Introduction and Scenario Description
When a patient enters the hospital, he or she expects the health care professionals to treat him or her with respect and fairness. The hospitals, clinics, and other healthcare settings should deserve and be reputed with a strong set of ethical principles and respect in the face of the law. To John, a 35 year old schizophrenic who is experiencing a crisis situation, his mental health depends greatly on his health care team. He wrote an advance directive that states which medications he would prefer to receive and that he wants his parents to be involved in his care, but he currently exhibits paranoia against his parents. John’s health care team must decide on what course of action to take. The purpose of this paper is to examine the legal and ethical aspects of John’s advance directive and his recipient rights.
Ethical Principles
The ethical principles that most pertain to John’s situation are those of autonomy and beneficence. John deserves respect to his autonomy and his health care providers should consider beneficence in all of their interventions.
Autonomy
Autonomy is an important ethical principal that should be considered with great attention, especially with the limitation of personal autonomy one finds in hospitals. Burkhardt (2008) and Nathaniel define autonomy as self-governing and describe it as including four elements, the ability to determine personal goals, decide on a plan of action, to be respected, and to have freedom to act on choices. In John’s situation, his vulnerability in contrast to the power that the health care professionals hold over him put all four of these elements into jeopardy. Since his advance directive and his current choices differ, the matter of respec...
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Mental Health Code, Section 708 (1974). Retrieved from http://www.legislature.mi.gov/(S(gufhuo45waexpbfzp0b1k3rk))/mileg.aspx?page=getObject&objectName=mcl-330-1708
Mental Health Code, Section 748 (1974). Retrieved from http://www.legislature.mi.gov/(S(3nal0oebralvrq45dznsj2f0))/mileg.aspx?page=getObject&objectName=mcl-330-1748
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Alan Goldman argues that medical paternalism is unjustified except in very rare cases. He states that disregarding patient autonomy, forcing patients to undergo procedures, and withholding important information regarding diagnoses and medical procedures is morally wrong. Goldman argues that it is more important to allow patients to have the ability to make autonomous decisions with their health and what treatment options if any they want to pursue. He argues that medical professionals must respect patient autonomy regardless of the results that may or may not be beneficial to a patient’s health. I will both offer an objection and support Goldman’s argument. I will
Beauchamp and Childress (2012) defined autonomy as self-ruled, self governance or self determination. John Peter Smith hospital did not respect the advance wishes of Mrs. Munoz. Although Marlise did not have a formal advance directive Mr. Munoz, her surrogate, continued to advocate her wishes . Mrs. Munoz right to autonomy
According to Terrence F. Ackerman, as of the 1980s the American Medical Association had to include the respect for a person’s autonomy as a principle of medical ethics (Ackerman 14, 1982). This includes having the physician provide all the medical information to the patient even if the information could cause negative implication onto the patient. The physician is also expected to withhold all information of the patient from 3rd parties (Ackerman 14, 1982). Although it is seen as standard in today’s world, in
This ethical scenario presents an 86 year old female with numerous health issues and chronic illnesses. Mrs. Boswell’s advancing Alzheimer’s disease makes it extremely difficult to initiate dialysis, leading her physician to conclude a poor quality of life. The ethical dilemma portrayed in this case is between nonmaleficence and autonomy. Health care workers should focus on promoting the patient’s overall wellbeing and weigh the benefits and risks of the course of action, while also considering what the family declares they want done. Since the patient is deemed unable to make decisions, the goal is to collaborate with family, assess patient quality of life, address prognosis, and establish realistic care goals.
Patient autonomy was the predominant concern during the time of publication of both Ezekiel and Linda Emanuel, and Edmund D. Pellegrino and David C. Thomasma's texts. During that time, the paternalistic model, in which a doctor uses their skills to understand the disease and choose a best course of action for the patient to take, had been replaced by the informative model, one which centered around patient autonomy. The latter model featured a relationship where the control over medical decisions was solely given to the patient and the doctor was reduced to a technical expert. Pellegrino and Thomasma and the Emanuel’s found that the shift from one extreme, the paternalistic model, to the other, the informative model, did not adequately move towards an ideal model. The problem with the informative model, according to the Emanuel’s, is that the autonomy described is simple, which means the model “presupposes that p...
