In fact, hospitals and nursing homes have the option of advising their patients of their right to either accept or refuse medical treatment and their right to formulate advance directives regarding their care should they become incompetent based internally generated mandates.
Conclusion

After lengthy debates in 1965, the United States Congress finally passed legislation that established the Medicare program as title XVIII of the Social Security Act. However, based on the fact that our population is aging and that there are growing trends of the population having high levels of uninsured and underinsured individuals, the healthcare system will continue to be hit hard in the future. One way to combat the potential problems of the future is to create more universal do-not-resuscitate and "ight to Die" policies, procedures and laws.

From a nursing perspective, one should be in favor of the concept of patient rights especially when do-not-resuscitate and "ight to Die"…...

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References

Birenbaum, Arnold. (1997). Managed Care: Made in America. Westport: Praeger.

Joint Commission on the Accreditation of Healthcare Organizations. April 2005. Retrieved on August 7, 2005, at  http://www.jcaho.org .

Joshua-Amadi, Mabel. (2003) "Recommendations: A Study In Motivation: Recruitment And Retention In The NHS; In The December Issue Of Nursing Management, Mabel Joshua-Amadi Examined What Is Sometimes Needed To Keep Staff In The NHS" Nursing Management (Harrow): February.

Social Security Administration. (1993) "Social security programs in the United States." Social Security Bulletin:12/22/1993.

A recently enacted policy, however, enforces the use of a dogmatic and uncompromising ideological speech as a standard replacement of informed consent (Minkoff & Marshall, 2009). The policy requires a list of statements, considered "facts," which discuss risks, benefits and alternatives. These focus largely on risks, misinformation and implied government disapproval. The use of this script compels the physician to commit an ethical and professional wrong, deceive his patient with false information and withhold genuine evidence-based data. These clearly amount to a violation of the physician's First Amendment rights to protection for scientific speech and information in the informed consent process. The lack of protection for doctors by the appellate courts has produced situations of direct collision between medical ethics and the law (Minkoff & Marshall).

Medical Futility

A doctor judges a case as medical futile when care is unlikely to produce benefits for the patient (Eskildsen, 2010). However, determining "significant benefit"…...

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BIBLIOGRAPHY

Curtis, J.R. And Burt, R.A. (2007). The ethics of unilateral "do not resuscitate" orders:

the role of "informed assent." Vol 132 # 3: 748-751 Chest: The American College

of Chest Physicians. Retrieved on April 18, 2010 from http://chestjournal.chestpubs.org/content/132/3/748.full

Eskildsen M.A. (2010). Medical futility: ethical, legal and policy issues. Vol 18 issue 3

When patients with chronic or acute illness in the setting of a severe chronic illness with a declining functionality so that death is expected within days to weeks, no CP will be initiated.
The keys to the policy are severely chronic illness as represented by the patient's declining functionality; and that death is imminent. It is a policy that advocates the right of a patient to forego life sustaining technology and intervention in what is constituted as legal death when the patient's heart stops and, without CP which could ostensibly revive the patient to life, is final death for the patient. The policy resolves decisions of the healthcare provider and the healthcare staff to act in response to the patient's cessation of life.

Today, unless a DN order is signed by the patient or the patient's family rights designee, then the hospital staff responds to the cessation of patient life with…...

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Reference List

Dubbler, N. And Nimmons, D. (1993). Ethics on Call: Taking Charge of Life and Death

Choices, Harmony Books/Crown Publishers, New York: New York.

Jones, M. And Marks, L. (1999). Disability, Divers-ability, and Legal Change, Martins

and Nighoff Publishers, Kluwer Law International, The Hague, Netherlands.

The term ‘deontology’ has its roots in the Greek language – ‘deon’ being the Greek word for ‘duty’ and ‘logos’ meaning ‘study/ science of’. Within the context of modern ethical philosophy, the normative theory of deontology involves prohibited, allowed, or ethically incumbent choices. That is, deontology is categorized under those ethical theories which drive and evaluate one’s choice of what one should do (i.e., deontic theories), as opposed to virtue/aretaic theories which drive and evaluate the type of individual one is or ought to be. In the context of ethical theories involving choice assessment, deontologists and consequentialists maintain opposite stands (Stanford Encyclopedia of Philosophy, 2016). Deontological Ethics or Deontology represents an ethical approach which concentrates on how right or wrong an action is, as against how right or wrong its effects or consequences are (Consequentialism) or the player’s behavior and traits (Virtue Ethics). Therefore, for deontologists, the decision on whether any…...

