Case Study: The Health Care Proxy

Mr. B, the patient’s brother is Mr. E’s designee to make healthcare decisions in the event that he is unable to do so for himself. He is left to make these decisions without a code of ethics or without medical knowledge. He counts on the medical professionals to assist him. He has an ethical obligation to abide by his brothers wishes and directives. He is influenced by his own beliefs and his perceptions of what his brother would want. If he has the good faith belief that his brother did not understand the need for the ventilator or the outcome of refusing the treatment, then it is not unreasonable or unethical

Researchers agree that approaching the end of one’s life can affect the dying patient and their family both

According to ("Health care proxies - Medicare Interactive", 2016) a health care proxy is a health document that lets a patient chose an agent or proxy who makes decision on behalf of the patient.Situtation like these arise when a patient is not in a position to express his/her wishes. If the patient gains the ability to speak, he/she can change preferences. Health care proxy assumes the patient is incapacitated hence requires a proxy. However the patient has the right to periodically go through the health care proxy document in order to assess decisions made by the agent. Health care proxy allows a patient to name a second person who can act as your back up agent. In case one is not in a position to choose an agent, most states let close family

CNA Code of Ethics for Registered Nurses (2008) provides guidance in dealing with cases like this by explaining the core nursing values and responsibilities involved which are: a) providing safe, compassionate, competent and ethical care; b) promoting health and well-being; c) promoting and respecting informed decision-making, and d) Preserving dignity; e) maintaining confidentiality, f) promoting justice and g) being accountable. The first nursing value is always expected to be upheld in any case because it is their duty to provide care using appropriate safety precautions and preventing/minimizing all forms of violence (CNA, 2008). The collaboration of the nurses between the physician and Mr. C’s family has been evident since then. This therefore calls Mr. C’s nurses to be more compassionate about his situation and try to recognize where he is coming from as they build a trust-worthy relationship before judging him or jumping into conclusions like he does not want to live anymore. Even if he decides to withdraw from these potentially life-sustaining treatments, health care providers are still obliged to give him the care he need the best way they can up until the end of his life. The second nursing value, just like the first one, still calls nurses to still aim to promote or at least maintain Mr. C’s health and well-being to the highest possible level regardless of the path he had chosen for his life. This can be achieved by continuing to collaborate well with other

2009), it’s no surprise that some of these issues directly affect us. The American Psychological Association (2016), explains that when “people approach the end of their lives, they and their families commonly face tasks and decisions that include a broad array of choices ranging from simple to extremely complex. They may be practical, psychosocial, spiritual, legal, existential, or medical in nature. However, the medical end-of-life decisions are often the most challenging for terminally/chronically ill people and those who care about them.”

They got her a stable heart rhythm, so she never had a chance to consent to anything. The patient is currently in a state incapacity. There is not preference found or submitted to the hospital stating the patient treatment preferences. The appropriate surrogate to make decisions for the patient is her three adult children. The patient’s kids have the right to make the decision because she doesn’t have a living will or appointed anyone to make medical decision for her. I understand each state has guidelines to follow in a situation like this on who to consult in a situation like this. Some states may follow the same hierarchy plans as Washington State which are included in this order legal guardian, individual with power of attorney for health care decisions, spouse, adult children (all in agreement), parents of patient, and adult sibling (all in agreement). The patient cannot state whether she is unwilling or unable to cooperate with treatment (Clarence H. Braddock III, MD, MPH, 1998).

Many people are unclear about pain and symptom management during the end of life. Some believe that if you choose to medicate for pain then they are hastening or responsible for the death of their loved one. Others believe that all measures should be taken to help prolong their loved one’s life. No all deaths are the same. Some people pass away peacefully, while others will have difficulty transitioning through the end of life stages

You are a nurse on an inpatient oncology unit. Your patient is a 72-year-old competent male who has been told his cancer is terminal and that further treatment is unlikely to have any benefit. He accepts that and would like to explore hospice. However, his two adult children insist that he should continue chemotherapy and fight on and they tell you not to discuss with him or get a consult for hospice.

In this world, all living creatures die because it is one of the things that happens to every one of us. However, when this happens, it may be the hardest thing to accept or understand the fact of life. Nowadays, people are living well into their 70 and 80 or even longer, but death comes to all ages, sometimes young people die due to sickness, accidents, and so on. This topic talking about death and dying is not easy and almost all the people find it hard to starting the conversation about end of life. According to Your Conversation starter kit “90% of people way that talking with their loved ones about end-of-life care is important” but only 27% have actually done so”(Foundation, 2017). This a big number of people thinking about end-of-life but very few started the conversation.

In the realm of modern medicine, which pervades the framework of North America’s health system, death is to be avoided and delayed at all costs (McGarry 2017). For all its mensurable successes in the treatment of illness, biomedicine is incapable of curing death; an axiom unsettling for the majority of Westerners (Text 2017: 254). Given such, accounts of death as unapologetically

Of the healthcare team, nurses spend the most time with the patient at the bedside, resulting in sufficient knowledge of the patient and their family. Information about the clinical and psychological condition of the patient, information provided, and signals given by the family are mostly gathered by the nurse. The ICU nurses involved in the study emphasized the urgency to be present in multidisciplinary meetings on a regular basis to share their knowledge with other professionals. Because nurses have specific information about the patient and his or her family, nurses can communicate this information to the rest of the health care team (Noome et al.,

Most important to this case was the question of capacity. In this situation, the patient was clearly incapable of making medical decisions. We were fortunate to have an SDM readily available who understood his condition and previously stated wishes and was able and willing to act in the patient’s interests. In any case of formal or informal application of “advanced directives” or previous statements of a patient’s wishes, it is important to consider the intent of the stated wishes [1]. In this case, it was fairly clear that while the patient stated he would not want aggressive resuscitative measures in a terminal situation, this did not mean he would not want basic investigations done which could reveal a potentially treatable cause of his presentation. Pauls et al discuss a case when overly strict adherence to the “letter” of a patient’s advanced directive, without considering the intent behind it, would have tragically resulted in the death of a patient with a stated DNR from a treatable epidural hematoma. Had the daughter refused the CT or bloodwork, a true ethical dilemma could have arisen which may have required us to question whether she was truly acting in accordance with the spirit of the patient’s previously stated

Yes, the right of an adult patient in receiving or not receiving medical treatment under the legal and ethical standards requires the patient to provide informed consent. If the patient cannot provide informed consent, a legally authorized surrogate can make decision. The same legal and ethical standards apply for the terminally ill adult patient in the case of withdrawal of life-sustaining treatments. In other ways, medical ethics does not involve the life of patient to be preserved in all circumstances at all costs.

We are all going to die, and death is inevitable. At the end of life, each story is different. For some older adults, the body is sick while the mind stays healthy. Others remain physically strong, and suffer mind losses, which is sorrowful. Elders at the end of life need more care in different areas, including physical problems, emotional and spiritual perspectives, and functional concerns (NIH Senior Health, 2012). The idea of end-of-life care is that everyone has the opportunity to die with dignity and without pain, and the patient’s family receives compassionate care and support.

The legal and ethical effects of decision making in withholding and withdrawing life support have been largely debated. The unanimity in the United States is that it is standard to waive or decline life support with permission of the patient or a surrogate under some circumstances (American Thoracic Society, 1991; Council on Ethical and Judicial Affairs, 1991). However, such practice is not always accepted and varies greatly from country to country and over time (Asplund and Britton, 1990; Koch et al., 1994). End of life decision making can be a very stressful event for both the physician and the patient; and when there are two conflicting cultural backgrounds, communication about these