Doctor Facilitated Denial Summary

D- The patient arrived on time for her session and reports being stable on dose and haven't used any illicit drugs. This writer advised the patient that this writer was in fact in receipt of missed phone call about coming to the session at 10:30 am rather than 10 am due to her mother in the process of selling the house. This writer addressed with the patient about letter from CHR from her counselor, Jade Bray stating about the patient non-compliance with her appointment due transportation barrier. According to the patient, she is going through hardship as her mother is no longer taking her to her appointment as the patient says, " She's tired of bringing me everyone, Charlene. She complains about bringing me here and does not understand why I can't even get a bottle...:Like c'mon. What do I have to do?" This writer explained to the patient about TEAM decision, at which the patient disagree with the decision. This writer asked the patient about her "judgement." According to the patient, she feels she is making judgement by not engaging any further altercation with patient at the clinic, dosing daily, coming to her counseling session, and trying to get help from Chrysalis for

.“As medical technology continues to advance and health care choices become more complicated, the preservation of end-of-life autonomy is an increasingly important issue faced by various client populations.” (Galambos, 1998).

Other barriers in implementation might include the legality of certain medical interventions, associated costs and limited resources for providing the best care possible (Mason, 2013, p.12). As nurses, a barrier in implementing advance directives might also arise when advocated end-of-life wishes are undervalued or poorly recognized by others who do not share the same comfort or high priority in the medical workplace. Finally, the patient, families, and healthcare professionals face barriers in misconceptions regarding advance directives, especially in regards to

Another factor affecting peoples perception could be their locus of control, Rotter (1954) made distinctions between beliefs of people with an internal and an external locus of control: people who are said to be ‘internal’ are thought to believe that their own actions can change the outcome of situations, making these situations under personal control, however ‘externals’ are seen generally to believe that the outcome is beyond their personal control, believing that their actions are unrelated to the events. Therefore if someone has an internal locus of control they believe that they have a significant say in how their lives are run, whereas a person with an external locus of control believes that ‘fate’ has already decided upon the events of their lives. Niven (2000) suggests that people who have an internal locus of control may be more highly motivated to take action concerning their health; however they are less likely to adhere to medical advice. This may be due to the fact that internals feel that they have a choice and say in the outcomes of their health and can decide not to adhere when it is appropriate. For example in Susan’s case when she spoke about having a bilateral total knee replacement, she said that when the doctor had advised having

Serious diseases such as acquired immunodeficiency syndrome (AIDS) and metastatic cancer have directed societal attention to end-of-life decision making because many patients who are suffering as they die would like their death to be hastened. In "Oregonians' Reasons for Requesting Physician Aid in Dying" ( Archives of Internal Medicine , vol. 169, no. 5, March 9, 2009), Linda Ganzini, Elizabeth R. Goy, and Steven K. Dobscha discuss the reasons that terminally ill Oregonians gave for wanting a physician to aid them in dying. In Oregon dying patients may make such requests under the Oregon Death with Dignity Act. Of the 56 patients who were surveyed, the average age was 65.8 years and nearly half had completed college. Slightly more were female

Even though organizations such as hospice which minimize pain are made aware to patients with terminal illnesses, it begs the question why do people still want to partake in physician assisted suicide? The issue of wanting to commit suicide is not so much an issue of physical health but more so an issue of mental and spiritual health. In her paper, Foley refers to a study which says “depressed patients with cancer said they would view positively those physicians who acknowledged their willingness to assist in suicide. In contrast, patients with cancer who were suffering from pain would be suspicious of such physicians”(121). In other words, the majority of a patient 's suffering actually comes from their mental state. As we all know, there

The terminally ill think about not only their life but how their decisions will impact their family after passing. They turn this fear of disappointment into a burdensome feeling which make them feel as if they family does not want to take care of them or take on their issues. Studies conducted by the NCBI, in “Patients’ Experiences of Being a Burden on Family in Terminal Illness” show how when asking participants about end of life care their response was they “wanted to feel that they were not being a burden on family or society was one of the eight factors rated as important by most patients but not seen as important by most of the doctors.” By allowing patients to seek PAS, they are opening the door to liquidate this feeling. If a patient knows he or she can take PAS to resolve these worries in the end they will have a more peaceful transition into

“Against Medical Advice” is a book about a family who care for their son, Cory, who suffers from Tourette's Syndrome, Severe Anxiety Disorder, Depression and Seizures. Cory takes around fifty to sixty medications to treat him, and not one of which actually works. The only thing that helps him cope is alcohol. The story is told in the eyes of Cory which brings a unique form of storytelling to the table. It tells the story in the eyes of one who is mentally ill rather than a normal person we are all used to reading about. It is the hope of Cory and his parents to make his condition better so he can become sane again.