Health Care Management
"Culture eats strategy."

The Business Case for Evidence-Based Management

Management literature across all disciplines points to the critical importance of quality decision-making. A fundamental practice problem for decision makers is that the information that is readily available or accessible may be incomplete, outdated, and/or not based on evidence. Quality decision-making is dependent on access to and use of quality information. That is to say that, the old adage used by the early computer scientists -- "garbage in, garbage out" -- is applicable to management decision-making. This tenet is pivotal to management in healthcare for reasons that span the high stakes patient care decisions to the survival of medical institutions in a punishing fiscal environment.

In the service-oriented organizations of healthcare, decisions are part of an interwoven network -- a fabric that encompasses the administrative, operational, and patient care aspects as a unified entity. Poor decisions made in any single business or…...

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References

Chen, Y.Y., Gordon, N.H., Connors, A.F., Garland, A., Chang, S.C., and Youngner, S.J. (2014, August). Two distinct Do-Not-Resuscitate protocols leaving less to the imagination: an observational study using propensity score matching. BMC Medicine, 29(12), 146. doi: 10.1186/s12916-014-0146-x.

Henneman, E.A., Baird, B., Bellamy, P.E., Faber, L.L., & Oye, R.K. (1994, November). Effect of do-not-resuscitate orders on the nursing care of critically ill patients. American Journal of Critical Care, 3(6), 467-472.

Kovner, A.R. & Rundall, T.G. (2006). Evidence-based management reconsidered. Frontiers of Health Services Management, 22(Spring), 3-46.

Lambton, J. & Mahlmeister, L. (2010). Conducting root cause analysis with nursing students: best practice in nursing education. Journal of Nursing Education, 49(8), 444-448.

Deontology and DNR: Addressing the Issue Introduction
Do Not Resuscitate (DNR) orders are an issue for a number of care providers in hospitals, especially those who work within the context of hematology and oncology care. As Weissman (1999) notes, DNR is a stumbling block for many nurses and nursing students: for example, he states that his students unanimously struggle to understand the purpose of asking terminally-ill patients what their preferences are on resuscitation—“We know it’s required under hospital policy to ask patients their preference about resuscitation, but these cancer patients . . . well . . . you know . . . they’re dying . . . it doesn't make sense” (Weissman, 1999, p. 149). Weissman (1999) states that while DNR orders were “designed to ensure patient autonomy while at the same time identifying patients in whom resuscitation is not indicated,” they have come to serve, unfortunately, as “an example of how…...

esolving Conflict in a Healthcare SettingThe purpose of this paper is to provide a summary of a real-life conflict in a healthcare setting, including the cause of the conflict, the parties that were involved, how the conflict was resolved, and whether the outcome was fair to all the individuals who were involved. In addition, an explanation concerning how the conflict could have been avoided from the outset is followed by a description of the associated DNP essentials and which leadership competencies were applied and how they served to accomplish the outcome. Finally, the paper provides a summary of the findings in the conclusion.eal-life example of conflictSeveral years ago, a program specialist in the office of quality assurance (OOQA) in a tertiary healthcare facility was tasked with trending all patient incidents by her supervisor to identify trends and opportunities for improvement in the delivery of patient care. These reports were to…...

