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Cardiopulmonary resuscitation eaws
Cardiopulmonary resuscitation eaws
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The Patient Self-Determination Act (PSDA) was implemented to allow patients to state “Do Not Resuscitate” (DNS), or to assign a surrogate decision maker in the event the individual is unable to make the decision. Closed cardiac massage was introduced in 1960 and still the health care provider operated in fear on who to actively resuscitate and they would sluggishly respond on patients who may not benefit based on extent of illness (Ball, 2009). The care providers operated in fear of litigation depending on the family’s response but was fairly relieved by introduction of the Patient Self-Determination Act (PSDA).
Implementation of advance directive or do not resuscitate (DNR) order on patients undergoing surgery is at times compromised in institutions
where the ethics committee have a policy requiring all patients with DNR to hold the order on the surgery day which goes against the purpose of self-determined act. Surgery team finds this challenge since resuscitation is considered part of anesthesia (Ball, 2009). This is one of the situations where the ethical team is required to offer guidance. In my unit, we ask all patients whether they has advanced directive, this is what guides should resuscitation be required. When there is a surgical patient with DNR orders the surgeons offer three options 1, to rescind the DNR with a written informed consent, 2) retain the order and 3) to keep the orders and have a list of procedures and treatment that the patient or the legal representative has approved. Patient’s wish should be sort and be honored but if the team feels inadequate, they should bring in the ethics team for advice (Ball, 2009). Another emphasis our unit is educating the patient and family during pre-surgery evaluation visit, a period where they may be better placed to make their life choices other than minutes before surgery when the pain is mentally unstable. Ball, K. (2009). Do-not-resuscitate orders in surgery: decreasing the confusion. http://eds.b.ebscohost.com.lopes.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=8&sid=95c58160-2401-4d3c-a09a-3d662d4a7b28%40sessionmgr120&hid=119
Although the hospital was following the directive in order to maintain legal immunity for its hospital staff, the rights of the family were violated along with the medical fundamental principle to “first, do no harm”. First of all, despite the wishes of Marlise Munoz, she continued to receive the help of machines and hospital staff at John Peter Smith Hospital even after being declared dead. Marlise was found on her kitchen floor after more than an hour without oxygen on November 26, 2013. Arriving at the hospital, the staff placed Marlise on life support in accordance with section 166.049 of the Texas Advance Directives Act. The directive states, “A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.”
This can be seen in the case study as ethical and legal arise in resuscitation settings, as every situation will have its differences it is essential that the paramedic has knowledge in the areas of health ethics and laws relating to providing health care. The laws can be interpreted differently and direction by state guidelines may be required. Paramedics face ethical decisions that they will be required to interpret themselves and act in a way that they believe is right. Obstacles arise such as families’ wishes for the patients’ outcome, communicating with the key stakeholders is imperative in making informed and good health practice decision. It could be argued that the paramedics in the case study acted in the best interest of the patient as there was no formal directive and they did not have enough information regarding the patients’ wishes in relation to the current situation. More consultation with the key stakeholders may have provided a better approach in reducing the stress and understanding of why the resuscitation was happening. Overall, ethically it could be argued that commencing resuscitation and terminating once appropriate information was available is the right thing to do for the
Prior to discussing why Advanced Directives are so essential the definition of Advanced Directives is crucial. An Advanced Directive is made up of several legal components which ultimately online the patient’s wishes if one was to be incapacitated or unable to verbally make wishes know regarding healthcare. The understanding of what a living will and a durable power of attorney both need to be discussed before one is able to compare and contrast. A living will ensures that anyone reading this paper will understand how the patient wanted to continue their form of treatment. With a living will anyone ranging from patients to healthcare professions should be able to determine the specific actions the patients would want taken if they are unable to make said wishes known. A
However, the framework in practice is very complex, and has various inconsistencies, such as the legality of refusing treatment, the sovereignty of a living will and the issue of prosecuting those who assist someone to end their lives. There is evidence that shows doctors using palliative sedation as a means to facilitate death in patients that are in extreme pain and the use of limiting or even stopping treatment at the patient’s request is not uncommon. The difficulties of putting the law into practice make it extremely difficult for courts, legislators and doctors to reach clear decisions on individual cases. Therefore, the inconsistencies in the legal framework need to be addressed, as with these present the argument against legalising the right to die is weakened. Legalising assisted dying would simplify the framework and ensure that set barriers and safeguards could be created in order to protect the patient and his/her
Mohr, M., & Kettler, D. (1997). Ethical aspects of resuscitation. British Journal of Anaesthesia, 253.
