Medical Indicator, Patient References, Quality Of Life, Contextual Features

The nurse in the case study is faced with an ethical and professional, dilemma. How can she be an advocate for her patient Mr. E? Dr G. is proceeding on a course of action or plan of care that is directly contrary to the patients advance directive and his verbalized objections to the course of treatment proposed by the physician and that is concerning for her. There are multiple issues to consider. For the nurse, she needs to think about her code of ethics, her scope of practice and the legal issues regarding advance directives and Durable Power Of Attorney (DPOA). She also needs to consider the patients right to privacy and confidentiality. As with most areas and issues in modern healthcare the statues can be

Depending on the context of how an individual resulted in a state where they were unable to transmit their feelings on if they want to decline or desire to prolong their existence and the connections others around them, should predict who has the power to make medical decisions on the one in question's behalf. In Schiavo's case, she had a medical emergency that resulted in her decline of being unable to communicate her end of life desires, considering her relationship with her loved ones, the closest individual with the highest understanding of her wants should have the authority over her

In the case of a minor unable to consent or make decisions (due to a mental condition or conscious state) and the absence of parents or legal guardians, two medical doctor must make all medical decisions on his behalf including cardio pulmonary resuscitation and termination of life support.

2) If the patient is not legally deemed competent to make his or her own medical decisions then an appointed guardian, next of kin, or power of attorney must provide consent on behalf of the patient, unless it is an emergency situation in which the health care providers must act fast, based on the case of Schloendorff v. Society of New York. In the case of an emergency the medical team may necessary care to keep the patient safe and sustain his or her life.

This scenario presents various ethical issues that could be argued several ways from HIPPA violations to whether or not this patient has/had the cognitive ability to understand the execution of an advanced directive and Power of Attorney. Advance Directives are put in place for this very reason. It eliminates the need for family members to make a choice in the heat of the moment and also respects the wishes of the person whom it affects directly. Although Mr. E’s hypoxia could affect his ability to think clearly one cannot assume that he has an altered level of consciousness nor the inability to execute an advance

Since the patient has verbally communicated with her husband to make the decisions she should ever find herself in this situation. In this case, the New York’s Family Health Care Decisions making Act (FHCDA) and the New York Health Care Proxy Law will be used. The FHCDA, which is newly established, allows the family to make decisions for an incapacitated patient, regardless if the patient has either a signed advanced directive and the surrogate decision maker has direct knowledge of the patient's wishes or will act in the best interest of the patient (State of New York, Revised 2012). As an appointed guardian for Lydia, Mr. Bevin’s is allow make decisions for his

At the time of the Court’s ruling, eighteen states and Washington, D.C. had laws that allowed family members to withhold treatment from patients lacking the capacity to make medical decisions. The majority of these statutes required that the patient be terminally ill. As of June 1998, thirteen states require that the proxy have specific authorization and/or specific conditions be met in order to withhold artificial nutrition and hydration.

Since the patient is unable to provide the consent based on the information presented by the doctor, the informed consent will rely on the healthcare directive or next of kin. There is the possibility of the next of kin agreeing with the patient’s wishes, which can cause a delay in a decision. Many family members are unable to make the decision to take a patient off of the ventilator even after being declared brain dead. (Health, 2015)

The current health situation should be explained in a non-technical way so the patient (if possible) family, and or valid surrogate can understand every aspect. The physician should also help them understand when there is no hope for recovery. Most often the organs are no longer functioning, or there is little to no brain activity; at this point suffering potentially outweighs the probability of recovery. Medical teams most often realize that the focus should be on comfort, rather than extending a dying life. This decision comes with a great deal of uncertainty, and will always be hard, no matter what age of the patient, or the circumstances. Kathryn Kosh, MD explains that, “Ready access to advanced modern technology has changed death from an event to a process… Defying death requires payment [in the form of] pain and discomfort or in an unacceptable decline in the quality of life.” Often times physicians will not prescribe treatment in the first place knowing that this option will not benefit the patient, prolong suffering; and will likely end in termination anyway. Therefore, allowing the nature of the illness or injury to take its own course of action. Another point of interest regarding this topic is that medical teams realize in most cases, that providing an ethical and dignified death can be just as rewarding as administering aggressive measures to save a

