Essay about 724.7.1-01,03,05, 7.2-01-05,07

Submitted By medic6791
Words: 1257
Pages: 6

Pursuing a career in medicine was a decision I made because I wanted to help people. However, I experienced an internal struggle the first time I realized helping a patient meant respecting and supporting their wishes to discontinue medical care and to allow the patient to pass on their own terms. The following exercise discusses patient’s rights and a particular situation in which a patient’s rights were violated. As a nurse it is important to fully understand our ethical and legal responsibilities in order to better serve and advocate for our patients. In this scenario we must first attempt to determine what Mr. E’s wishes expressed wishes were. In the ER, there was an attempt to obtain consent for mechanical ventilation, but the patient told staff to go away and that he wanted to go home. What was not indicated was his mental status or decisional capabilities during this statement. It was inappropriate for Dr. K to assume that Mr. E must be hypoxic without further assessing his mental status. If Mr. E’s decisional capabilities were altered, then the decision whether or not to intubate would default to his living will which clearly stated that he did not wish to be placed on a mechanical ventilator. It does say that Dr. K tried to explain the situation but did he explain the entire scenario including the risks of both refusing to be intubated as well as the risks of being intubated. Is the patient fully informed? In the state of Florida an advanced directive is defined under chapter 765 of the human right statutes that states an advanced directive is a witnessed written document or oral statement in which instructions are given by a principal or in which the principal’s desires are expressed concerning any aspect of the principal’s health care, and includes, but is not limited to, the designation of a health care surrogate, a living will, or an anatomical gift made pursuant to part V of this chapter. It also goes onto to states that while the advanced directive must be witnessed by 2 people, both cannot be family and neither has to be family. So in the absence of a newer advanced directive to contradict the first advanced directive, the one filled out at the nursing home 7 years ago should be followed. Unfortunately it is not clear from this scenario as to what extent Mr. E’s developmental delay is so it is hard to determine what his decisional capabilities were at the time the advanced directive was completed. It does not state the type of delay or the degree in which Mr. E was delayed. If the doctor chooses to ignore this directive and only obtain consent from the Mr. Y he may do so since Mr. Y was given medical power of attorney by Mr. E, however, Dr. K should fully inform Mr. Y of Mr. E’s wishes so that he may obtain informed consent. Dr. K should never have obtained verbal consent from Ms. H neither since she was neither a guardian nor dedicated as medical power of attorney. Her consent would be unacceptable both ethically and legally. The American Nurses Association has a code of Ethics that every nurse should abide by and there are two particular passages that would pertain to this discussion. Provision 2 states that the nurse’s primary commitment is to the patient and in this scenario the patient does not want any aggressive lifesaving treatment. The nurse should be an advocate for the patient and not only inform the doctor of the patient’s wishes but the medical power of attorney as well. Mr. Y still has the right to choose to place Mr. E on a ventilator but at least if he presented with all the information the nurse has fulfilled their role in advocating for the patient. Also in the ANA’s code of ethics, is provision 1.4 that states that all patients have the right to self-determination. If a patient is mentally competent and understands the risk of withholding treatment, they have the right both legally and morally not to have any or all treatments performed. Following the arrival of Ms. H at the