Patient Self-Determination Act Project Scott Betzelos, Remedios C. Lazaga, Emelin Tan, Maya C. Richardson HCS/578 - Ethical, Legal, and Regulatory Issues in Health Care November 28, 2011 Susan M. Kajfasz Patient Self-Determination Act Project – Advance Directives Congress enacted the Patient Self-Determination Act, a healthcare policy, as part of the Omnibus Reconciliation Act signed by President Bush in 1990. The act went into effect in 1991(Nathanson, 1997). According to Nathanson (1997), the law intends to protect the patient’s right to make his or her own decisions through advanced directives.
Advance directives designate another person to make decisions for him or her should a patient lose his or her decision-making capacity. The Medicare and Medicaid programs established a requirement that health care providers must acknowledge the law through the implementation of written policies and procedures that illustrate the patient’s rights (Nathanson, 1997). Therefore, it is the responsibility of the health care professional to comply ethically and legally according to the policies dictated by the organization.
Nathanson (1997) interpretation of the law asserts that the patient must receive advice and written information about advanced directives illustrating his or her right to accept or refuse medical treatment. The Patient Self-Determination Act requirement ensures that health care professionals receive education and training that is appropriate and in subordination with the specific laws, regulations, organizational policies, and procedures. The Act requires each state to furnish health care providers and agencies with a description of the law.
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The Act also requires providers to give their patients information through various forms of media such as the policy of Concerned Home Care, Incorporated, (Concerned Home Care, Inc, 2011). How does this agency’s policy influence your professional work? The Advanced Directive Policy creates a unique physician patient relationship by placing the patient at the center of the health care decision-making process from the onset of the relationship. The patient has an inherent right to “accept or refuse medical treatment” through the formulation of an Advanced Directive. Through this policy the hysician-patient relationship begins with discussions that center on the desires of the patient rather than the processes of the health care provider. The Agency’s policy mandates that physicians, nurses, and other health care providers “provide the patient with written information regarding Advance Medical Directives and ask the patient if he/she has prepared an Advance Directive; either a living will or durable power of attorney. ” Advance Directives allow patients to implement specific boundaries for treatments at the beginning of the clinician-patient relationship.
Pre-existing advance directives also empowers patients because it allows family members to speak on their behalf in the event that they become incapacitated or unable to render decisions on their own. A patient’s medical wishes were often preempted for the application of intensive and invasive treatments of the past. Advance Directive Policies changed this standard of care and gave patients the opportunity to determine their own treatment plan. The initiation of Do Not Resuscitate (DNR) Orders is an early example of Advance Directives.
Later developments embrace the inclusion or exclusion of specific treatment medications, invasive procedures, and care maps that can impact patient longevity in the event that complications from disease arise. Written Advance Directive Information protects the patient from personal bias of staff members. The policy states “the staff member is not authorized to give the patient advice about advanced directives,” and “shall refer the patient to the Advanced Directive Questions and Answers section of the admission packet and also shall inform the patient to seek further information from the physician. This further advances the discussions between the physician and the patient ultimately ensuring that the desires and expectations of the patient remain central to the care map. Advanced Directive decisions “require open communication between the patient and the health care team” (Burkhardt & Nathaniel, 2008, pp. 242-243). The Agency is also required to raise awareness of Advanced Directive within the community by including “Advance Directive information in its presentations,” either “in presentations made directly to the community members or in presentations made to other providers and/or other organizations. Enhanced discussions regarding Advanced Directives, end of life care and the patient’s desired plan of treatment becomes part of the heath care provider’s relationship during an office or in home. The creation of open and honest lines of communication stimulates healthy discussions and strengthens the bond between providers and patients. In fact the term “physician-patient relationship” has forever changed with Advanced Directive policies. It is more fitting that the terminology reflects the fact that patients have greater control over their care.
Thus the term should be “patient-physician relationship,” placing the patient at the center of the health care continuum. As the patient centered relationship continues, the past “passive position” that makes it difficult “to remain intellectually and emotionally in control of your own experience” will continue to progress placing patients first and normal operating procedures second (Ashton & Richards, 2003, p. 7). What are the effects of the increasing technology of patient confidentiality and data security on health care organizations?
Health care organizations face an enormous task of maintaining the privacy of their patients with the onslaught of new technology. This task involves ensuring that employees have policies and procedures to follow when using new technology to access protected health information (PHI), faxing PHI, and using the Internet. Health care organizations and health care providers have the responsibility of implementing a patient’s Advance Directives. However, new technology can give way to digression to past behaviors and the paternalistic attitudes of some clinicians may result in disregarding a patient’s Advance Directives.
Some clinicians may believe they know what is best for the patient because advances in technology often raises hope that a provider can positively impact or alter a patient’s current medical condition (Burkhardt & Nathaniel, 2008). According to Miller and Tucker (2009), the use of electronic medical records (EMRs) could reduce America’s annual health care bill by $34 billion through higher safety and efficiency but only 41% of hospitals in the United States have adopted its use. Concerns over effectively protecting patient privacy and the cost of securing information have prevented the widespread use throughout the industry.
A prime example of the fruition of security concerns is the downfall of the Santa Barbara County Care Health Data Exchange in 2007 (Miller & Tucker, 2009). The state mandated privacy filters but the system still failed. New technology requires privacy protection devices to protect PHI. This may force health care organizations to increase the rates of medical record use just to keep financially afloat. Conclusion The creation of Agency policies has impacted the physician-patient relationship effectively giving the power to control the course of treatment to patients.
In essence, physicians have become advisors in the presence of Advanced Directives, yielding to the desires of patients and their families. The provision of care changed with advances in technology. Information sharing and dissemination requires physicians and other health care providers to successfully navigate between their new role as advisors and their commitment to ensure the best delivery of care to their patients. Melding the two provides the best guarantee that patients will have both their wants and needs met maximizing the opportunity for positive health outcomes.
References Burkhardt, M. A. , & Nathaniel, A. K. (2008). Ethics and issues in contemporary nursing (3rd ed. ). Mason, OH: Delmar Cengage Learning. Concerned Home Care, Inc. , (2011). Concerned Home Care Policy and Procedure Manual Harbor Beach, MI. : . Miller, A. R. , & Tucker, C. (2009). Privacy protection and technology diffusion: The case of electronic medical records. Management Science, 55(7), 1077-1093. Nathanson, M. D. (1997). Home Health Care Law Manual (5th ed. ). Gaithersburg, MD. : Aspen Publication. Appendix I: Advance Directives for Concerned Home Care, Inc. [pic]
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