Advance Directives Problem Solutions

¶ … advance directives. The writer explores what they are and possible solution to reduce problems with them. There were three sources used to complete this paper.

The past few decades have seen an increase in law suits revolving around the final medical wishes of those who fall ill. Media coverage has provided the nation with front row coverage when it comes to people in comas, vegetative states, and no hope of recovery. Family members are often pitted against each other and the hospitals as the patient lays waiting for a decision to be made. One of the things that has been increasing in popularity to prevent such problems is the use of advance directives. While advance directives are gaining in popularity and power their relative infancy creates an atmosphere for problems. Advance directives can lay to rest painful family decisions, as well as doctor decisions that may or may not agree with the family. They provide a blue print of the patient's wishes that everybody can follow.

WHAT IS IT

An advance directive is really as simple as an advance supervision of one's own medical decisions in the event the person is not able to make them at the time the decisions have to be made. The advance directive, often referred to as a living will, is written and documented while the person is still healthy and of sound mind. The directive can serve many purposes regarding the future need for medical care and decisions for that person. (Norlander, 2001)

Advance directives are legal documents that provide several avenues of decision making in the event that the patient is in a vegetative state, a coma or other situation whereas they cannot competently make or communicate their wishes to medical personnel and family members. An advance directive provides for the owners of them to:

1) state their wishes regarding medical treatment in the event that they are incapacitated, 2) name one or more health care agents who will make decisions for them if they cannot speak for themselves.

They are sometimes called living wills or health care directives."

Advance directives first took hold in 1967 but didn't really gain popularity until 1991 when the Patient Self-Determination Act (PSDA) was passed by Congress. The act mandated that any facility that receives Medicare or Medicaid funding must provide information to patients about health care decisions and document any existence of an advance directive.

The act was intended to increase the ability of patients to be involved in health care decisions, especially regarding care at the end of life. Despite the law and the existence of health care agents, little evidence exists that the wishes stated in directives are being consistently honored. Health care facilities, physicians, nurses and even families share the blame for this problem. The health care management community must take certain risk management precautions to ensure that patients are getting the treatment they ask for and that health care organizations are able to meet these requirements."

Advance directives are written instructions about how someone wants their end life health care decisions made. The directives decide things such as resuscitation issues, feeding tube issues, intubations issues and others. The birth of advance care directives stemmed from fear that the medical community would prolong the dying process with medical interventions that had no hope whatsoever of curing the problem or restoring any quality of life.

The issue of care at the end of life is problematic because of the wide array of procedures and choices available. Many treatments are offered that do not always make sense for a person whose body is dying. For example, artificial resuscitation (CPR) can restore the heartbeat and breathing of someone who has suffered a sudden heart attack. For someone who is in the terminal stages of heart disease, however, CPR can be a brutal and often useless treatment. Although more and more people are turning to written advance directives as a way to prevent unwanted treatments and care, their wishes are not always met. "

One of the most significant problems with advance care directives is the fact that they are not federally mandated and vary from state to state. New York recognizes an advance care directive but does not recognize health care agents, while Ohio state recognizes both. When a patient from one state becomes deathly ill in another state, it gets very complicated about which state's statutes come into play regarding the patient's advance directives. The differences in state mandates present huge complications when hospitals and doctors try to determine their level of responsibility when carrying out an advanced directive.

The health care facility has three basic legal responsibilities under the PSDA regarding advance directives. First, staff must inform incoming patients of their right to make health care decisions. Second, they must ask the patient if they have an advance directive and document this on the medical record. Third, if the advance directive asks for a treatment or procedure that is against the facility policy, they must inform the patient they will not honor this part of the directive. This can be an issue, for example, if the patient does not want to be resuscitated and the facility has a "we resuscitate all" policy. "

Another problem that comes into play when it comes to advanced directives in health care is the timing of the directive. Whether or not a person is terminally ill is a medically subjective question and when that person is no longer saveable can have different answers. This causes a problem when deciding when an advanced directive needs to be put into effect. Doctors often have to ask themselves if the patient can ever recover and if not at what point should the medical community stop treating that patient according to their directive. This issue can be further complicated when family members challenge the medical beliefs and decisions, or when the medical personnel challenge the family's belief about when the directive is to take over and direct care.

Still another problem with advance directives is the fact that most state laws do not provide penalties or punishments for failure to follow advance directives. This means that life sustaining measures can be forced upon somebody, causing them to suffer, even though they provided written advanced health care directives not to do so. Lawsuits have been popping up nationwide to combat the failure to follow advance directives when it comes to health care.

SOLUTIONS

Solutions to this advanced health care directive problem will have to be multi-faceted. One solution to the problem of state to state differences in mandates would be to have advance directives supervised and mandated on a federal level.

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Most state laws regarding advance directives carry little or no penalty if the directive is not followed. But because the U.S. health care system tends to err on the side of providing more treatment rather than less, a growing number of lawsuits are being filed under medical battery for failure to comply with advance directives. In a 1997 case in Michigan (Osgood vs. Genesys Regional Medical Center), a jury awarded a family $16 million dollars for mental anguish, and past and future expenses after a patient was resuscitated against the stated wishes of an advance directive.