This can be a difficult time not only for the patient but also for the loved ones and family. Sue Ellen, due to the fact that she was in a comatose state isn’t aware that she is possibly living in her final days of her life. During this stage health care professionals try to make the patient as comfortable as possible. The healthcare workers and physicians tried to make Sue Ellen as comfortable as possible. There are several myths about the end of life care that support good health care and good medical ethical practices. During this critical time, ethics, clinical judgement, and the law can run into major conflicts. The patient, families and physician can find themselves considering clinically actions that are ethically appropriate, but could possibly raise legal issues. In this particular case, Sue Ellen family and the healthcare facility are concerned. According to Meisel, Snyder, Quill (2000), “The 7 major legal myths regarding end-of-life-care are: (1) Forgoing life-sustaining treatment for patients without decision-making capacity requires evidence that this was the patients actual wish. Sue Ellen, did not have person that was a designated surrogate. This would play a major factor in my decision as a Health Administrator to have her moved from the AICU to a hospice facility for care. (2) Withholding or withdrawing of artificial fluids and nutrition from terminally ill or permanently unconscious patients is illegal. The only time

A. Minor Point 1: Many patients can’t decide for themselves and it is not fair for family members to decide for them.

This standard relies on the process through which a decision is to be made. But when a patient is unable to go through such process, this standard fails to stand on its ground. It is to some extent an ambiguous concept that tries to meet both sides of the previous two standards. Determination of competence is the core part of the ethical and legal decision making. Brock and Buchanan (1989) have made it clear that competence is not a global concept, but it is mainly related to specific decision-making. We all have to understand the standard values of this problem. To decide the competence of a person, we must analyze the situation under which a decision has to be made and also the nature of the decision that is to be made. Thus, time and condition play vital and defining roles in decision making. In medical decision making, it is the complexities of a particular treatment and of the given information that have a great influence. A patient can give consent to a life-saving treatment and it does not require a high level of

Though ethics committees have been helpful, scores of physician-patient disagreements end up in the U.S. court system with inconsistent results. The states adopted individual “statutes regulating DNR orders and their provisions vary in analysis throughout the U.S.” (Bishop, Brothers, Perry & Ahmad, 2010). One ethical dilemma that is constant in emergency rooms, the intensive care unit and terminally ill persons is a futility of treatment. In the case of CPR/DNR, New York State wanted to enact a law that describes the decisive responsibilities of the patient, and the family or surrogate, and physician. “In April 2003, the New-York Attorney General asserted that the DNR law would require a physician to obtain a consent of the patient’s health care surrogate before entering a DNR order, even when the physician

Malingering is when a person presents extravagant false symptoms (physically or psychologically) intentionally because they are motivated by external incentives (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000). It is important to determine whether one is malingering because the court can misdiagnose someone as malingering when they are actually in fact mentally ill or someone is malingering and does not get caught. Medical treatments, time and effort get put into these people when they could be used on someone who actually does need it. They can also get off for their crime by going into civil commitment or serving less time than if they were put on trial as being perfectly okay.

Even if the patient's husband remains as her legal surrogate decision-maker, his decisions on the patient's behalf are constrained by legally imposed standards. First, a surrogate is legally required to provide "substituted judgment" on behalf of the patient. This means that the surrogate must act in accordance with the patient's wishes. If substituted judgment isn't possible (i.e., unknown what the patient would want under the current medical circumstances), then the law requires the surrogate to act in the patient's "best interests." Since the medical team has significant input about what would medically be in the patient's interest, a decision by a surrogate which doesn't adhere to this standard should not be automatically followed and may need to be reviewed by the institutional ethics committee, risk management, or legal counsel.