The Case Management Monthly A Case Study

A patient barrier might include having limited knowledge surrounding life-support systems and treatment options, thereby hindering their ability to fully comprehend or demand certain interventions. Good counseling is therefore essential to overcoming this barrier in implementing the patient’s true and best wishes (Kroning, 2014, p. 222). Another barrier in implementing advance directives concerns the role and influence of family members and the patient. There may be discordance between the desires of the patient and family, which can result in serious debate and tension if not addressed and taken into consideration. Physicians still may have reservations, as certain demands made by the patient may raise ethical concerns in the future, if the provider feels the interventions being done are no longer medically appropriate.

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

It’s never easy for a family to say they want someone taken off life support. We want our family member to live; therefore, leaving this decision to them in their time of fear and grief is not fair. According to an article I found not many have made this choice, the article states, “but if we mirror the larger US population, only 25% to 30% of us have completed an advance directive” (Alspach, J. G., 2016). It’s often thought that just telling your family what you want will be enough, but without written proof, at that time, it’s no longer your

The healthcare system places emphasis on involving patients in their plan care throughout the disease or healing process. Nurses and other members of the healthcare team are responsible to ensure that the competent patient has the right to refuse any medical treatment. Patients can have an active voice in their treatment throughout their disease process by clearly stating their treatment requests in an advanced directive. Patients who file advanced directives are warranting their current wishes are met in the event that they are no longer able to make decisions for themselves. However, an advanced directive (AD)

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

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

Advance Directives are our wishes when we are at end of life stages of life that give specific direction of how, who, and when to treat us in our final days and hours. We can have documents drawn up to say what we want in the event we are in a state where we cannot voice our wishes aloud. These documents have legal and ethical basis, and they should be followed unless the legally or ethically unable to do so.

Patient autonomy follow the rights and choices that a patient make and is unimpeded by bias. Patient autonomy is typically exercised in a case where the patient is given the opportunity to direct and make decisions about the course of their own health. In the case of Sue Ellen, this patient is in a comatose state and is unable to exercise her rights to autonomy. It is not disclosed rather or not Sue Ellen has an advanced directive on file signed. According to MedlinePlus (2016), Advance directives are legal documents that allow individuals to spell out the decision about end-of-life care in advance.” Advance directives are important and give the individual an opportunity to express to family, friends, and health care professionals what he or she wants. This is a great way to avoid confusion that could later arise from this particular matter. Living wills include which treatments the individual wants if they are dying or in a situation of comatose state such as Sue Ellen. This case scenario is very similar to the 2005 Terry Schiavo case. Terry was unconscious, had no advance directive and was unable to make her own medical decisions. The “Surrogate Consent Acts” has been passed and mandates surrogates to make decisions about the care of individuals that are not in a state of mind to make decisions on their

I am sorry for your loss Tacarla. It is important to have advance directives or living will because it will guide family members on what the patient’s wishes are, even if they do not agree with it. I recently took care of a patient with an end-stage renal disease; he stated that enough is enough and he is stopping all treatments. The patient did not have an advance directive or DNR. The doctor explained to him and his family what it means if he stopped treatment and encouraged him to sign a DNR. Refusing treatment is the patient choice of forgoing all life-sustaining treatment; therefore a sign advance directive is needed to honor the patient’s wishes (DeSpelder & Stickland, 2015). The patient was ready, but the family was not. The family asked

Mary is a patient in the local hospitals Intensive Care Unit. Mary has a history of end stage COPD, lung cancer and renal failure. Mary is currently on life support via a ventilator. Knowing that her life would end due to her health complications, Mary had a living will and an Advance Directive written by an attorney in case that someday she would not be able to make her healthcare wishes be known. Mary did not name a Durable Power of Attorney in her living will. Mary’s family is aware of her wishes but thinks

What if an individual could no longer make personal decisions about health care? In the event a patient is unable to personally advocate, having an advance directive ensures that end of life care will be carried out as desired and specified. As Galambos (1998) explains, advance directives are written documents acknowledged under State law that allow the expression of wishes regarding the extent of healthcare and intervention in the event of losing the capacity to express end of life wishes. The two most common advance directives are the Living Will and Durable Power of Attorney for Healthcare. In the event of a terminal condition and the patient 's inability to express his or her desires, living wills are intended to specify wishes for various end-of-life care procedures. Durable powers of attorney are used to designate a surrogate who will share the wishes of the represented patient and act in the patient 's best interest (Nelson & Nelson, 2014). Advance directives are important because they guide and direct health care professionals, patients and family members to protect end-of-life autonomy for clients (Galambos, 1998). This paper will explore advance directives within the context of federal and state laws, legal and ethical principles, and implications for the registered nurse.

This past Tuesday, I attended Dr. Eric Vogelstein’s philosophical forum titled “Advance Directives: Problems and Prospects.” This talk focused upon the use of advance directives, which can be described as written legal documents that detail a patient’s wishes regarding their medical treatments in the case that he or she unable to verbalize them due being in an unforeseen medical state or circumstance, as well as the implications of their use in the medical field. Advance directives themselves usually consist of living wills, either scenario-based and value-based, and medical powers of attorney (i.e. proxy designation). Thus, the purpose Dr. Vogelstein’s discussion was to examine whether such ethical justification can be considered as valid

This writer advocates for ensuring that everyone address the issue of advanced directives to anyone over 65 coming into the facility. The Patient self determination act in December 1991 has mandated that health care personnel invite patients to complete their advance directives. However, the frequency of preparation has remained static for the last 15 years (Dobbins 2007). According to Ethicists Beauchamp and Childress : The fundamental requirement is to respect a particular person’s autonomous choices . Respect for autonomy is not merely ideal in healthcare; it is a professional obligation (Beauchamp, et al., 2001). In a report published by the Institute of Medicine in 1997, the authors concluded that individuals should be able to

Advance directives are the legal documents that allow you to make choices about your health care and medical treatment in case you become unable to speak for yourself. Advance directives are a way for you to communicate your wishes to family, friends, and health care providers. The specified people can then convey your decisions about end-of-life care to avoid confusion if you should become unable to communicate.

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.