Advanced Directives Essay Research Paper CONTENTSI INTRODUCTION

Advanced Directives Essay, Research Paper

CONTENTS

I. INTRODUCTION 4

II. Will Your Advance Directive be Honored. 4

III. What are Advanced Directives 5

IV. Advanced Directives Fall Short 5

V. Who Decides 7

VI. Why are Advanced Directives not Followed 8

VII Conclusion 9

BIBLIOGRAPHY 10

Introduction This paper presents an in-depth discussion about the issues involved in honoring a patient’s advance directive. Ethical considerations surrounding the issue as they relate to the nursing profession are addressed. The purpose of the paper is to express an informed position on the issue of honoring a patient’s advance directive and explore reasons why one may not be honored. The topic was chosen on account of personal observation and awareness in an acute care setting. The sources used to develop this paper are published nursing journals, current books related to this issue, and the Internet.

Will Your Advance Directive be Honored.

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. On the whole 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 of time. Moreover, there are situations in which neither the patient nor the family has the ability to bring such unhappy circumstances to an end. For this reason, advanced 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).

What are Advanced Directives

Advance directives, also known as living wills, and health care proxys 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 clients 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 couldn’t be more dissimilar. Euthanasia is largely illegal. Advance directives are seen as a way to protect one’s legal rights for refusal of treatment. But are advance directives effective in achieving the aim intended.

Advanced Directives Fall Short

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 clients who subsequently became incompetent.

The physicians interviewed indicated that they would only follow a client’s advance directive if it was 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 client’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). Jaffe and Ehrlich (1997) report “unfortunately, the advance directive movement has not had great success . . . breakdowns occur with alarming frequency in the chain of responsibility to observe them” (p. 145). When clients were transferred from ambulatory to acute care settings, only 26 percent of the clients who had advance directives had them recognized by the admitting hospital (Jaffe & Ehrlich, p. 143).

These statistics command our attention. They also make us focus on the tension and disagreement that exists between physicians and their clients. The population clearly seeks more control over both their future medical care and also the method, timing, and place of their death. Patients want “. . assurance that there will be no unreasonable efforts, an affirmation that the dignity to be sought in death is the appreciation by others of what one has been in life. . . the acceptance of one’s own death is a nec