January 15, 2013
Advance Directives are a type of blueprint for individuals to map out their plan of care in case they become mentally unable to make decisions. Two highly published cases involving women who lacked decisional capacity started the ball rolling for what became known as the Patient Self- determination Act of 1990 (Odom, 2012). This act required medical professionals to advice patients of their rights once be admitted as a patient. There are moral, ethical and spiritual factors that come into play when a patient is making end of life plans and keeping the family informed will help with the caring through of those decisions even if the patient can no longer make their own choices. As Nurses it our job to educate and inform the patient of these rights and what choices they have in making these types of decisions. We must obtain written consent and document as much information as possible so that a patient feels we are making choices in their best interest. Advance directives is a formal document or verbal consent depending on the circumstances, giving healthcare workers an outline of what care a patient wants after they are not mentally capable of making the decision themselves. In 2005, the introduction of the mental capacity act formalized law on advance directives. (McGhie,2012) This Act gave recommendations on how to draft an advance decision, what valid requirements were needed, restrictions that may apply and how withdrawals or amendments were to be handled. In some cases where disagreements have come up the court will step in and decide whether: A person has capacity, the advanced decision is valid, or if it is applicable to the proposed treatment and current circumstances. (McGhie, 2012) According to the article the importance of carefully drafted advanced decisions, an example of where an advanced directive was question came from a case where a man suffered from motor neurone disease (MND). He was at some point put given a tracheotomy and sent home on a ventilation device which prevented him from speaking. He was only able to communicate with his eyes. November 2011 the man made an advance decision that at some point if he were no longer able to communicate or lost his capacity to make his own decision’s this document would come into effect. The advanced directive was drafted by his doctor and presented to the man and his wife was present as a witness. Sometime later another caregiver of this man questioned the AD by bringing it in front of the court under the notion that the patient did not fully understand what was being read to him. The court found that the caregiver was not even at the reading of the AD and that everyone who was there was fully aware of the plan the man had agreed to. As explained in the beginning of the next article, twenty-two days and two blinks of an eye, people always have the right to refuse medical treatment but when does it come into question if a person is capable to make those decisions for himself? It goes on to explain how advanced directives are formal ways for people to protect themselves when questions like this arise. Described in this article is the case of two daughters who did not agree with the advance directive to refuse life-sustaining treatment their mother had already had in place. After the death of their mother they were later interviewed and videotaped as to why they made the decisions to forgo their mother’s wishes. Mrs. GF as she is referred to in the article is an 83-year old woman with multiple health problems. Repeatedly she had voiced her concerns about not wanting to live on a machine. Just before her death she was brought into the emergency department and appeared to be septic. The doctor approached the daughter about having to intubate her mother and she of course said yes. Mrs. GF saw what was happening and again gave the ok to let her go and not prolong her suffering. Ultimately the...
References: Abadir, P. M., Finucane, T. E., & McNabney, M. K. (2011). When Doctors and Daughters Disagree: Twenty-Two Days and Two Blinks of an Eye. Journal Of The American Geriatrics Society, 59(12), 2337-2340. Retrieved from http://search.ebscohost.com.proxy.itt-tech.edu/login.aspx?direct=true&db=rzh&AN=2011400713&site=ehost-live&scope=site
Gardner, D. B. (2012). Quality in Life and Death: Can We Have the Conversations?. Nursing Economic$, 30(4), 224-227. Retrieved from http://search.ebscohost.com.proxy.itt-tech.edu/login.aspx?direct=true&db=rzh&AN=2011657131&site=ehost-live&scope=site
McGhie, F., & Maguire, C. (2012). The importance of carefully drafted advance decisions. British Journal Of Neuroscience Nursing, 8(5), 304-305. Retrieved from http://search.ebscohost.com.proxy.itt-tech.edu/login.aspx?direct=true&db=rzh&AN=2011739789&site=ehost-live&scope=site
Meile, D. D. (2012). Advanced directives in the intensive care unit. Critical-Care Nursing, 24, 200-210. Retrieved from http:// aacn.org/index.p102
Mitchell, M. (2012). An analysis of common arguments against Advance Directives. Nursing Ethics, 19(2), 245-251. Retrieved from http://search.ebscohost.com.proxy.itt-tech.edu/login.aspx?direct=true&db=rzh&AN=2011499902&site=ehost-live&scope=site
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