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Essays on advanced care directives
Reflective essays on advance care directives
Reflective essays on advance care directives
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Do Not Resuscitate
In this report I will explain what the DNR means for us as patients and Health Care Providers. I will analyze the “varying approaches to identification devices, medical prerequisites, surrogate authority, revocation, reciprocity, and the interrelationship of DNR orders with other types of advance directives” (Ladwig, n.d. pg 34 para 8) between states and hospitals in order to identify the areas of law that seems to create confusion due to their differences in advance directives. Last but not least, I will examine ways in which to improve the confusion/differences nationwide.
The do not resuscitate aka DNR is a legal order provided by a patient stating that they are not to be resuscitated via CPR or with advanced cardiac life support. If they stop breathing or their heart stops beating they have the legal right to say no to life saving measures. The patient may have this legal form in advance or they can receive one from the hospital (U.S. National Library of Medicine, 2014).
Health care facilities will honor the patient’s wish as long as the paper work is legit with signatures and witnesses or whatever is required by their state. The DNR is most often requested by the patient themselves although; in some cases they may be requested by the health care provider who has the power of attorney (U.S. National Library of Medicine, 2014).
Hospitals have been mandated to honor their patient’s decision ever since 1991, when Congress passed the Patient Self- Determination Act Law. Forty-nine states with the exception of my home state of Missouri gave permission for the next of kin to make decisions for incoherent relatives. Missouri also has an extra requirement for their Living Will Statute and that is any form...
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... family calls 911 EMS will still follow Advanced Life Support protocol even though the patient is terminally ill and hospice unless the proper DNA form is presented by the patient or the one that has power of attorney (Hospice Patients Alliance, 2014).
Anesthesiologists are those that patients who have active DNR orders encounter quite often. 15 percent of their patients with do not resuscitate orders go to the operating room for procedures that are most of the time geared toward improving the quality of life (Kelley , 2014).
A do not resuscitate order for patients who have emergency surgery is an “independent risk factor for poor surgical outcome and postoperative mortality” (Kelley , 2014 pg 1 para 3) and the probability of returning patients to their previous level of functioning is higher for CPR performed during the peri-operative period (Kelley , 2014).
Brody, Michael, and Donald Martin. “The Role of Anesthesiologists.” Physicians Protecting Patients. N.p. N.d. Web. October 21, 2015. An anesthesiologist is a physician who has received at least 8 years of schooling and has completed a residency program dealing with anesthesiology. Now, a licensed physician, an anesthesiologist deals with the administration of anesthesia during many medical procedures, including surgical or obstetric procedures, and pain management for acute and chronic illnesses, or cancer related pain. Anesthesiologists are also in charge of “anesthesia care teams” that include the anesthesiologist, an anesthesia assistant, certified registered nurse anesthetist, and an anesthesia technician. As the leader of the care team, the anesthesiologist is responsible for assessing the patient before, during, and after medical procedures, as well as developing and monitoring performance and quality of practices and standards in regards to administering anesthesia. The entirety of
... others with decision making at the end of life through the Cruzan Foundation.The Cruzan case drew national attention, and the family was put under media throughout the process. Missouri now allows health care directives (though not living wills) to instruct that medically assisted nutrition and hydration be removed after a diagnosis of permanent or persistent vegetative state has been made. The Cruzan case became the first "right to die" argument ever heard by the United States Supreme Court.
...o get a do not resuscitate order. That is an order that the families may sign so the hospital does not have to give effort to bring a person back to life anymore once they have stopped breathing.
According to Career Cruising, “anesthesiologists are doctors who administer drugs or gases that prevent patients from feeling any pain or sensation during surgery.” They monitor the patient before, during, and after the operation. Career Cruising also noted that before surgery, anesthesiologists consult with patients and make decisions
No healthcare professional or hospital can force a person to make an advance directive if they do not want one. Although they are extremely encouraged, hospitals and doctors may not discriminate against anyone that does not have an advance directive. Advance directives are more so that the patient has a say in their end-of-life care even if they are unable to make the decisions at that time. It is helpful for doctors and other healthcare professionals because it allows them to provide better patient-centered care. If a person does not have an advance directive, the state of Indiana allows any member of the person’s immediate family or someone appointed by the court to make decisions for them. A person will get care more suitable for their personal beliefs if they write a living will or have a power of attorney.
In this context, new emphasis is being placed on the rights of patients. Recent federal legislation, for example, requires all health care facilities receiving Medicare or Medicaid monies to inform patients of their right to make medical treatment decisions. This includes the right to specify "advance directives," [1] which state what patients wish to be done in case they are no longer able to communicate adequately.
