Question

Analyze the ways in which an advance directive might support a patient’s legal and ethical rights. Considering the interview you conducted, describe any questions, comments, or concerns your interviewee expressed regarding how an advance directive supports their legal and ethical rights. Then, evaluate the impact an advance directive might have on end-of-life care from the perspective of health care providers and organizations. Apply ACHE policy for end-of-life planning for patients.

Answer 1

Advance directives  are the written documents designed to allow competent patients the opportunity to guide future health care decisions in the event that they are unable to participate directly in medical decision making.

This advance directive can be of two types, instructional and proxy, which allow competent individuals to make their healthcare choices in advance or specify their wishes to their providers or families in case of future disability in carrying out end-of-life decision . This can give the patient an “individual autonomy” so as to receive end-of-life care consistent with their preference. In case of a competent individual, he or she can convey or document their end-of-life treatment preferences autonomously to the authorities on admission or can take a consensus autonomous decision after getting end-of-life care information from the physician .

On the other hand in case of incapacitated individuals, families play a central role as proxies or primary care givers. Families have a responsibility of putting forth the end-of-life care preference of the patient. Family members play the role of proxy due to the virtue of their relationship with the patient and may not be very good in guessing the patients preference for end-of-life decision making, in the case where explicit declaration of patients preferences is not clear.

The following are some frequently asked questions regarding advance directives:

• Why Should I Make an Advance Directive?

• How Do I Make an Advance Directive?

• Who Should I Designate as My Healthcare Agent?

• What if I Change My Mind?

• What Happens if I Don't Make an Advance Directive?

• Where Should I Keep My Advance Directive?

• What should i do if i change my mind after signing it?

• Do they withhold the treatment unnecessarily?

  The American College of Healthcare Executives (ACHE) expects healthcare executives to be committed to the compassionate and competent care of dying patients, including addressing the ethical dilemmas surrounding death and dying. Additionally, executives should promote public dialogue that will lead to awareness and understanding of end-of-life concerns.

  ACHE encourages all healthcare executives to play a significant role in addressing this issue by:

  Ensuring Ethical End-of-Life Decision Making

• Healthcare executives and their organizations should ensure the patient’s (or, when lacking decision-making capacity, the authorized surrogate’s) self-determination regarding end-of-life decision making. Generally, informed adult patients or their surrogate have the ethical and legal right to accept or refuse any recommended treatments based on the ethical principle of autonomy. Such decision making should include an open, truthful discussion regarding the patient’s situation and evidence-driven healthcare options.The healthcare executive should ensure patient or surrogate decisions are appropriately documented and respected.