Patient Decision Making

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.

I must be aware, as the patient’s advocate, of the choice of each individual patient regarding his or her medical management or, as in this case, the withholding of treatment.

“The final moments of one’s life are difficult for everyone involved-the patient, loved ones, and even the healthcare provider” (Klein, 2005). If a patient’s final wishes regarding his/her care are undefined or not clear, then the situation could be worse or uncomfortable. During what should be a time of caring, mourning and supporting one another can quickly become overshadowed by ethical and legal battles. However, this can be prevented and avoided by the execution of advanced directives.

As stated in Joseph A. Carrese’s article “Refusal of Care: Patient’s Well-Being and Physicians’ Ethical Obligations,” introduces the fundamental principles and responsibilities that physicians have in order to preserve the welfare of their patients in any circumstances. On the other hand, Debbie Dempsey, author of “Refusing Treatment: Practical, Legal, and Ethical Issues,” strongly supports the patient’s right to make their own medical choices, whether it be to accept or decline any help. W.D Ross solidifies the dependent yet incompetent patient to not refuse care and treatment because the physician has a duty of fidelity, beneficence and a duty to

They got her a stable heart rhythm, so she never had a chance to consent to anything. The patient is currently in a state incapacity. There is not preference found or submitted to the hospital stating the patient treatment preferences. The appropriate surrogate to make decisions for the patient is her three adult children. The patient’s kids have the right to make the decision because she doesn’t have a living will or appointed anyone to make medical decision for her. I understand each state has guidelines to follow in a situation like this on who to consult in a situation like this. Some states may follow the same hierarchy plans as Washington State which are included in this order legal guardian, individual with power of attorney for health care decisions, spouse, adult children (all in agreement), parents of patient, and adult sibling (all in agreement). The patient cannot state whether she is unwilling or unable to cooperate with treatment (Clarence H. Braddock III, MD, MPH, 1998).

Refusal of treatment allows for an individual to refuse the recommendations set forth by their physician if they are found to be of sound mind to make that decision. This option does allow for a person to have a say in their medical care and dying process however may not take away their pain and suffering which in turn could affect their overall quality of life. The final legal option is a living will or advance directive. This is an officially binding document drawn up by an individual which allows them the capability to make medical decisions in the event they become incapacitated to do so (Nordqvist).

Hydration and food is a fundamental staple in our everyday lives that we sometimes take for granted. For a healthy person, nutrition is taken into the body as easily as breathing in air. If a patient is in need of a feeding tube to stay alive is it ethical to not place the tube and let them die? It is devastating to families when a tragedy occurs and their loved one can no longer sustain what was once a simple bodily function, such as eating or drinking. Now, the decision must be made to either keep them alive via feeding tube, or allow them to pass on. This topic continues to stir up an enormous amount of controversy and deserves a great deal of moral and ethical consideration. Tube feeding is a basic care that delivers vital nutrients

How medical decision making aides the health care professional and the patient regarding the patient’s treatment, medical cost and autonomy.

In this role, nurses ensure that patients receive the necessary care, defend the patients’ rights, assure quality of care, and serve as a link between the healthcare system and the patient. Through advocacy, nurses ensure that the choices of the patient are respected by the multidisciplinary team in the healthcare system and that the patient’s interests are not endangered (Negarandeh et al. 2006). Generally, there are various ways to manage health problem, and each may result in a different outcome. In these preference-sensitive decisions, the nurse must take into consideration the valuations of the patient concerning the outcomes. The nurse should always use effective communication to attempt to uncover the preferences and choices of the patient and follow patient’s wishes (Coulter, Parsons, & Askham 2008). It is vital for nurses to be familiar with patient’s care choices, including those that relate to advance care planning for them to ensure that those choices are protected and respected (Davidson, Banister & de Vries

I asked her if they, as husband and wife, had discussed what they agreed to do in situations like this. Using the AHCD and the POLST forms as a guide to explain both forms in detail, I asked her what she thinks her husband's wishes are if his condition deteriorates? She could not answer straight and became tearful. I tried to rationalize each option for her and explain that she could always change the elected choices. In the end, she elected to keep her husband, Full Code. She also elected to have artificial nutrition and hydration provided to the patient if the patient's condition deteriorates. However, she did not want to specify a surrogate decision

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

This project illustrates a RAD approach for designing a patient decision support research platforms (web-based). This web-based research platform is designed with three components: an introduction of shared decision making, a patient decision aid (web-based), and items for decision process data collection. A feedback on paper drafts and online prototypes is also provided by this research platform (web-based). Consider a shared decision making (SDM) process that allows the health care providers and patients to make decisions collectively on the basis of an evidence-based scientific knowledge and the patient’s preferences. Consequently, this process provides both the provider’s practiced knowledge, and the patient’s right to be informed of all

Many individuals who have lost the capability to make their own decisions have what is called a “surrogate” make health-care decisions for them (Jussim). Living wills are a major part in the legal aspects of euthanasia. A living will can express a patient’s thoughts towards his or her future medical treatment (Jussim). Living wills are legal in forty states (Jussim). They permit anyone capable of making decisions to tell the doctor beforehand that they do not wish to be put on life support (Jussim). If the patient is unconscious or in a state where he or she isn’t capable of making

Therefore, other ways are done to bring the decision to light.  An “advance decision” is where they have already made preparation anticipating such events, stating whether they choose to live or die. Not only that, a “Lasting Power of Attorney” (“LPA”) which would make the choice for the patients based on the circumstances of the patient’s welfare. There are also concerns as to whether the patients were in an autonomous state making such preparation, whether they were uninfluenced by others, their decision solely based on their reasoning.

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.