1. What is your understanding of the Advance Directive for Healthcare and how does your facility (current or past) deal with the issue?
There are two different types of Advance Directives, a Health Care Power of Attorney and a Living Will. An advance directive is a proactive legal document a patient fills out in advance making their wishes know in regards to complicated health care decisions in case they are unable to make the decisions for themselves for some reason. This document appoints a health care power of attorney to make the decision on the patient behalf if they are unable In my facility, we ask all patients or their representative upon admission if they have an advance directive in place. If they do not have one we
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Having worked in critical for many years I personally believe as demonstrated in the LearnScape video that having the discussion and putting those wishes down on paper can be one of the best gifts a person can give their family or loved ones. I once had an older seasoned nurse tell me that to her there are things a lot worse than dying. Unfortunately I grew to understand completely what she meant by that statement.
3. While an emotional topic for many, Assisted Suicide and certain forms of euthanasia have been supported in certain US states (Oregon for example) and countries (Switzerland). What is the nurse 's role (if any) in the U.S. in these end-of-life issues?
Euthanasia remains illegal in the United States but, assisted suicide is now legal in three states: Washington, Oregon, and Montana. The primary difference in between euthanasia and assisted suicide is who administers the lethal dose of medication. The nurse role should be similar to that listed above in regards to Do Not Resuscitate (DNR) and Allow Natural Death (AND). The nurse should not only support the patient but the patient’s family/ loved ones as well not judging the patient or their decision.
4. Which ethical principles do you believe are at play during LearnScape video
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References
Bipartisan bill encourages Americans to complete ‘advance directives,’ plan for life-sustaining health decisions| News Releases| U.S. Senator Chris Coons of Delaware. (2015, November 18). Retrieved from http://www.coons.senate.gov/newsroom/releases/release/bipartisan-bill-encourages-americans-to-complete-advance-directives-plan-for-life-sustaining-health-decisions
Nursing Care and Do Not Resuscitate (DNR) and Allow Natural Death (AND) Decisions. (2012, March 12). Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Nursing-Care-and-Do-Not-Resuscitate-DNR-and-Allow-Natural-Death-Decisions.pdf
Olin, J. (2012, February 24). Nursing’s Role in Assisted Suicide | Notes from the Nurses ' Station. Retrieved from http://www.rncentral.com/blog/2012/nursings-role-in-assisted-suicide/
Short Definitions of Ethical Principles and Theories Familiar words, what do they mean? (n.d.). Retrieved from
The first ethical mistake that was made was the DNR status being deflected by the team. In “ANA’s Code of Ethics for Nurses with Interpretive Statements”, it states the right to self-determination in Provision 1.4. This provision guides nurses to know that “patients have the moral and legal right to determine what will be done with and to their own person”. The role of the nurse is to be an advocate for the patients’ wishes (ANA, 2015). There should have been a push to have the DNR signed the first time the family asked for it and not deflected (Chen, 2019).
Make and keep your major health decisions with advance health care directives. While they vary by state, advance directives can carry significant importance, especially as one gets older and increasingly concerned with health care and end-of-life decisions. Typically, two basic advance directives can cover a patient’s needs: the durable power of attorney for health care and the living will. Both serve the purpose of empowering the individual concerning personal health care in the case of incapacitation by illness or injury.
Delbeke discusses how some people believe assisted suicide should not just be up to physicians to perform. Some people feel that, depending on the task, even nurses, social workers and clergy could perform the suicide. A benefit of this would be less responsibility and burden on the physician, but there are more bad factors. If it starts to become acceptable to let non-physicians perform assisted suicide then more people may become involved than necessary. Delbeke provides information that she thinks assisted suicide would become institutionalized and a certain routine would come about.
The legalization of PAS under the DWDA influences the nursing profession because it gives patients an alternative option to the usual end of life care, also called hospice or palliative care. However, the American Nurses Association (ANA) position statement regarding PAS and euthanasia states that participation in these acts contradicts the Code for Nurses with Interpretive Statements and is discordant with the principles of the nursing profession as a whole (ANA Center for Ethics and Human Rights, 2013). The most similar alternative is palliative sedation, a practice in which high dose narcotics are administered to keep the patient comfortable; however, this may accelerate the patient’s death as the narcotics suppress the central nervous system
This is a part of the stage where finding recovery and answers challenge doctors and the loved ones that are suffering. In the Institute of Medicine’s critical report Dying in America, there is an idea that emphasizes the importance of making a decision for the patient that is on the stage of death. JoAnn Grif, writer of Dying in America, identifies that decisions for a patient should be made before as a living will from the patient’s own preference and decision. Letting the doctor know so it can improve communication and awareness for the individual that is on treatment, and this consent should ahead of time and planned out. Although, how soon should patients reveal a will to their doctor, some will ask.
