b. The nurse must ascertain the status of a health care proxy and other mandates by the patients request such as DNR (Do Not Resuscitate) orders, etc.

c. The mental stability of the patient may need to be reviewed to ascertain whether such decision by the patient can be made according to hospital policy, state and federal laws.

Interpretation:

4: The issue of informed consent and/or refusal has several dimensions when dealing with any population, including HIV. The first, and probably the most important, is the attempt to ascertain the cognitive capacity of the patient in determining his or her own care and treatment. Any adult whose decision-making capacity is intact has the right to absolute self-determination in making informed health care decisions. "A person with HIV has the right to refuse any medical treatment or procedure, even if a decision not to undergo treatment may result in death." (Rubenstein, Eisenberg & Gostin, 1996, p. 110)

4a: These decisions are part of the care of the patient and should be thoroughly scrutinizes and not left one person's sole responsibility.

4b: Living Wills, health care proxy, DNR orders, etc. should certainly all be in place in order to assure that the patient's rights and wished are followed if he or she is incapacitate.

4c: However, though it may be established that the patient does not have the capacity to make the decision a court may intervene:

Most courts have recognized that patients who lack capacity to make decisions still have some sort of interest in refusing treatment. These rights are founded in the state or federal rights to privacy or liberty, the doctrine of informed consent, or both…[the] courts have...

Under this doctrine, the court attempts "to determine with as much accuracy as possible the wants and needs of the individual involved." (Rubenstein, Eisenberg & Gostin, 1996, p. 113)
5. The patient has the right for full confidentiality protection under hospital policy, state and federal regulations.

Interpretation: Following Hipaa guidelines and hospital procedure.

6. The nurse will collaborate with other health professionals chosen by the patient both within and outside her particular hospital/agency to promote teamwork and continuity of care for the patient.

Interpretation: Full involvement by all team members is essential to help preserve the continuity of care as well as the rights of the patient with HIV.

References

Adrian, a., & O'connell, J. (2000). 3 Nurse Practitioners. In Clinical Challenges: Focus on Nursing, Lumby, J. & Picone, D. (Eds.) (pp. 40-51). St. Leonards, N.S.W.: Allen & Unwin.

Codes of ethics for the helping professions. (2004). Ethical standards of human service professionals. Belmont, CA: Brooks/Cole.

Gallagher, a. (Nov. 2004) Dignity and respect for dignity -- Two Key Health Professional

Values: Implications for Nursing Practice. Nursing Ethics; Vol. 11 Issue 6, p.587-600.

Lumby, J. & Picone, D. (Eds.). (2000). Clinical Challenges: Focus on Nursing. St. Leonards, N.S.W.: Allen & Unwin.

Rubenstein, W.B., Eisenberg, R., & Gostin, L.O. (1996). The Rights of People Who Are HIV Positive: The Authoritative ACLU Guide to the Rights of People Living with HIV Disease and AIDS. Carbondale, IL: Southern Illinois University Press.