Patient Self Determination

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Patient Self-Determination Act Project
Scott Betzelos, Remedios C. Lazaga, Emelin Tan, Maya C. Richardson HCS/578 - Ethical, Legal, and Regulatory Issues in Health Care November 28, 2011
Susan M. Kajfasz

Patient Self-Determination Act Project – Advance Directives Congress enacted the Patient Self-Determination Act, a healthcare policy, as part of the Omnibus Reconciliation Act signed by President Bush in 1990. The act went into effect in 1991(Nathanson, 1997). According to Nathanson (1997), the law intends to protect the patient’s right to make his or her own decisions through advanced directives. Advance directives designate another person to make decisions for him or her should a patient lose his or her decision-making capacity. The Medicare and Medicaid programs established a requirement that health care providers must acknowledge the law through the implementation of written policies and procedures that illustrate the patient’s rights (Nathanson, 1997). Therefore, it is the responsibility of the health care professional to comply ethically and legally according to the policies dictated by the organization. Nathanson (1997) interpretation of the law asserts that the patient must receive advice and written information about advanced directives illustrating his or her right to accept or refuse medical treatment. The Patient Self-Determination Act requirement ensures that health care professionals receive education and training that is appropriate and in subordination with the specific laws, regulations, organizational policies, and procedures. The Act requires each state to furnish health care providers and agencies with a description of the law. The Act also requires providers to give their patients information through various forms of media such as the policy of Concerned Home Care, Incorporated, (Concerned Home Care, Inc, 2011). How does this agency’s policy influence your professional work?

The Advanced Directive Policy creates a unique physician patient relationship by placing the patient at the center of the health care decision-making process from the onset of the relationship. The patient has an inherent right to “accept or refuse medical treatment” through the formulation of an Advanced Directive. Through this policy the physician-patient relationship begins with discussions that center on the desires of the patient rather than the processes of the health care provider. The Agency’s policy mandates that physicians, nurses, and other health care providers “provide the patient with written information regarding Advance Medical Directives and ask the patient if he/she has prepared an Advance Directive; either a living will or durable power of attorney.”

Advance Directives allow patients to implement specific boundaries for treatments at the beginning of the clinician-patient relationship. Pre-existing advance directives also empowers patients because it allows family members to speak on their behalf in the event that they become incapacitated or unable to render decisions on their own. A patient’s medical wishes were often preempted for the application of intensive and invasive treatments of the past. Advance Directive Policies changed this standard of care and gave patients the opportunity to determine their own treatment plan. The initiation of Do Not Resuscitate (DNR) Orders is an early example of Advance Directives. Later developments embrace the inclusion or exclusion of specific treatment medications, invasive procedures, and care maps that can impact patient longevity in the event that complications from disease arise.

Written Advance Directive Information protects the patient from personal bias of staff members. The policy states “the staff member is not authorized to give the patient advice about advanced directives,” and “shall refer the patient to the Advanced Directive Questions and Answers section of the admission packet and also shall inform...
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