Healthcare Decisions for Capacitated Patients - Research Paper Example

? Healthcare Decisions for Capacitated Patients Healthcare Decisions for Capacitated Patients More than often, health care practitioners are faced with challenges when making decisions for capacitated patients. In most cases, the elderly capacitated patients are considered more likely to lack either adequate present emotional or cognitive ability to express or make personal autonomous decisions. Likewise, people unable to grant informed consent include mentally retarded adults, newborns, and children as they are deemed not fit to give consent to their health care. As a result, their health care decisions are usually made by surrogates based on the best interest in the patient’s values and preferences as a way of ensuring achievement of the patient’s welfare. As a result, health-care providers face challenges in such situations, because they routinely turn to available formal or informal surrogates as a way of expressing the best interests’ standard as they make health related decisions for the capacitated person. More so, depending on the beliefs and philosophical leanings, of different individuals perception on removal of life-sustaining treatment could be viewed as the cause of allowing a patient to die. More importantly, the doctrine of informed consent was formulated to represent the legal right of embodiment of self-determination in health care cases (Kleinman,I. (1991). As a result, the doctrine acts as a guiding process of medical decision making as it defines the restrictions of the patient-physician dialogue. Therefore, the health practitioners have to follow the clear and consistent health legal principles that stipulate their directives on treatment limitation, and decision making for patients who lack capacity even though they are capacitated. More so, the use of opioids, futility and physician-assisted suicide expose challenges to health-care providers based on the legal, ethical, societal and individual values that are either in favor or against making decisions for the capacitated patients. For this reason, those against the idea of making healthcare decisions for capacitated patients consent to the fact that it is ethically, legally, and clinically better to always ascertain the level of patient’s valid goals, preferences, wishes, and values as compared to taking an immediate default to a family member or other surrogate decision maker. Nonetheless, those in support of making decisions for the capacitated patients believe decisions made give best interest of the patient and family members as it relieves them from the pain and suffering. Pro Side Even though, patients are normally considered to have the right to participate in making decisions that relate to their care including cases of diagnostic and treatment interventions, ambulation, diet, daily care, and end-of-life care. More significantly, health related decisions that involve capacitated patients expose health care providers to a challenging situation because it involves the health of a patient who cannot make sound decisions for themselves (Sessums, Zembrzuska, & Jackson, 2011). This is because some capacitated patients are considered to have either insufficient cognitive or emotional ability that will guarantee the health-care provider that the patient cannot make and express independent decisions personally. As a result, the health-care provider will depend on either an instruction directive that the patient previously executed in advance through a living will, or take the second alternative of available formal or informal surrogates. This is because the patient’s surrogates will give or withhold informed consent regarding the medical treatment options available on behalf of the capacitated patient who cannot make an independent decision. Nonetheless, such decisions should be in favor of the capacitated patient in legal, ethical, societal and individual values thus, should be unbiased. Societal and Individual Values Relevance More importantly, those in favor of making a decision for capacitated patients believe that patients should demonstrate consideration of the benefits, burdens and risks of the decision. More so, as the physicians are supposed to always act in the best interest on the capacitated patient they as a way of preventing mistakenly capacitated patients from directing course of their healthcare because nurses are meant to protect capacitated patients from the harmful effects in their decisions. In most cases, capacitated patient would have lost their capacity through age or ill-health and cannot give directives. Nonetheless, patients who are capacitated may not be in a good position to consent or refusal to the diagnostic and treatment interventions therefore, calling for the intervention from either the immediate default to a family member or other surrogate decision maker. This is because it remains a clinical decision to assist a capacitated patient who does not have the capacity to understand, and make an independent decision get assistance from individuals who have the patient’s best interest and not take a question of legal competence (Post et al, 1996). This is because the situation to be given priority is that which favor the patients survival clinically rather than the legal competence criterion that delay action on saving the patient’s health. Considerably, as long as the substituted judgment standard, made on behalf of a capacitated person is in an attempt to give a choice similar to the patient when competent there exist boundaries of reasonableness in protecting the patient’s life. Ethical Values Relevance More so, the ethical practices of best interests standard, make a decision by another party acceptable if it intentionally promotes an hypothetical average person welfare in the position of the patients incompetence, subject to close similarity to the patient’s aspect because choices might not be similar. It is arguably that the ethical duty of the formal and informal surrogates is to give a sufficient justification to providers to relieve the physical, emotional, physiological and psychological pain suffered by a capacitated patient. Based on the deontological theory it remains the duty of the paternal parent to make decisions and this compels the health practitioners and society to adopt paternalism intervention in capacitated patients cases (Staden, & Kruger, 2003). However, in cases of spouses there is no exclusive legal right that exists in the spouse making healthcare decisions on behalf of his or her capacitated spouse. Nonetheless, the fiduciary duty that allows one spouse to make a decision on behalf of another spouse allows the spouse to act as a surrogate decision maker. In addition, the health care workers and the state can play the role of the father under the deontological theory and make decisions on behalf of the capacitated patient’s best interest. The physicians sometimes less expectedly, do not necessitate the need for surrogates’ decisions to adhere to the wishes of the patients’ as they go ahead and treat capacitated patients. This is because, in some instances the decisions physicians should make remain inharmonious with the legally and normatively supported chain of command that stipulates health decision-making standards in such cases of capacitated patients. As a result, nurses carry out decision making in ethically challenging situation such as the ultimate choice based on whether or not to withdraw life-support because it remains challenging to the surrogates to allow it. Legal Values Relevance The decision made by the formal or informal surrogates should be stipulated by the legal definition of capacitated patients who cannot make sound decisions. This is because, capacitated patients for example, those who suffer from mild-to-moderate dementia cases usually have the capacity to make some of the decisions based on their health care (Vars, 2008). More significantly, patients with mild capacitated cases have the ability to participate in decision making up to the extent of their impaired memory recall. This is because, they cannot recall some information that might preclude their ability to understand the treatment options and the health-care providers can therefore, include formal or informal surrogates. Con side More significantly, those opposed to sub delegation point out at cases of long legal history that deal with cases of lack of standards in such decisions because, surrogates and immediate family provide unclear guidance for decision making in cases of their original contexts. In addition, they point out at cases of more urgent, complex, and personal setting within the health care setting that does not allow for decisions that are in the best interest of the capacitated patient. This is supported by substantial evidence of surrogate inaccuracy, in their decisions that remain understandably widely accepted by the health care practitioner. Ethical Values Relevance Nonetheless, in some instances physicians misinterpret their ethical obligations as they simply yield to family members’ and surrogates demands. In most cases, the decision made by the formal and informal surrogates could not be in the best interest of the capacitated patient however, the physician undertakes it to avoid stressful encounters (Stonecipher, 2006). More probably, many physicians undertake acceptance of the surrogates’ choices of treatment for the capacitated patients even though, they do not consider the unarticulated recognition in their treatment decisions. This is because; such decisions could be situational and dynamic especially with the complexity of the relationship between patient and family. Therefore, the preferences and behaviors of many surrogates, and physicians may not be in patient’s best interest. Legal Values Relevance Even though, decisions made could be focused on giving nurses and health practitioners autonomy over the guidelines of decision making for capacitated patients based on ethical and legal questions without surrogates based on foregoing life-sustaining treatment. Some states focus on giving the physicians treating the capacitated patient absolute authority that limit life-sustaining treatment, while other states focus on the requirement of a legal appointed surrogate to make the