It is important that people are in control of what happens to them while under the care of their doctor, especially if they're alert and aware. A provider cannot force treatment; if a patient is unconscious, the situation changes because competency and informed consent are not present.
“Action X is an informed consent by person P to intervention I if and only if:
One of the greatest dangers facing chronic and terminally ill patients is the grey area regarding PAS. In the Netherlands, there are strict criteria for the practice of PAS. Despite such stringencies, the Council on Ethical and Judicial Affairs (1992) found 28% of the PAS cases in the Netherlands did not meet the criteria. The evidence suggests some of the patient’s lives may have ended prematurely or involuntarily. This problem can be addressed via advance directives. These directives would be written by competent individuals explaining their decision to be aided in dying when they are no longer capable of making medical decisions. These interpretations are largely defined by ones morals, understanding of ethics, individual attitudes, religious and cultural values.
Lisa Keränen introduces us to her article through a discussion of the technicality (from both an actual technological and also an official standpoint) as it regards to the decision to end a humans’ life. Dr. Keränen uses a hospital as a ‘micro example’ of a much bigger point she is trying to get across to its reader. The hospital in question uses a patient worksheet form in order to let stakeholders (i.e: family members of patients and/or patients who are of sound mind) to know of the patients and their options allowed when the disease has progressed to a stage where it is certain that he or she cannot recover from. The worksheet offers options which the patient has to reduce their pain and the goal of Dr. Keränen article is to show how much a personal decision such as choosing death has now become an institutionalized
I personally feel that the life of a person is well above all policies and regulations and if an attempt to rescue him or her from death at the right time remains unfulfilled, it is not the failure of a doctor or nurse, it is the failure of the entire medical and health community.
Advance directives might have many guidelines for patient’s preferences with regard to any number of life-affecting, or end of life situations, such as chronic disease or accident resulting in traumatic injury. It can include directions for other health situations, such as short-term unconsciousness, impairment by Alzheimer disease or dementia. These guidelines may consider do-not- resuscitate (DNR) orders if the heart or breathing stops, tube-feeding, or organ and tissue donation. The directive might name a specific person, or proxy, to direct care or may be very general with only basic instructions given for treatment in time of the incapacitation of a patient. Some states say that if you do not have a written directive, a spoken directive is acceptable.
Health care providers were over used CPR on every patient without knowing the consequences of CPR. Studies were showed high mortality rate in post CPR patients. Then physicians were made patients DNR without telling patients or their family and nurses were placed a purple sticker on these patients charts to provide a visual cue to other health care providers. Eventually few stickers were fell off or misplaced. In 1987 New York state passed the bill that physician can write DNR order according to patient or health care proxy’s decision. In 1991, congress has passed patient self-determination act (ANA 2012). It clearly states that physicians are not allowed to enter DNR order without the permission of patient or health acre
The U.S. Congress passed the Patient Self-Determination Act (PSDA) of 1990 as an amendment to the Omnibus Budget Reconciliation Act that is legislation intended to guarantee that individuals are given the opportunity to determine the course of their own medical care, such as advanced directives, and that these decisions are protected. The Patient Self-Determination Act Amended titles ⅩⅧ (Medicare) and ⅩⅠⅩ (Medicaid) of the Social Security Act. This legislation requires healthcare providers including hospitals, nursing homes, home health agencies, hospice providers, HMOs, and other healthcare organizations to provide information about advanced health care directive to patients upon their admission to the healthcare facility.
Patients always go for this advance measured when they realize that they have suffered enough and consider euthanasia or DNR as an extreme measure that could help reduce their suffering. This measure may affect decision making in the society because individuals may be making this kind of decisions when they are start thinking hopeless about life, when life should actually be about hope, for instance, patients flood Netherlands so that they may have euthanasia done on them. Therefore, these orders may influence suicides that may be deemed as lawful. Additionally, families remain to be guilty when such decisions are made because of their personal or religious beliefs about life. A patient who is clinically dead and still in a life support machinery may be very wary and costly to a family, it may drain their savings that have been accumulated over an extended period without a change in patient condition being witnessed. In some cases, patient relatives may end up getting depression or a psychotic disorder secondary to the death of their parent or child based on these
The University of Pittsburgh Medical Center uses a protocol for cardiopulmonary death in which they declare the patient dead after two minutes of cardiac arrest.1 This has become controversial because some critics argue patients could be resuscitated at the two minute mark, therefore the patients have not experienced irreversible loss of function and are not truly dead.1 In the event of organ donors, this violates the dead donor rule, which states that the patient must be dead in order to harvest organs.1 However, their council’s rebuttal states that ethically a patient has irreversibly lost function if the patient wishes to be free from life...