Medical Indicator, Patient References, Quality Of Life, Contextual Features

Though ethics committees have been helpful, scores of physician-patient disagreements end up in the U.S. court system with inconsistent results. The states adopted individual “statutes regulating DNR orders and their provisions vary in analysis throughout the U.S.” (Bishop, Brothers, Perry & Ahmad, 2010). One ethical dilemma that is constant in emergency rooms, the intensive care unit and terminally ill persons is a futility of treatment. In the case of CPR/DNR, New York State wanted to enact a law that describes the decisive responsibilities of the patient, and the family or surrogate, and physician. “In April 2003, the New-York Attorney General asserted that the DNR law would require a physician to obtain a consent of the patient’s health care surrogate before entering a DNR order, even when the physician

This scenario presents various ethical issues that could be argued several ways from HIPPA violations to whether or not this patient has/had the cognitive ability to understand the execution of an advanced directive and Power of Attorney. Advance Directives are put in place for this very reason. It eliminates the need for family members to make a choice in the heat of the moment and also respects the wishes of the person whom it affects directly. Although Mr. E’s hypoxia could affect his ability to think clearly one cannot assume that he has an altered level of consciousness nor the inability to execute an advance

In the case of a minor unable to consent or make decisions (due to a mental condition or conscious state) and the absence of parents or legal guardians, two medical doctor must make all medical decisions on his behalf including cardio pulmonary resuscitation and termination of life support.

Depending on the context of how an individual resulted in a state where they were unable to transmit their feelings on if they want to decline or desire to prolong their existence and the connections others around them, should predict who has the power to make medical decisions on the one in question's behalf. In Schiavo's case, she had a medical emergency that resulted in her decline of being unable to communicate her end of life desires, considering her relationship with her loved ones, the closest individual with the highest understanding of her wants should have the authority over her

2) If the patient is not legally deemed competent to make his or her own medical decisions then an appointed guardian, next of kin, or power of attorney must provide consent on behalf of the patient, unless it is an emergency situation in which the health care providers must act fast, based on the case of Schloendorff v. Society of New York. In the case of an emergency the medical team may necessary care to keep the patient safe and sustain his or her life.

In that situation a patient must be incapable of giving consent and no lawful surrogate is available to give the give the consent. Treatment can be initiated if there is danger of life or danger of a serious impairment of health. Immediate treatment can avert danger and save life. Treatment may be initiated in non-emergency situations if the patient is doubtfully competent and refuses treatment, the benefit of doubt goes to the patient unless the doctor seeks and obtain a court order. A health care provider should know that one individual does not have authority over another. A health care provider should look for the advanced directives such as a living will. A legal system like court order should be used to get a guardian who can give consent. In a nutshell the autonomy of individuals should have the protection of proper process and law in all health care settings. When there is any doubt a court may help. The court-appointed guardian will be the lawful surrogate who can consent to or refuse treatment in line with the best interests of the patient or the balanced choice

This can be a difficult time not only for the patient but also for the loved ones and family. Sue Ellen, due to the fact that she was in a comatose state isn’t aware that she is possibly living in her final days of her life. During this stage health care professionals try to make the patient as comfortable as possible. The healthcare workers and physicians tried to make Sue Ellen as comfortable as possible. There are several myths about the end of life care that support good health care and good medical ethical practices. During this critical time, ethics, clinical judgement, and the law can run into major conflicts. The patient, families and physician can find themselves considering clinically actions that are ethically appropriate, but could possibly raise legal issues. In this particular case, Sue Ellen family and the healthcare facility are concerned. According to Meisel, Snyder, Quill (2000), “The 7 major legal myths regarding end-of-life-care are: (1) Forgoing life-sustaining treatment for patients without decision-making capacity requires evidence that this was the patients actual wish. Sue Ellen, did not have person that was a designated surrogate. This would play a major factor in my decision as a Health Administrator to have her moved from the AICU to a hospice facility for care. (2) Withholding or withdrawing of artificial fluids and nutrition from terminally ill or permanently unconscious patients is illegal. The only time

Since the patient is unable to provide the consent based on the information presented by the doctor, the informed consent will rely on the healthcare directive or next of kin. There is the possibility of the next of kin agreeing with the patient’s wishes, which can cause a delay in a decision. Many family members are unable to make the decision to take a patient off of the ventilator even after being declared brain dead. (Health, 2015)

Inspection: I am looking to see if there is any abnormal vision, hearing, sensing, smelling, or even if I notice any discoloration of the skin, texture of the skin, and lesions, or any redness of the skin and hair texture. I would document my findings, and if I notice a problem then

Spouses, in particular should be very clear about their ability to make health care decisions about their partners, spouses assume if their husband or wife become incapacitate and are unable to make decisions, they have the automatic right to step in. When incapacitated, a patient's inability to understand consequences may or may not be temporary. Under these circumstances a patient's spouse is not statutorily authorized to be first in line to make decisions (Vergari, 2007). Probate code only places a spouse in the category of a family member (Vergari, 2007). Established case law states that marital status alone does not create authorization, in essence all family members have equal right (Vergari,

Since the patient has verbally communicated with her husband to make the decisions she should ever find herself in this situation. In this case, the New York’s Family Health Care Decisions making Act (FHCDA) and the New York Health Care Proxy Law will be used. The FHCDA, which is newly established, allows the family to make decisions for an incapacitated patient, regardless if the patient has either a signed advanced directive and the surrogate decision maker has direct knowledge of the patient's wishes or will act in the best interest of the patient (State of New York, Revised 2012). As an appointed guardian for Lydia, Mr. Bevin’s is allow make decisions for his

This standard relies on the process through which a decision is to be made. But when a patient is unable to go through such process, this standard fails to stand on its ground. It is to some extent an ambiguous concept that tries to meet both sides of the previous two standards. Determination of competence is the core part of the ethical and legal decision making. Brock and Buchanan (1989) have made it clear that competence is not a global concept, but it is mainly related to specific decision-making. We all have to understand the standard values of this problem. To decide the competence of a person, we must analyze the situation under which a decision has to be made and also the nature of the decision that is to be made. Thus, time and condition play vital and defining roles in decision making. In medical decision making, it is the complexities of a particular treatment and of the given information that have a great influence. A patient can give consent to a life-saving treatment and it does not require a high level of

Malingering is when a person presents extravagant false symptoms (physically or psychologically) intentionally because they are motivated by external incentives (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000). It is important to determine whether one is malingering because the court can misdiagnose someone as malingering when they are actually in fact mentally ill or someone is malingering and does not get caught. Medical treatments, time and effort get put into these people when they could be used on someone who actually does need it. They can also get off for their crime by going into civil commitment or serving less time than if they were put on trial as being perfectly okay.

The case of Karen Ann Quinlan led to four basic approaches to this ethical problem; advance directives or other clear evidence of the patients wishes while competent, surrogate decision making (power of attorney), and action in the patients best interest. Each solution has deficiencies both in theory and practice, but there can be no debate that their application has changed the landscape of medical ethics.

Even if the patient's husband remains as her legal surrogate decision-maker, his decisions on the patient's behalf are constrained by legally imposed standards. First, a surrogate is legally required to provide "substituted judgment" on behalf of the patient. This means that the surrogate must act in accordance with the patient's wishes. If substituted judgment isn't possible (i.e., unknown what the patient would want under the current medical circumstances), then the law requires the surrogate to act in the patient's "best interests." Since the medical team has significant input about what would medically be in the patient's interest, a decision by a surrogate which doesn't adhere to this standard should not be automatically followed and may need to be reviewed by the institutional ethics committee, risk management, or legal counsel.