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ReferencesDetermining Patient Days for Summary Data Collection. (2022). U.S. Centers for Disease Control and Prevention. Retrieved from sumdata_guide.pdf.The Essentials of Doctoral Education for Advanced Nursing Practice. (2006, October). American Association of Colleges of Nursing. Retrieved from https://www.aacnnursing.org/Portals/ 42/Publications/DNPEssentials.pdf.https://www.cdc.gov/nhsn/pdfs/patientday_

An adult do not need to make all decisions in advance, but educating oneself is a vital first step. (Death with Dignity: Planning Ahead for End-of-Life Care) few guidelines for signing a DN order are given here. A Do Not esuscitate Order - DN is a physician's order to not to employ cardiopulmonary resuscitation - CP in case of cardiac or pulmonary arrest. Competent adult patients may relinquish CP for medical or non-medical reasons. The patient may make such requests verbally irrespective of whether or not he/she is fatally ill. An appeal to relinquish CP may also be part of an Advance Directive. When it has been determined that the patient is short of decision-making capacity, the suitable substitute decision-maker should be recognized to make treatment decisions, including decisions to relinquish CP, if no such person has been appointed by an Advance Directive. If the patient is out of…...

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References

Care of the Sick and Dying. Roman Catholic Bishops of Maryland. Retrieved at   Accessed on 17th March 2005http://www.mdcathcon.org/Care.htm .

Collins, Tony. Dealers of Death. Retrieved at   Accessed on 17th March 2005http://www.envoymagazine.com/planetenvoy/Update-TCollins-TerriS-Jan04-Full.htm .

Dealers of Death. 30 November, 2004. Retrieved at   on 17th March 2005http://www.catholicexchange.com/vm/index.asp?vm_id=2&art_id=26177Accessed 

Do not Resuscitate- DNR Orders. 1 January, 2001. Retrieved at   on 17th March 2005http://www.healthsystem.virginia.edu/internet/housestaff/policy-manual/dnr.cfmAccessed 

Roles and ValuesA. Discuss the evidenced-based practice regarding advance directive DNRNursing care is purposed to meet the comprehensive needs of both the patients and their families throughout their healthcare process. This is especially fundamental in the care of patients and their corresponding loved ones at the end of life. Nurses are advocates for the rendering of honourable and compassionate care. Nurses actively take part in examining and ascertaining the responsible and suitable use of interventions so as to decrease any instances of unwarranted treatment and patient anguish and suffering (American Nursing Association, 2012).B. Discuss the nurses moral responsibility by doing the following:1. Describe the nurses responsibility to the patient in the scenarioIn the case of Mr. Miles, the nurse has a moral responsibility to provide advocacy and protection of both the patient and his desires, which encompasses his request to be a do not resuscitate patient. Despite the fact that…...

Illinois Department of Conservation Police Law Enforcement
The American system of local governance for the purpose of maintaining parks and other recreational areas is political as well as democratic, and is based on certain citizens' awareness and desire to create better living conditions as far as environment is concerned, for the benefit of future generations. This entails preservation and conservation of natural parks and wildlife to a large extent. This is especially true in the case of the citizens of Illinois, who are always on the campaign for more open spaces, more parks, and more as well as better recreational facilities for its citizens. Officials are elected for the purpose of looking after and governing the problems that arise from these forests and natural forest preserves, and these officials do believe and also demonstrate the same determination and strongly idealistic beliefs of their predecessors, of the days gone by. The Illinois…...

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References

Blagojevich, Rod. (April 2004) "Illinois's Multi-Year strategy to Control Drug and Violent Crime FFY2004" Retrieved at   Accessed on 28 October, 2004http://www.icjia.state.il.us/public/word/Byrne/ByrneStrategy.doc .

Carlile, Harry E. "Keeping our parks a safe place to play" Retrieved at   Accessed on 27 October, 2004http://www.lib.niu.edu/ipo/ip960919.html .

DUI, International Referral Database of DUI, DWI, Impaired and Drunk Driving, Drinking and Driving, Lawyers & Attorneys" Retrieved at Accessed on 28 October, 2004http://www.lawyers.ca/international/summaryoflaw.asp.

Educational information: Illinois Department of Natural Resources" (2003) Retrieved at Accessed on 27 October, 2004http://dnr.state.il.us/lands/education/index.htm.

