the patient’s wishes. BiPAP (bilevel positive airway pressure) is a non-invasive ventilation device that can increase the volume of air that enters the lung when a patient breathes in. Studies have proven that BiPAP has been used effectively to prevent the need for intubation...
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...JAMES F. LAWRENCE, & SUZANNE O. GRESLE Medical University of South Carolina, Charleston, SC, USA Abstract Tube feeding can be an appropriate and effective means of providing nutrition for individuals who are unable to achieve adequate nourishment orally because of various medical problems. However, the delivery of nutrients by tube feeding can cause ethical dilemmas in cases where the effectiveness of tube feeding diminishes and medical complications increase. The decision to tube feed is often influenced by regional and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual’s right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for those who can no longer advocate for themselves. Keywords: Enteral feeding, tube feeding, ethics, persistent vegetative state, dementia...
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...Diseases and illness can be so complex despite advances in technology and the evolution of education. Doctors spend years studying the human body, diseases and other illness but seem to take one step forward and three steps back as diseases conform. Infections become resistant to antibiotics, cancers spread at rapid rates, and auto immune disorders slowly attack the body as it slowly kills itself. Among these complex diseases is a disease known as Guillain-Barre Syndrome. Guillain-Barre Syndrome is a very rare condition that causes a person’s own immune system to rapidly deteriorate nerve cells, causing muscle weakness and sometimes paralysis. According to the Center for Communicable diseases an estimated 3,000 to 6,000 people develop GBS...
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... Both dilemmas are presented for examination and discussion in this class via two scenarios. In the first case scenario, the family of a victim of a hemorrhagic stroke must decide what measures they want the hospital staff to take to either sustain her life or if they want to deny any or all life-saving steps. In this instance, the father and children are at odds in their decision. The next case presents malpractice lawsuit scene where a nurse is called to testify on behalf of the patient against the negligent nurse and hospital. While these situations are vastly different, they share two inherent questions: What is the ethical thing to do? What is the nurse’s legal obligation? Each case study produced different legal questions. In the first case study the family of the patient could not agree on a course of action. There was no advance directive and the patient was not conscious. The husband of the patient in this case is the legal next of kin and is therefore legally responsible for making health care decisions for his wife when she is unable to do so. The children of the patient could challenge their father in court. A court battle would prolong any treatment the husband may deem necessary for his wife. The nurse has an obligation to the patient’s family as well as the patient. In the second case study, a nurse is called to testify in a malpractice case in which she had witnessed another nurse being negligent. The witnessing nurse previously reported the negligent...
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...include being able to decide what happens for their medical treatments if needed, this is by federal law. Each person is given the right to make the choice of what each individuals believes is the best for them. Advance directives which according to google it is defined as “A written statement of a person’s wishes regarding medical treatment” This can include a living will, or any wishes that they want carried out is that person is unable to talk with the doctor. Within this Patient Self Determination Act, it not only protects the patient is also protecting the healthcare institution when they have to determine what is best for the patient(s) as well. Some types of advance directives would be: A popular one is the DNR, which stands for Do Not Resuscitate. This includes the patient not to be given CPR if the patient stops breathing or their heart stops. Another one is to be an organ or tissue donor, the patient has to give the hospital a yes or no to this question because, that way the hospital is able to remove the organs and tissues for medical study and use. Let’s talk about a couple other advance directives. Power of attorney for health care, this is basically giving a person the power to decided what is needed for the patient, however this is only in the case when a person becomes mentally incapable of making decisions themselves. A living will, this is a document that will explain treatments or if one needs life support, it gives the doctors an idea well not an idea...
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