Advance Directives: Problems And Prospects

Advanced care planning is critical element in the therapeutic alliance between healthcare team and patient in providing adequate patient-centered care, with the patient a more willing collaborator. This process provides patient, family, and caregiver with realistic expectations about result of treatment and prudent preparation for possible outcomes. Effective advance care planning has been shown to increase satisfaction with care, lower moral distress, lead to healthier bereavement after death, provide timely

The nurse in the case study is faced with an ethical and professional, dilemma. How can she be an advocate for her patient Mr. E? Dr G. is proceeding on a course of action or plan of care that is directly contrary to the patients advance directive and his verbalized objections to the course of treatment proposed by the physician and that is concerning for her. There are multiple issues to consider. For the nurse, she needs to think about her code of ethics, her scope of practice and the legal issues regarding advance directives and Durable Power Of Attorney (DPOA). She also needs to consider the patients right to privacy and confidentiality. As with most areas and issues in modern healthcare the statues can be

Figure 1 displays each state within the United States and which form of advanced directive they have adopted into their individual state’s laws. Utah is one of twenty-eight states which have implemented an advanced health care directive with both a living will and a durable power of attorney for health care. In the state of Utah advanced health care directive is defined as “a designation of an agent to make health care decisions for an adult when the adult cannot make or communicate health care decisions; or an expression of preferences about health care decisions” (le.utah.gov). Agent is defined as “a person designated in an advance health care directive to make health care decisions for the declarant (le.utah.gov).” An individual has the right to not appoint and agent on Utah advanced health care directive forms as well (le.utah.gov).

The ethical principles for nurses to practice with beneficence and no maleficence. This legal battle between Terri Schiavo’s husband and her family was an ethical debate between continuing artificial life or remove her feeding tube by the request of her husband. Using the theories of utilitarianism and deontology can be applied or considered in making the most ethically correct resolution. The cases are very complex and raise many moral and ethical issues. The cases have brought awareness to society of “the importance of discussing end-of-life issues with family members and underscores how an advance directive, a living will and/or durable power of attorney for health care, are a healthcare proxy clarifies and provides evidence of the wishes of an individual regarding end-of-life decisions. Terri Schiavo should impress upon laypersons and professionals alike the uncertainty of the context in which issues of continuation and termination are argued ethically. Nobody knows what Mrs. Schiavo would have wanted. She left no advance directive and in its absence her husband says one thing and her parents

It is critical for people to recognize the importance of obtaining a living will or a Medical Power of Attorney before a health concern occurs. Since the health of an individual can never be predicted because of unseen accidents and conditions that can arise it is imperative to make this a priority. Thanks to the “Patient Self-Determination Act of 1990” it is now a priority for a health facility to obtain an advance directive from a patient before care is given (Goede & Wheeler, 2015). However, relying on the probability that a patient will enter into a health facility in a state of good health is unpredictable. To assure that a patient’s autonomy is being respected in the medical decision-making process obtaining a living will or a Medical

This film explains the legal role of advance directives in end of life issues. An advance directive is “a written document directing how medical decisions are to be made in the future when the patient lacks decisional capacity and is unable to decide and choose” (Hanlon, End of Life Issues, Slide 28, Bullet 1). All three of the cases demonstrate the importance in filling out some form of directive. When there is nothing to go off of, it makes decisions extremely tough for families and medical providers. Having legal documentation of patient wishes helps understand what treatments they would or would not consent to. In cases like

The use of advance directives is increasing day by day. It is the legal paper that describes the patient wish and provide power to someone to take decision on end of life situation. It helps to healthcare providers to take the treatment decision when the patient is in unstable condition. I agree with you that Like the use of advance directives would prevent a lot of critical situation like this if it was done on time. Changing and reviewing advance directive in a timely manner is important for healthcare provider because it help them to be updated with all rules and regulation regarding patient care. Advance directives can be changed at any time but once it is changed, a new form should be created and old should be destroyed. Changing and

