Patient Self Determination Act

The topic of end-of-life care may seem daunting and uncomfortable, and yet most individuals do have unique desires and concerns regarding their provision for the future. Providing the opportunity for that communication, the advance directive and POLST forms allow an individual to explicitly state their wishes before the future. Developed to lessen the apprehensions concerning patients undergoing any extensive and unwanted measures to preserve life at any cost, these medical directives lighten the decision-making burden for physicians and families alike and help comply with the patient’s utmost end-of-life wishes.

Sule stated that, “The Patient Bill of Right adopted by American Hospitals Association states that ‘a patient possesses the right to be informed of the medical consequences of his or her actions and decisions and refuse treatment to the extent permitted by the law’. However, this is true only if the patient is in position to understand the consequences of his treatment. Incompetent, senile patients neither have the correct judgment regarding which treatment is appropriate for them, nor are they in a state of understanding the implications of their treatment. In such case, their willingness to grant or deny consent cannot dictate the course of treatment.” Problem with the Act is being able to find that the patient component enough to make such a call. Another issue that Sule stated was on confidentiality and autonomy. According to Sule, “This is another ethical issue erupting from the conflict of patient's rights and professional ethics in nursing job and profession. The Patient Bill of Right makes it mandatory for the medical practitioners to reveal the form and extent of the ailment along with the course of treatment to be undertaken by the practitioners. However, this law of autonomy clashes with the nursing ethic that the professional should maintain high degree of confidentiality regarding the patient's health and treatment.” This can cause conflicting issues in the NP’s

Another issue with the implementation of Informed consent arises when the patient waives the right to Informed consent and leaves the right to make the decision on the physician. Though legally correct, this can cause psychological stress for the physician especially when the decision is about a life threatening medical condition. Moreover, this also makes the patient vulnerable to abuse. (Manthous, DeGirolamo, 2003)

Very often, deliberate decisions are made which results in the end of a life. For example, a person could be kept on life support, but instead, a family member or other significant person might choose to switch off the life support machine resulting in the official death of a patient. There is also the case that resuscitation of a patient may eventually prove to be trivial and a doctor might suggest just making the patient as comfortable as possible until their eventual passing. In the above situations, a medical professional’s decisions would not be questioned or doubted. It is conventional practice (Warnock and MacDonald 2008).

Should terminally ill people be allowed to decide rather or not they want to live in constant pain and suffering? “Physician-assisted death is defined as the physician providing the means for death, most often with a prescription. The patient not the physician will ultimately administer the lethal medication” (Braddock & Tonelli, 1998) To better explain physician-assisted suicide, a situation in which a patient kills him-or herself, using means which have been supplied by the physician, with the physician being aware that the patient will use those means for the purposes of suicide. Physicians are trained to heal the sick, care for the injured, and cure diseases. However, medical school does not prepare them when they cannot cure

Patient self- Determination Act (PSDA) encourages people to make a decision about the extent of medical care they want to accept or refuse (American Cancer Society, 2015). It is the responsibility of ethics committee to make patients aware of their rights. Also, “committee members need to be educational and advisory in nature, they should educate themselves, other health care workers, patients and the family members regarding the ethical principles and organization’s policy relating to the ethical issues”(Alexander & Kavaler, 2014). Many people are not aware with the advance directives, they don’t know how to complete advance directives (ADs), what are the state regulation to complete ADs and only a few people discuss their preferences with doctor, which do not protect their autonomy during the time of end- of- life (House & Lach, 2014). Health care professionals must be competent to provide information on ADs so that patients will be able to make a decision. In addition, patient’s wishes and ADs need to be discussed among family members and the health care providers so ethics committee plays an integral role in protecting patients’ preferences and supporting ADs process for

Although the patient themselves are going through the worst of it, it also takes a toll on the family members and friends who have to watch the patient suffer. An illness in the family is never easy due to the bills and all the time that taking care of the patient takes. It is also hard for the patient to watch their family members and friends suffer and know that it is their fault. The patient should be able to end all of that suffering if it is their choice.

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

The Patient Protection and Affordability Act (ACA) was enacted by President Barack Obama’s Administration on March of 2010. The ACA was designed to generate healthcare reform, and is actually the most comprehensive law affecting managed care legislation since Medicare and Medicaid were enacted in 1965 by President Lyndon Baines Johnson (Kongstvedt, 2013). One of the main reasons for the creation of the ACA has been to contain out of control healthcare costs in the U.S. by transforming the manner in which hospitals are paid for surgeries (Chow, 2013). The new role that government will play in the healthcare sector will undoubtedly effect current healthcare practices.