decision on behalf of the capacitated patient (Staden, & Kruger, 2003). In some cases, physicians undertook the decision making on behalf of capacitated patients when they lacked a surrogate decision-maker in case of legally appointed guardian, family, or health care proxy who is available and willing to give valid and sound decisions about the patient’s medical care. Societal and Individual Values Relevance More outstandingly, those against making a decision for capacitated patients believe surrogates could give a consent that is not in favor of the patient’s best interest. More so, as the physicians depend on the surrogates decision they sometimes make hasty and harmful decision without considering the consequences. In most cases, capacitated patient who have lost their capacity through age or ill-health are considered not capable of giving directives. In some cases, the decisions made on their behalf hinder their personal values of autonomy, beneficence, and justice as it is influenced by their surrogates autonomy and freedom of self-determination as stipulated by health care professionals and the state. More significantly, the awaiting of surrogates decision would lead to refusal or delay in offering treatment leading to death of the capacitated patient. As a result, treatment undertaken should be outweighed by the benefits of the treatment option rather than the informed consent of the surrogate (Stonecipher, 2006). This is because it remains a clinical decision to ensure that the best interest of a capacitated patient is independent in patient’s best interest and not take a question of legal competence. Therefore, the patient’s survival should be given priority on saving the patient’s health. Individual Stand on Healthcare Decisions for Capacitated Patients With the death, of Terri Schiavo based on the legal issues associated with medical decision making for the capacitated, a session of California legislative session gave two proposed bills that sought to address the surrogate decision makers and medical decision-making that were later on adopted (Fine, 2005). It stipulates that surrogates should have the ability make sound decisions, be in regular contact with the patient before and during the illness. In addition, the surrogate should show care and concern the besides being relatively familiar with the patient’s personal values. The surrogates should also be available to visit the patient and engage the patient in a face-to-face contact before participating in decision making accompanied by the health care. In my own opinion, as a pediatric nurse the adoption of a strictly hierarchical view of surrogate decision making makes the process less complex, personal, dynamic, and distinctive. This is because a strict hierarchical view of surrogate decision making allows the consideration of not only ethically valid considerations, but also morally applicable virtues and emotions that allow for mutual responsibility between surrogates and capacitated patients. However, in some cases clinicians should not always adhere to the normative standards that offer a framework for decision making, clinicians should not consider them bound, and the surrogates and medical practitioners should not be limited by them. Nonetheless, it is vital that the legal, ethical, societal and individual norms based on surrogacy should provide for the patients’ concerns and interests as a way of improving the quality of surrogates’ decision making. As a result, the clinical decisions made will remain fully respectful of the patient’s genuine interests, as it increases the physicians’ assurance as concerned with caring for capacitated patients. . More importantly, as the doctrine of informed consent give the legal right of embodiment of self-determination in health care cases (Fine, 2005). Health care providers should adhere to the doctrine as a guiding process of medical decision making as it defines the restrictions of the patient-physician dialogue. Nonetheless, the health practitioners should follow clear and consistent health legal principles based on treatment limitation, and decision making for patients who lack capacity even though they are capacitated. References Fine, R. (2005). From Quinlan to Schiavo: medical, ethical, and legal issues in severe brain injury. Baylor University Medical Center. 18(4): 303–310. Kleinman,I. (1991). The right to refuse treatment: ethical considerations for the competent patient. Can Med Assoc, 144 (10):1219-1254. Post, L., Blustein, J., Gordon, E., & Dubler, N. (1996). Pain: Ethics, Culture, and Informed Consent to Relief. Journal of Law, Medicine & Ethics, 24: 348–59. Sessums, L., Zembrzuska, H., & Jackson, J. (2011). Does This Patient Have Medical Decision-Making Capacity? JAMA.306 (4):420-427. doi: 10.1001/jama.2011.1023 Staden, C., & Kruger, C.(2003). Incapacity to give informed consent owing to mental disorder. J Med Ethics, 29:41–43 Stonecipher, M. (2006). The Evolution of Surrogates' Right to Terminate Life-Sustaining Treatment. Health Law. 8 (9): 593-598. Vars, F. (2008). Illusory Consent: When capacitated Patient Agrees to Treatment. Oregon Law Review. 87: 2,353-398 Read More