Patient Self-Determination Act Of 1990

The practically speaking, the case of Nancy Cruzan highlights the fact that an individual cannot rely only on telling his would be decision maker what type of care is desired should that individual become incompetent. Such evidence may not be viewed as sufficient to refuse medical treatment as happened with Nancy Cruzan. It thereby becomes important to record exactly what type of treatment should be accepted or refused if one’s decision making capacity is lost. The most common way to do this is in the form of an advance directive. Such a document would declare not only who the patient wants a surrogate decision maker, but also relates the degree of treatment desired by the patient. The presence of an advance directive makes caring for incompetent patients much easier because confusion over the patient’s wishes is avoided. Had Nancy Cruzan made an advance directive, withdrawing the artificial nutrition

.“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

The other part of an advance directive is the durable power of attorney. One’s proxy, who carries the durable power of attorney, should be a trusted relative or friend that can make decisions for a patient if the patient is incapable of doing so themselves. The patient should speak in depth with the proxy about their wishes overall and, if specific situations were to arise, how to proceed. A proxy that is trusted is a great resource should the unfortunate arise; they are able to speak out and advocate for a patient, as well as elaborating on certain written decisions. Having a proxy is especially beneficial if a patient is incapacitated and in a situation that is not clearly covered by a living will (Roberts, 2001).

This paper concerns the ethical basis for advance directives, or “Living Wills”; the value of these advance directives to the patients, their families; and the authorities that these advance directives give the above mentioned interested parties.

The patient freedom act is a bill proposed to replace and appeal certain mandates under the patient protection and affordable care act. This bill was proposed in January by four Republican senators: Bill Cassidy, Susan Collins, Shelley Moore and Johnny Isakson. This bill is one of the many attempts this year to repeal and replace Obamacare. The Patient Protection and Affordable Care Act has included Medicaid expansion, the individual mandate requiring health insurance, minimum insurance standards which required insurance to provide mental health, maternity, and emergency room visits to be provided on every plan,age-based premiums and also requiring that insurance companies provide coverage without regarding pre-existing health condition as

I discussed several scenarios with my advocates to indicate the thought processing I have toward quality of life I will have. One such scenario was, if I am severally injured, unconscious due to Acoma or brain injury my primary advocate will make medical decisions on my behalf. If I have irreversible brain damage, being kept alive by way of machine or equipment help and have no ability to sustain myself without these machines or life support, the advocates will make the decisions to turn off the machines and let me die in comfort and peace. If my primary advocate is also injured, deceased, or not of sound mind, then the successors will make final decisions for my care in the order listed in the document.

Every seriously ill patient and their family should have decided the following issues: proxy, resuscitation, hospitalization, and specific treatments. Every seriously ill person needs to have pointed out a person to speak on their behalf when they get too sick to do so. A “proxy” can be filled out at any hospital or nursing home granting “power of attorney” to a loved one to be able to make decisions. A person

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

This is illustrated in Mrs. Smith’s case. Mrs. Smith is an 85 year old who has suffered from a large stroke that extends to both of her brain hemispheres which has left her unconscious and unable to make medical decisions for herself. She only has some brain stem reflexes and requires a ventilator for life support. Mrs. Smith did not set up an advanced directive, which is defined by Miracle (2011) “mechanism by which individuals make known how they want medical treatment decisions made when they can no longer make them for themselves” (p.229). Without an advanced directive, medical decisions will fall to Mrs. Smith’s children, Sara and Frank. Each of which have different views regarding their mother’s plan of care. The decision that needs to be made is whether to prolong Mrs. Smith’s life with continued medical intervention, as Sara would like to do, or stop all treatments and care, as Frank

Since the inception of the Patient Self-Determination Act (PSDA) in 1990, Modan and Brill (2014) stated that modification has been made to reflect the true intention of clarifying and protecting the patient’s wishes for his end of life care. However, despite the improvement in advanced care planning (ACP), Modan and Brill (2014) reported that public participation remains low. Moreover, due to the fact that ACP requires communication strategies, Modan and Brill (2014) also commented that there is a disconnection between the patient and providers – when health care workers tend to focus more on protocols than the patient’s experiences. Thus, to effectively engage the patient in ACP conversations, a nurse must look into his

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

In addition, the legality of living wills is still being challenged in about 25 percent of all cases, decisions are made -– by family or physician – that are contrary to the patient’s wishes as stated in their living will (i.e.

The advance directive, or living will, is one way of circumventing the ethical dilemma of Quinlan, as it is essentially a set of choices by the competent patient if faced with different hypothetical circumstances. Patients can thus feel comfortable knowing that their competent wishes have been documented and can be easily interpreted in case of catastrophe. However, the authority of advance directives is a topic hotly debated amongst medical ethicists (see Advance Directive Authority). Arguments against directives state that not all factors are considered by the person creating the advance order. Also, in some cases of severe dementia, it is argued that the personal identity of the author is no longer intact and therefore has no authority over the treatment of the “new” person. The debate on this topic is extremely complex, but many of today’s cases are decided on an individual basis, with the directive often being upheld.

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.