Advance DirectivesHealth Care Decisions Essay Research Paper

Advance Directives/Health Care Decisions Essay, Research Paper

The Regulatory EnvironmentOctober 1998Advance Directives/Health Care DecisionsThe advance of modern medicine enables us to live longer and have healthier lives. Great progress has been made in conquering and preventing many serious diseases. Many challenges come with such progress. In time of serious illness or imminent death, health care providers are called upon to make wise choices about the means that are available to sustain life. Many may need to make such decisions either for themselves or for loved ones. These can be between the most complex and difficult decisions of our lives.Advances in medical technology have done a great deal to produce miraculous cures and recoveries. In some circumstances however, these advances have created problems for the elderly. More aggressive technology approaches are used to extend the life of the elderly. Overall the elderly, as well as others, welcome that development even if they fear some of its consequences. With these advances, it has become possible to keep people in a vegetative state for almost unlimited periods. Moreover, there are situations in which neither the patient or the family has the ability to end such unhappy circumstances. For this reason, advance directives are becoming increasingly prevalent. In a recent study, King (1996) reported that approximately 90% of the American public want advance directives. Both the young and the healthy express at least as much interest in planning as those older than 65 and those in fair to poor health (p. 77). According to Lynne (1986) nurses play a significant role because they attend to the patient continuously and have an especially strong claim to be allowed the opportunity to be comfortable with the care plan (p. 216). However, are advance directives effective in achieving the aim intended.There is evidence to indicate that advance directives alone fall far short of their objective. In a recent study conducted at Harvard Medical School, Fishback (1996) reported 66% of all physicians interviewed felt there was nothing wrong with overriding a patient’s advance directive, even if the directive unambiguously stated the conditions for the withdraw and withholding of medical treatment. Fishback also reported 40% of the physicians questioned chose a level of care different from that requested in advance by patients who subsequently became incompetent. The physicians interviewed indicated that they would only follow a patient’s advance directive if it were consistent with their own clinical judgment. The physicians indicated that they wanted to reserve the right to make clinical judgments about treatment regardless of a patient’s request. In another study, Docker (1995) reported on a study where 900 patients were studied over a period of ten years. In very few cases did advance directives have any influence over decisions to withdraw or withhold life-prolonging treatment. The passage of the PSDA half way through the study changed their effectiveness by barely one- percent. A study conducted in the state of Utah, among 1398 participants, found little evidence that advance directives affect life sustaining treatments (Jacobson, Kasworm, Baltin, Francis, Green, 1996). When patients were transferred from ambulatory to acute care settings, only 26 percent of the patients who had advance directives had them recognized by the admitting hospital (Jaffe & Ehrlich, p. 143). Advance directives, also known as living wills, are documents that a person can complete to ensure that health care choices are respected. An advance directive only comes into play if a person cannot communicate wishes because the person is permanently unconscious or mentally incapacitated. A 1991 law called The Patient Self-Determination Act (PSDA) requires hospitals and nursing homes to tell patients about their right to refuse medical treatment. People can put anything in their advance directives. Some people list every medical intervention they do not want, while others want to make clear their request for heroic measures at any cost. It is a way to spell out personal wishes. It is crucial that the issue of advance directives and the issue of euthanasia not be confused. These issues could not be more dissimilar. Advance directives are seen as a way to protect one’s legal rights for refusal of treatment. In one study, nurses indicated that family opposition to the terms of the advance directive was the primary factor that inhibited health care providers from following the patient’s living will (Weiler, Eland, Buckwater, 1996). When families contradict the patient’s wishes, physicians consider their views giving them immense weight. After all, whom does the physician have to answer to. The living of course. This is why when the family disagrees with the advance directive, the family’s decisions usually win out. Dealing with death and suffering on a daily basis does not make it easy for medical professionals to make decisions about removing life support. Most make an effort to be as dispassionate as possible about such situations so that families can make informed decisions. The result is that the profession tends to err on the conservative side (Edwards).Another factor for the failure to follow an advance directive was the treating physician’s refusal (Weiler et al). One reason for the physician’s refusal may be reluctance to acknowledge increasing patient autonomy.