Forcing someone to take medication or be hospitalized against their will seems contrary to an individual’s right to refuse medical treatment, however, the issue becomes complicated when it involves individuals suffering from a mental illness. What should be done when a person has lost their grasp on reality, or if they are at a risk of harming themselves or others? Would that justify denying individuals the right to refuse treatment and issuing involuntary treatment? Numerous books and articles have been written which debates this issue and presents the recommendations of assorted experts.
In this context, new emphasis is being placed on the rights of patients. Recent federal legislation, for example, requires all health care facilities receiving Medicare or Medicaid monies to inform patients of their right to make medical treatment decisions. This includes the right to specify "advance directives," [1] which state what patients wish to be done in case they are no longer able to communicate adequately.
According to Szasz (2005), “In principle, the mental patient is considered competent (until proven [otherwise]). In practice, the client is regularly treated as if he were incompetent and the psychiatrist who asserts that he needs treatment is treated as if he were the patient’s guardian” (p.78). During the 1940’s patients who were mentally ill were considered “legally incompetent” when committed into a mental health facility. Relatives of the patients could release them by providing care in their homes for the client. Unfortunately, Szasz (2005) claims, that “the treatment of mental diseases is no more successful today than it was in the past” (p.78).
Shultz, J.M. & Videbeck, S.L. (2009) Lippincott Manual of Psychiatric Nursing Care Plans. 8th ed. Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins.
The ethical controversies between patients and families and health care providers, regarding advanced directives dilemma of research and conflict with providers of care towards end of life choices, or accidental injuries leading to comatose state with patients who had never made or signed their advance directives, deciding on how they preferred to be cared for when those times came. This complex issue has in the past to present resulted in countless lawsuits, against healthcare providers by families who believed that no matter the state, meaning whether comatose, or in situations where a loved one had no choice in deciding for them, families have always assumed they automatically gain the power of attorney in
Autonomy is defined as “the right to make independent decisions concerning one’s own life and well being” which encompasses four main meanings describing autonomy as: “free action, effective deliberation, authenticity and moral reflection” (Yeo & Moorhouse, 1996, p.91-93). In the case of 59 year old Ms. R, who has stage IV metastatic lung cancer (Kirk, 2014), respecting her autonomy can be honored using three of the four autonomy principles; free action, effective deliberation and authenticity. Using autonomy as free action, defined as “being able to do what one wishes
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
NASMHPD. (2014, Accessed April 27). Retrieved from NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS: http://www.nasmhpd.org/About/AOMultiStateDisaster.aspx
In this diverse society we are confronted everyday with so many ethical choices in provision of healthcare for individuals. It becomes very difficult to find a guideline that would include a border perspective which might include individual’s beliefs and preference across the world. Due to these controversies, the four principles in biomedical ethic which includes autonomy, beneficence, non-maleficence and justice help us understand and explain which medical practices are ethical and acceptable. These principles are not only used to protect the rights of a patient but also the physician from being violated.
The Psychiatric Mental Health Nurse Practitioner (PMHNP), role and job description is providing primary mental health care services, to those with mental health problems, or psychiatric disorders. The PMHNP is required to assess, diagnose, provide treatment plans, prescribe medication therapy, and offer counsel across the lifespan. The PMHNP provides care in a wide range of settings to children, adolescents, adults, the elderly, and their families. This mental healthcare takes place in the primary care settings, emergency rooms, hospitals, outpatient mental health clinics, senior living communities and in private practices. Being culturally competent to care for the ever changing demographics of the United States is necessary. The PMHNP assess and treats in a holistic manor and utilizes evidenced based practice. Regardless of race, gender, age, religion, sexual orientation, political persuasion, or socio economic standing the PMHNP is there to treat. The PMHNP role also includes establishing a therapeutic relationship, being sensitive to many abnormal behaviors, and caring for those frequently distressed emotionally. Collaboration and the ability to make referrals are essential for the PMHNP. Patients present with undiagnosed problems and establishing the proper diagnosis by a qualified PMHNP begins with the initial assessment interview (Gilfedder, Barron, & Docherty, 2010).