10.1
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Morgan State University *
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Feb 20, 2024
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Uploaded by twise1978
10.1:
Your neighbor knocks on your door.
Knowing that you are a student in a healthcare
administration program, she asks you to explain advanced directives.
She explains that she is assisting her elderly father, and she has many questions:
o
What is a living will?
Living wills and advanced directives are legal instructions regarding medical care preferences written by a person in the case of their inability to provide an informed consent. A
living will is a legal document that specifies the exact medical treatment you would and would not want to keep you alive, your medical preferences for cases such as medical decisions like organ donation and main management (Mayo clinic staff, 2020). o
What is a health care durable power of attorney (also known as a health care proxy)? A health care power of attorney is a type of advance directive where a person names someone to make decisions when you are unable to do so; it is also known as a durable power of attorney or health care proxy (Mayo clinic staff, 2020).
o
How can someone create a living will or health care proxy?
Each state has its own requirements and forms for legal documents, they should be reviewed by you doctor and an attorney to ensure they meet all the requirements (Mayo clinic staff, 2020).
o
What issues should someone consider before making a living will or health care proxy? A person should address several end of life care decisions to determine their wishes and consider their values. Experts suggest speaking to your physician about CPR, mechanical ventilation, tube for feeding, palliative care, as well as organ and body donation (Mayo clinic staff, 2020).
o
How are treatment decisions made for incapacitated patients who do not have health care proxies or living wills? Most U.S. states direct physicians to turn to “substituted judgment” or surrogate decision makers to determine what the patient would have wanted had they been sentient or conscious (Shalowitz, Garrett-Mayer, & Wendler, 2007). Recently, there have been more occurrences of what are known as “unrepresented patients”, who have no available friends or family to make decisions and have no advanced directives to help guide medical decision making when they become incapacitated (Schweikart, 2019). These cases present a new set of ethical dilemmas for hospitals and clinicians in decision-making process. Typically, there are three noted approaches for such decisions with vulnerable patients: a physician approach, an ethics committee approach, and a guardianship approach and many laws require a tiered approach to a best interest standard (Schweikart, 2019). o
What will happen if a patient’s family members disagree about the care of an incapacitated patient? In cases where an incapacitated patient who did not designate a surrogate while capacitated, a surrogate can be designated based on the state’s hierarchy. In the case of Terry Schiavo for instance, the courts sided with the spouse and allowed for the removal of feeding tubes (Haberman, 2014).
o
What will happen if a patient’s health care provider believes that the family
is insisting on medically inappropriate treatment?
A hospital ethics committee can help resolve difficulties that arise when surrogates request treatment that, a reasonable physician believes it would be futile or nonbeneficial (Patel and Ackermann, 2016). References:
Haberman, C. (2014). From Private Ordeal To National Fight: The Case of Terri Schiavo The New York Times https://www.nytimes.com/2014/04/21/us/from-private-ordeal-to-
national-fight-the-case-of-terri-schiavo.html?_r=0
Patel, A. V., & Ackermann, R. J. (2016). Care of Patients at the End of Life: Surrogate Decision Making for Incapacitated Patients.
FP essentials
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447
, 32–41. https://pubmed.ncbi.nlm.nih.gov/27490071/
Schweikart, S. (2019). Who Makes Decisions for Incapacitated Patients Who Have No Surrogate or Advance Directive? AMA J Ethics. 2019;21(7):E587-593.
doi: 10.1001/amajethics.2019.587. https://journalofethics.ama-assn.org/article/who-makes-
decisions-incapacitated-patients-who-have-no-surrogate-or-advance-directive/2019-07
Shalowitz, D. I., Garrett-Mayer, E., & Wendler, D. (2007). How should treatment decisions be made for incapacitated patients, and why?.
PLoS medicine, 4(3), e35.
https://doi.org/10.1371/journal.pmed.0040035
Mayo Clinic Staff. (2020). Living Wills And Advance Directives For Medical Decisions consumer health patient care and health info. https://www.mayoclinic.org/healthy-
lifestyle/consumer-health/in-depth/living-wills/art-20046303
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