A personal experience of mine was this past year, when a close family member was diagnosed with brain cancer. She had refused treatment, with that was given 6-8 months to live. She was the most strongest, independent, family oriented lady I have ever met, however, that quickly changed when the tumour spread like rapid fire. She could not eat on her own, she could not talk, and she could not do the basic everyday routine, needing constant help. As the days went on she was getting worse, she was not herself. Now, we are left with these memories and the sadness of witnessing a strong independent lady just disappear in front of us. For a terminally ill patient with the knowledge of dying with dignity should be given this choice. As learnt in class it is based on the rights approach, giving the individual the right to choose for him or herself. The right to choose to die before the illness takes over and takes away who the person really was. Their right to leave their family with happy memories, instead of sad memories of them being sick and in

Rising healthcare cost, consumerism, advancement in medical practice, and the movement to increase the use of advance directives were the important driving forces for the development of a federal act called as the Patient Self-Determination Act (PSDA). According to chapter 26 of Indian Health manual, “Patient Self-Determination Act (PSDA) was passed as part of the Omnibus Budget Reconciliation Act of 1990, which took effect on December 1, 1991”. This act mandates hospitals, skilled nursing facilities, hospice, home health agencies, and organizations such as HMO’s and other health care organizations participating in Medicare and Medicaid programs “to inform patients of their right under existing state law to accept or refuse medical or surgical treatment and to formulate advance directives” (Patient Self-Determination n.d.). The PSDA requires health-care providers to educate their staff and the community about advance directives. It also prohibits hospital personnel from discriminating against patients based on whether or not the individual has executed an advance directive. For those patients who already have an advance directive in place, facilities should document it in their medical record. The purpose of PSDA was not only to respects the patient’s right of self-determination, but also to provide a mechanism for controlling health care cost by maintaining a balance between healthcare

It should be clarified that when inevitable death is imminent, it is legitimate to refuse or limit forms of treatment that would only secure a precarious and burdensome prolongation of life, for as long as basic humane, compassionate care is not interrupted. Physicians are not obligated to and should not offer useless or futile treatments, even in the name of patient automony. Despite this, physicians still seek to obtain patient and proxy consent before writing a Do Not Resuscitate (DNR) order. Reasons for this include fear of legal repercussions, limited physician patient relationship, time constraints, hospital culture, guilt, grief and concerns about family reaction. Some data show that physicians, tend to avoid end of life discussions due in part to their own discomfort with death and dying. Agreement to DNR status does not preclude supportive measures that keep patients free from pain and suffering as possible. Acceptable clinical practice on withdrawing or withholding treatment is based on an understanding of the medical, ethical, cultural, and religious issues of each patient. There is a need to individualize care option discussions to illness status, and patient and family preferences, beliefs, values, and

Current legislations that address “right to die” issues, such as the Patient Self-Determination Act (PDSA), are limited in its efforts to increase the number of patients with advance directives (ADs). The PDSA states that all “Hospitals, nursing homes, health maintenance organizations, and home care agencies receiving Medicare or Medicaid funds provide written information to adult patients regarding their rights to make health care decisions,” including the right to refuse treatments and the right to formulate ADs (Burkhardt & Nathaniel, 2008, p. 277). The number of patients with some form of an advance directive, however, has remained low since the PDSA went into effect in 1991. According to an Advance Directive Attitude Survey conducted in

The Patient Self-Determination Act is derived from the understanding that people should be given knowledge that will make them to give wishes for the extent of medical treatment they wish to receive if they incase become incapacitated. The Power of Attorney for Health Care is taken from the later to meet the wishes of the incapacitated in the state. The document power of attorney is legalized and therefore allows you to choose someone who can make decision for you in case your health condition has worsened and you are unable to decide anything by yourself concerning your health.

As an administrator I would need to take into consideration the patient’s autonomy, autonomy is recognizing an individual’s right to make his/her own decisions about what is best for them regarding their health care (Pozgar, 2012). The patient’s rights always should be considered before any decisions are made by any other family members. In this scenario it is clear that the patient is unable to make any decisions, the patient has suffered a serious brain damage, and although it is not complete brain death, we must determine how to proceed.