Term Paper: Advance Directives

Pages: 5 (1450 words)  ·  Bibliography Sources: 0  ·  Level: College Senior  ·  Topic: Healthcare  ·  Buy This Paper


[. . .] 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 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.

While most health care facilities are not likely to be sued for failure to comply with a patient's advance directive, the result of this failure can be costly in other ways. Aggressive treatment-oriented care for someone who is dying can be very expensive. Beth Israel Deaconess Medical Center in Boston looked at the financial implications of "terminal hospitalizations" and discovered that they generated more than $20 million in costs but only $14 million in revenues.

What cannot be measured is the emotional cost to the surviving family when disputes arise over an advance directive. A woman ran into problems with a Twin Cities hospital over a feeding tube for her father. "Even though Dad had specifically written that he did not want a feeding tube placed and had told this to the doctor, I felt terrible pressure to agree to it," she says. "One nurse actually took me aside and said, 'I don't understand why you don't want to feed your dad.' She made me feel like I was trying to kill my father."

Getting Better

Improvement begins by stepping beyond the bounds of simple compliance with the PSDA. Advance directives should be carefully reviewed when a patient is admitted to ensure:

The patient and family have a clear understanding of what an advance directive is and how it should be written

The patient's wishes have been discussed with the doctor

The orders for medical treatment reflect the patient's wishes, and [END OF PREVIEW]

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Advance Directives.  (2003, October 31).  Retrieved June 26, 2019, from https://www.essaytown.com/subjects/paper/advance-directives-writer-explores/5560115

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"Advance Directives."  Essaytown.com.  October 31, 2003.  Accessed June 26, 2019.