In an effort to provide the standard of care for such a patient the treating physicians placed Ms. Quinlan on mechanical ventilation preserving her basic life function. Ms. Quinlan’s condition persisted in a vegetative state for an extended period of time creating the ethical dilemma of quality of life, the right to choose, the right to privacy, and the end of life decision. The Quilan family believed they had their daughter’s best interests and her own personal wishes with regard to end of life treatment. The case became complicated with regard to Karen’s long-term care from the perspective of the attending physicians, the medical community, the legal community local/state/federal case law and the catholic hospital tenants. The attending physicians believed their obligation was to preserve life but feared legal action both criminal and malpractice if they instituted end of life procedures. There was prior case law to provide guidance for legal resolution of this case. The catholic hospital in New Jersey, St. Clare’s, and Vatican stated this was going down a slippery slope to legalization of euthanasia. The case continued for 11 years and 2 months with gaining national attention. The resolution was obtained following Karen’s father being granted guardianship and ultimately made decisions on Karen’s behalf regarding future medical
Autonomy is an important ethical principal that should be considered with great attention, especially with the limitation of personal autonomy one finds in hospitals. Burkhardt (2008) and Nathaniel define autonomy as self-governing and describe it as including four elements, the ability to determine personal goals, decide on a plan of action, to be respected, and to have freedom to act on choices. In John’s situation, his vulnerability in contrast to the power that the health care professionals hold over him put all four of these elements into jeopardy. Since his advance directive and his current choices differ, the matter of respec...
Implementation of advance directive or do not resuscitate (DNR) order on patients undergoing surgery is at times compromised in institutions
The medical Profession recognizes that patients have a number of basic rights. These include but are not limited to the following: the right to reasonable response to his or her requests and need and needs for treatment within the hospital's capacity. The right to considerate, respectful care focused on the patient's individual needs. The right of the patient to make health care decisions, including the right to refuse treatment. The right to formulate advance directives. The right to be provided with information regarding treatment that enables the patient to make treatment decisions that reflect his or her wishes. The right to be provided upon admission to a health care facility with information about the health care provider's policies regarding advance directives, patient rights, and patient complaints. The right to participate in ethical decision making that may arise in the course of treatment. The right to be notified of any medical research or educational projects that may affect the patient's care. The right to privacy and confid...
Everyday, people go through surgery and require a specialist that will monitor their surgery as well as give them what they need to be able to persevere the pain, which is exactly what anesthesiologists do. In order for the patients to be able to get into surgery and deal with the agonizing aches after the abscission, anesthesiologists have to give the sufferer the proper treatment before and after the surgery. Overall, anesthesiologists must be highly educated in both medicine and communication, they need to be able to give the patient the right amount of medicine as well as speak with the family of patients and other doctors to inform them all with what will be done during the surgery, and they need to be able to properly assist the surgeons during operations.
The so-called ‘right to life’ debate has been beaten to death with no resolution in sight…but what of the ‘right to die’ issue? In California, legislation was passed last year that allows terminally ill patients, who are not expected to live more than six months, to request physician-assisted suicide. However, as with the other four states that have adopted similar legislation, the patient must be capable of administering the lethal drug to himself or herself, medical personnel are not required to participate in any way, and the relief does not benefit any others, such as quadriplegics or those suffering from chronic debilitating diseases("State-by-State Guide to Physician-Assisted Suicide"). Therefore, healthcare professionals can choose to follow their own moral values regardless of the patient’s wishes…and they do. The option to choose not to follow a patient’s wishes, or to deny assistance, steps squarely on the personal rights and freedoms of the
DNR is a legal order to facilitate natural death or no intervention to prevent death. This is an important decision on someone’s life and reflect their wishes (ANA 2012). In New York state Nurse practitioners are allowed to sign death certificates but not allowed to enter Do Not Resuscitate order. In New York state, nurse practitioner’s scope of practice includes diagnose, treat illness and give compassionate care but not “eligible” to give end of life care (NYSOP, 2016). This also interferes the continuity of care. DNR policy in New York state is a main barrier to achieve full extent of our education and training.
This past Tuesday, I attended Dr. Eric Vogelstein’s philosophical seminar and 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 medical powers of attorney (i.e. proxy designation). The use of advance directives is often ethically justified based on the belief that it allows patients to exercise their autonomy through self-determination.
In the face of the threat of euthanasia, does the patient have the right to the final word? What are his rights in the area of medical care? This essay will explore this question, and provide case histories to exemplify these rights in action.