Honoring Patient Autonomy and End-of-Life Decision-making
Thesis Introduction: It is the right of every competent patient to make decisions regarding medical treatment. When a patient is informed and educated on the risks versus benefits, he/she can make choices without the inference of the healthcare proxy. End-of-life issues are even more difficult. Unfortunately, by adhering to the current standards, patients have suffered from not being able to make decisions that are followed through by health care professionals. This is because of numerous reasons. The purpose of this paper will show research and discuss current options to preserve patient autonomy, examine policies/procedures that surround end-of-life, case law and current legislation. My thesis will conclude by proposing changes in policies to better protect patients and preserving patient autonomy.
Definition of patient autonomy
What is autonomy?
“The right of patients to make decisions about their medical care without their health care provider trying to influence the decision. Patient autonomy does allow for health care providers to educate the patient but does not allow the health care provider to make the decision for the patient.”
End-of-life is a difficult time for all and should not be complicated by having family members, physicians or judicial system trying to predict what treatments patients would have wanted. A competent patient should be able to make medical decisions without any meddling from healthcare professionals.
The primary goal of protecting patient autonomy is to preserve the human dignity and autonomy of the person. The ultimate hope would be for all members of society to make their wishes known to healthcare professionals and the healthcare proxy would abide by them.
Patient Self-Determination Act (PSDA): The Federal Patient Self-Determination Act confirms the fact that autonomy is one of the core ethics in American healthcare, if not the dominant ethic. Consistent with this, when patients are able to speak for themselves, informed consent is a fundamental prerequisite to providing care. When patients are unable to speak for themselves, the American medical and legal system still strives to ensure that patients’ autonomy is respected with the use of advance directives. Provide written information to all adult patients on their rights under state law to make decisions—including information about the right to execute an advance directive and how the institution implements them.
Document presence of an advance directive in a patient’s medical record.
Provide education for staff and the community about advance directives.
Incomplete Advance Directives: The Agency for Healthcare Research and Quality (AHRQ) studies found only 18-36 percent of the adult population have completed advance directives and less than 50 percent of the severely or terminally ill patients studied had an advance directive.
Importance of Improving Patient Autonomy
Improving patient-physician relationship
Lessons learned from Terri Schiavo case: This is a well-known case raised many emotional and complex issues about the end of life. This case exhibits the difficulty in surrogate decision making that occurs all the time in the healthcare setting. It shows that the need for end-of-life documentation that clearly states the wishes of the patient
Improving Patient Self-Determination Act and the use of Advance Directives.
Consequences of Failure to Act
Using statistical figures and analysis from the Centers for Medicare and Medicaid, examining the cost of end-of-life care. In 2011, the baby boomers entered the Medicare program, causing a major shift to the young-elderly age groups. “Then around 2031, there will be a shift toward the groups aged 85 and older. This shift is important because on average these age groups have different per capita costs. As the Medicare population increases and the distribution shifts to older age groups, there will be increases to aggregate Medicare expenditures.” End-of-life care consumes approximately 25 percent of all Medicare expenditures.
The Patient Order for Life Sustaining Care (POLST) paradigm was created to provide mechanism to communicate patient preference for end-of-life care treatment across care settings. POLST document turns patient treatment preferences into medical orders, with an overall goal of ensuring that wishes for treatment are honored. “The National Quality Forum and other experts have recommended nationwide implementation of the POLST paradigm”
Oregon physician –assisted suicide
Hospice and Patient Protection/Affordable Care Act: There are hidden deep and are not well known but there are two provisions that may have an impact on end-of-life care and relate to hospice.
Training healthcare professionals in end of life care and making sure that physicians become better providers when their patients are faced with end-of-life issues.
Follow Oregon’s way???
I am still deciding on my proposals.
It is clear that a patient’s wishes in end-of-life care needs to be addressed and honored by all healthcare professionals. There are policies that could be put into place to ensure patient autonomy. Along with heath care professionals properly educated on death and dying, would only better society and patient’s whom are dying.
From my professor about outline:
You need a good organizational structure: Introduction–you said, by adhering to this standard–what standard? your introduction needs to be strong, so that upon reading it, someone would really want to read your paper, so make it stronger by being clear and forceful–appealing to the topic. After the introduction which should contain your drfinition of patient autonomy then you move to
1. Importance of Improving Patient Autonomy
A. Improving Patient-physiciam
B. Lessons learned……
11: Legislation & Policies
A. Patient self determination Act
B. Patient Life Order of Life sustainin Care
C. Hospice & Patient Protection Care Act
D. Perspectives from other states
i) Oregon Physician-
you get the point. It does not necessarily has to be as I have done–i just organized from what is in your paper. Putting like discussions together.
Not sure what you’re trying to say under consequences of Failure act, but it is unclear and does not seem to flow logically from prior sections. Write as if you’re telling a story, that way it flows coherently and logically.