Advance Directives

Advance directives are legal documents that allow individuals to make decisions in advance regarding end-of-life care. Through advance directives, they can communicate to family and health care providers what treatment options they find acceptable or unacceptable should they become unable to make these decisions later. As useful as these documents are, they are not always well understood by the public.

For this Discussion, you will interview someone who has not yet completed an advance directive and learn firsthand what questions and concerns an individual may have about the purpose and nature of an advance directive. To prepare for this Discussion:

• Review the description of advance directives on pages 138–148 in Legal and Ethical Issues for Health Professionals, noting the value of a living will to patients and their families.
• Download and print an advance directive form that is valid in your state. A link to these forms is available at http://www.caringinfo.org/stateaddownload.
• Identify an individual you can interview in person about advance directives. This may be a friend, family member, or other acquaintance who has not yet completed an advance directive form.
• Sit down with this person and invite him or her to read the form and consider completing it. It does not matter whether the person actually does so or not. Take notes on what questions the person had, whether he or she understood the purpose of the form, whether the person thought the form was a useful way of dealing with future health care issues, and other key points about the conversation.
• Consider the ways in which an advance directive would support a patient’s legal and ethical rights, and also the impact an advance directive might have on end-of-life care from the perspective of health care providers and organizations.

Assignment:

• Summarize the key points in the conversation. For privacy reasons, do not identify the person you interviewed by name, but note key factors about this person that you think influence his or her views on, or concerns about, advance directives.
• Discuss the ethical and practical issues involved in the use of an advance directive form.
• In what ways would a completed form of this kind be helpful to health care providers if the individual completed the form, later lost capacity, and needed care in a health care facility?

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SECOND ASSIGNMENT

Conscientious Objection

What happens if a health care provider refuses to perform an assigned task, citing moral grounds? Few providers make this decision lightly. In addition to bringing the conscientious objector into conflict with his or her organization, this action can interfere with the rights and safety of patients.

For this Discussion, you will analyze the following scenario, assessing the legal and ethical challenges that can result from conscientious objection and proposing ways to address this as an administrator.

Harry Rogers, a pharmacist employed for six years in a small community hospital’s pharmacy, has told his supervisor that, because of a religious conversion that he has recently undergone, he cannot in good conscience fill any prescription written by a physician who performs abortions. Sometimes, though rarely, Rogers is the only pharmacist on duty during a shift.

The pharmacy supervisor comes to you, an administrator in human resources, to ask what to do. Assume that your state has a law that says the following: “The refusal of a licensed health care professional to participate in or assist a health care service for reasons of religious, moral, or ethical convictions is not grounds for civil or criminal liability or disciplinary action.”

To prepare for this Discussion:

• Review the article “Legal Protection for Conscientious Objection by Health Professionals,” noting the various arguments regarding conscientious objection.
• Consider the legal and ethical issues that the scenario of Harry Rogers presents. How might his choice impact patient care? What effect might it have on the rest of the organization, including the workload of other employees and financial or other business considerations?
• What do you think is legally and ethically the appropriate course to take?

Assignment:

• Summarize the challenges posed by this case, both legally and ethically, explaining who is impacted by the pharmacist’s decision, and how.
• What are the issues that complicate this case?
• How do the rights and interests of patients affect your view of the case?
• What advice would you give on this matter? Provide your rationale. What impact will your decision likely have on this organization?

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