Patient's decision-making is influenced by several factors. Patients may change their decisions, from accepting or refusing treatment depending on the available treatment options. The capacity of the individual to make informed medical decisions can differ as the patient's status changes cognitively, emotionally, and/or physically and as the proposed treatment interventions change. Treatment refusal is a common situation faced by clinicians. Patients do not usually refuse the medical advice if the advice is of good intention. When patients refuse an advice, it indicates some underlying reasons related to the patients or family, factors associated with the physician as well as social and organizational issues.

Sometimes physicians go so far as to make patients feel belittled and helpless. Patients, in turn, are relatively passive and accommodating, at least while they are with their doctors"(du Pre 53).

A patient requesting surgery must first go through a physical examination as procedure, to confirm they are candidates for the operation. This is to eliminate technical errors during surgery that could be caused by a patient’s medical issues. If their current medical problems are severe, this could seriously injury or kill the patient if they go forth with surgery. In my additional resource, it states that, “Arnold Schwarzenegger signed the Donda West Law in California in October 2009. This law required that a patient requesting cosmetic surgery must first go through examination, reveal their medical history, and attain written clearance for procedure.” He signed this law as Kanye West’s mom, Donda, died from complications after having liposuction and a breast reduction. It is unclear whether the surgeon who performed the operation on her performed a prior examination. Another surgeon she had visited before receiving surgery elsewhere to get the liposuction and breast reduction, declined performing the surgery.

In accordance with previous studies, they found that higher education is correlated to positive attitudes toward Advance Directives. They found that when family members have higher education than patients, the family members also have more positive attitudes than patients about Advance Directives. Aside from looking at level of education and demographics, they also discovered that on one’s perceptions of the healthcare professionals’ role in treatment decisions, belief in opportunities for treatment choices, effect of an Advance Directive, and perceptions regarding the severity of illnesses all effect one’s decision to complete or reject an Advance Directive. This study also discovered that physicians, nurses, social workers, and other healthcare experts might contribute to the low percentage of individuals who complete an Advanced Directive. Physicians’ lack of discussion and nurse’s lack of education to patients about Advanced Directives may be the results of few completed Advance Directives. Due to time limitations and other possible legal complications that may occur, it can be challenging for healthcare professionals to adequately discuss an Advanced

  Doctors do err on cancer patients' survival times, so how can they say when the time is ripe for assisted suicide. A study in the July 1 issue of Cancer, the journal of the American Cancer Society, finds that doctors are often wrong in predicting how long terminally ill cancer patients will live. After studying the accuracy of doctors' predictions regarding 233 patients with end-of-life cancer, the researchers found most doctors had a tendency to overestimate survival time. But among patients who lived longer than six months, 40% had been expected to die sooner. The results are relevant to decisions to refer patients to hospice care -- and also to decisions for assisted suicide, which in Oregon can only be

Inputting Reasons for Treatment Refusal: Remember, the goal is to have a reason documented for each patient who refuses treatment. My recommendation would be to write these in with pencil (or type and print it out) so that you can make updates as needed as the categories may change over time (as we discussed).

Our society finds it difficult to talk about dying and euphemisms are the norm. It is typical for both doctors and patients to be hesitant to initiate a discussion on dying. Focus instead is often more often placed on interventions and actions for managing symptoms. This avoidance can leave patients and their families unprepared for the inevitable death. (Schapira, 2010) It also often results in requests for therapies which may be excessive, costly and even painful in the hopes for a cure. One study demonstrates that when patients are aware that they are terminally ill, the majority are able to reach a state of peacefulness and also exhibit lower levels of distress. (Ray, Block, Friedlander, Zhang, Maciejewski & Prigerson, 2006) It is also important that family members are willing to discuss end-of-life options with their loved ones. According to elderly patients, they are most often the ones who initiate these conversations with their