“Be smart, be strong, live honorably and with dignity, and just hold on” (Fray). Physician assisted suicide or better known as Death with Dignity isn’t your everyday topic or thought, but for the terminally ill it’s a constant want. The Death with Dignity isn’t something that all people or religions are in favor of and nor is the act passed in all states in the United States. Only three states in the U.S. today, Oregon, Vermont, and Washington offer their residents the option to have aid in dying as long as all the requirements are met. Death with Dignity doesn’t effect just the terminally ill person, but as well as family and friends around them creating many conflicting thoughts when opinion if Death with Dignity is truly moral and a choice
The Death with Dignity Act (DWDA), which allows terminally-ill patients to request physician-assisted suicide, was first introduced in Oregon in 1997. The basic premise of the law is that terminally ill patients, with no outside help, should be able to choose the right to end their life. Since then a few more states have the DWDA or an similar law in their state; an ongoing debate is going on to make the act legal across the nation. The Death with Dignity act allows the individual’s request to die to be acknowledged by the state. Though various of groups and people have spoken against this act, Oregon, with close to two decades of experience with the law, has shown that it can work well even when faced with backlash from the public because
Life and Death in Assisted Living Facilities Assisted living facilities are one of the fastest growing industries in the United States. Unfortunately, assisted living facilities have a history of being problematic. Specific cases from the movie Life and Death in Assisted Living Facilities indicates that assisted living facilities are often under staffed, poorly trained, and often admit elderly patients who are not qualified candidates for their facilities (Byker and Thompson, 2013). When taking this in to account, it is important to consider why families may admit their loved ones in to assisted living facilities.
1 Outline the factors that can affect an individual’s views on death and dying •Social •Cultural •Religious •Spiritual 2 Outline the factors that can affect own views on death and dying •Emotional •Past experience •Psychological •Religious •Social •Spiritual 3 Outline how the factors relating to views on death and dying can impact on practice Current and previous professional roles and responsibilities and past; boundaries limited by legal and ethical issues; professional codes of practice - internal and national; impact of management and leadership; input from other team members and workers. 4 Define how attitudes of others may influence an individual’s choices around death and dying different models of nursing care; person-centred
By implementing these recommendations, policymakers can enhance the Medicare Hospice Benefit policy to better serve individuals with changing prognoses and promote patient autonomy and choice in end-of-life care
Advance directives intend to provide adults with the opportunity to express their desires about medical treatment before becoming debilitated. Personally, the freedom to choose one’s own destiny through advance directives directly aligns with the constitutional value of liberty. It permits an individual to be in charge of his
The purpose of experiencing a hospice clinical was to give me the opportunity to observe and participate in the care of my patients who are receiving hospice care in their home. My first encounter occurred in Jenks, Oklahoma at the patient’s personal home. Upon entering the house, we were greeted by his wife and one of their sons. Before we spoke with the patient we had a pre-conference in the patient’s living room with his wife. My nurse asked how the patient’s wife was doing and the wife stated that she needs more help with his care.
An Integrative Review. JAN Journal of Advanced Nursing, 1744. Karlsson, M. B.-F. (2015). A Qualitative Metasynthesis From Nurses’ Perspective When Dealing With Ethical Dilemmas and Ethical Problems in End-of-Life Care. International Journal for Human Caring, 40-48.
Since Oregon began allowing physician-assisted suicide of the terminally ill in 1997, more than seven hundred people have ended their own lives with prescription medications in the state alone (NPR.org). Physician-assisted suicide is not only becoming a topic of controversy in the United States, but foreign countries as well. Supporters of the issue believe that competent people who do not have a chance of longevity should be able to choose their fate. Opponents argue that terminal diagnoses can be inaccurate, or that the person with the illness may not be capable of making informed decisions. Assisted suicide refers to the act of one giving another the “Instructions, means, or capability to bring about their own demise.”
The dying patient no longer has quality of life, they have lost their independence, are lonely, are forced to endure inevitable pain, are publicly humiliated, are suffering immensely, and are forced to watch their loved ones grieve because of them. It is an innate Constitutional Right to choose how to die, since we all will die. There comes a point when the poking and prodding becomes too much, when the patient wants to just die in silence in the loving arms of their