The Institute of Medicine defines a good death as one that allows patients, families and caregivers to avoid distress and suffering at a difficult time (Con & NET, 2007). What is considered a rational step in preparation for end of life in Western biomedicine, is seen as hindering to various ethnic minority groups, who are unable to exercise their beliefs (Frearson, Henderson, Raval, Daniels, Burke, & Koffman, 2013). Western medicine has expanded and taken predominance over medical practices worldwide. One of the key constituents of medical practice in Western societies, is the importance of ensuring patient autonomy. The implementation of the “Patient Self-Determination Act (PSDA)” in 1991, was a strategy employed to ensure that individuals were able to exercise their autonomy in making decisions regarding medical treatments (Doorenbos & Nies, 2003). The PSDA was instilled as a strategy to encourage healthcare professionals in educating their patients about the importance of advance directives (Doorenbos & Nies, 2003). The four main values carried by the PSDA revolve around the concepts of “autonomy over end of life care, informed decision making, truth telling, and control of dying process” (Giger et al., 2006, p.4). However, since its implementation, national statistics for completed advance directives amongst

With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient

Ethical dilemma may also arise in cases where a patient may feel their right to DNR should be carried out when giving direct order. The DNR process, however, is required to be documented by a physician. Andrew Putnam (2003) presents a case where an eighty-eight year old patient’s code status was DNR; “However, the patient has never signed formal advance directive statement or assigned durable power of attorney for her health care to anyone.” (Putnam, 2003, 2025) Ethics can be simply stated as doing the right thing (Roberts, 2002, 242); but in this case ethics is questioned because the physician was faced with the decision to carry out the wishes of the patient or to make a decision based on legality. In this case, it may have been morally right to carry out the wishes of the patient who wanted DNR orders carried out, but it may have been the right choice to do the legal thing and not carried out due to lack of signed documentation.

Advance Directives are our wishes when we are at end of life stages of life that give specific direction of how, who, and when to treat us in our final days and hours. We can have documents drawn up to say what we want in the event we are in a state where we cannot voice our wishes aloud. These documents have legal and ethical basis, and they should be followed unless the legally or ethically unable to do so.

The final ethical issue that may be faced is clinical issues. Clinical issues happen as a result of the caregiving relationship that forms between practitioners and clients (Kunstler, 2010). Clinical issues form from outgrowths of foundational and systemic issues. Kunstler (2010) says that “clinical ethical issues include the rights of clients, decision making for those who are incapacitated, privacy and confidentiality, and boundary issues” (p.15). An example of this issue is when a client with a chronic illness is no longer able to make conscientious decisions. It is the practitioners job to follow the patients caregivers wishes, even if your opinion differs. As a professional in healthcare the ‘‘person before label concept” is important

This paper will evaluate the medical profession’s compliance in honoring a patients’ living will and durable powers of attorney. Every human being of sound body and mind have the right to decide what happens with their body. If a doctor performs a procedure without the patients consent then that doctor has committed an assault. In the event a patient has done their due diligence and created a living will or obtained a durable power of attorney to manage their wishes or affairs, be it medical, or financial if some unforeseen situation prevents them from speaking or detailing their wishes. The question is, will their legal documents be honored.

Advance Directive is a document that states how an individual would like to be treated and cared for at the end of their life. This document will typically appoint a Health Care Agent and an alternative Health Care Agent. It often states the patient’s attitudes and views towards life and death decisions. It gives direction as far as how the patient would like things to be handled when they are dying. Authority however, is only given to the Health Care Agent when this document needs to be exercised. The Advance Directive document will only be utilized when the patient is in a vegetable like state, dying, or unable to speak or make a logical decision for themselves. An advance directive can come in many different forms such as Health Care Surrogate, Medical Power of Attorney, or a Living Will. There are many different things to consider when it comes to an Advance Directive document such as religious beliefs, family preferences, financial ability, and personal ethics. Many Christians often have a skewed view of an Advance Directive due to some cases leading to Euthanasia. There are several cases where treatment can be withdrawn from handicapped individuals leading to death. Advance Directives can be a very viable and healthy thing when it comes to the decisions at the end of a person’s life and can coincide with biblical teaching about death and health decisions. Advance Directive documents can eliminate confusion and quarreling between family and friends by appointing a

Advance directives are becoming popular and highly recommended today. However, they have their advantages and disadvantages. In the case of Margo, her advance directive raises conflict between the principle of autonomy and beneficence. The principle of autonomy describes a person’s ability to make his or her own decisions without others controlling their choices or influencing their decisions. The principle of beneficence describes the act of doing good to others by either removing harm, preventing harm and promoting good. The advance directive serves to maintain a person’s autonomy in situations in which they are not competent enough to make informed decisions. Applying this principle to Margo, the healthcare team would have to respect her wishes and deny her any treatment. However, in doing so, the healthcare team would not be upholding the principle of beneficence because they would not be providing treatment that would be beneficial to the patient. If the patient were to receive the treatment, the healthcare team would be removing harm from the patient.