But there will also be situations where clinicians are asked to discuss with a patient whether they want to or should have resuscitation if they have had a cardiac arrest or life-threatening arrhythmia. The potential likelihood for clinical benefit in accordance with the patient's preferences for intervention and its likely outcome, involves careful consideration, as with many other medical decisions, in deciding whether or not to resuscitate a patient who suffers a cardiopulmonary arrest. Therefore, decisions to forego cardiac resuscitation are often difficult.
Cardiopulmonary resuscitation (CP) is a set of specific medical procedures designed to establish circulation and breathing in a patient who's suffered an arrest of both. CP is a supportive therapy, designed to maintain perfusion to vital organs while attempts are made to restore spontaneous breathing and cardiac rhythm (Braddock 2).

The standard of care is to perform CP in the absence of a valid physician's order to withhold…...

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References

Braddock, C.H. (1998) Termination of life-sustaining treatment. University of Washington School of Medicine. Seattle: Department of Medical History and Ethics. Retrieved 3/12/07 at  http://depts.washington.edu/bioethx/topics/termlife.html .

Frequently asked questions. (2007). The World Federation of Right to Die Societies. Retrieved at  http://www.worldrtd.net/faqs/qna/?id=8 .

Guru, V., Verbeek, P.R. And Morrison, L.J. (1999). Response of paramedics to terminally ill patients with cardiac arrest: an ethical dilemma. CMAJ. 61 Nov; 161(10).

Hilz, L.M. (1999). Psychology Terms: Transference and countertransference. Kathy's Mental Health Review. Riverside, CA: Mental Health. Retrieved at  http://www.toddlertime.com/mh/terms/countertransference-transference-3.htm .

With regard to the medication administration itself, in a life saving circumstance, which this clearly is not the weight of the potential for depression of respiration and cardiac status is clearly indicated, yet it would seem unethical under these circumstances, if the review of the documentation proves its validity and clearly indicates the patients wishes, to deny at least the smallest dosage (2mg) of ordered Morphine to reduce the pain and potentially allow the patient to regain calm, which will clearly improve his status with regard to short-term treatment.
If the fear of doing harm, drives every medical decision, based on the extreme notion that all patients can be saved under all circumstances then bioethical decisions are futile. The observations and communications of others in the immediate vicinity to care, including the family, other nurses, support staff and most importantly the orders of the doctor to administer palliative care for…...

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References

Andre, J. (2002). Bioethics as Practice. Chapel Hill, NC: University of North Carolina Press.

Forsythe, C.D. (2005). Protecting Unconscious, Medically-Dependent Persons after Wendland & Schiavo. Constitutional Commentary, 22(3), 475.

Mantz, a. (2002). Do Not Resuscitate Decision-Making: Ohio's Do Not Resuscitate Law Should Be Amended to Include a Mature Minor's Right to Initiate a DNR Order. Journal of Law and Health, 17(2), 359.

Saunders, D.E. (2003). Removing the Mask. The Hastings Center Report, 33(2), 12.

Martha must have been unconscious after she suffered the cardiac episode. She therefore had no intact decision making capacity. However, she had made it clear to her daughter Alice that she never wanted CP, something that Alice intimated to the hospital authorities before she left. This ought to have been respected. Martha's condition could not be cured.
Even if CP was administered, the quality of her life was so poor that meaningful survival was not expected. espect for autonomy requires that the patient and/or their family members be allowed to play a role with regards to Do-Not-esuscitate Order. Written DN Orders must be cosigned by the attending physician (University of Washington School of Medicine, 2008). Alice actually singed the color-coded DN order.

However, we are not told whether the attending physician signed it. It could have been ethically wrong not to subject Martha to CP if the DN order only bore…...

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Reference

University of Washington School of Medicine, (2008). Do not Resuscitate Orders. Retrieved September 20, 2012 from  http://depts.washington.edu/bioethx/topics/dnr.html

According to this second view, contemporaneous autonomy trumps precedent autonomy because honoring precedent autonomy imposes preferences and values of a different person, the formerly competent self (Buccafumi, p. 14).
The role that patient's families, doctors, health aides, pastors, chaplains and administrators, health educators and others play is crucial. Few people have executed an advanced directive, much less appointed a healthcare power of attorney by the time they enter a hospital with a debilitating condition. An informed consent form only marks the fact that a conversation has taken place in a health facility. The process that needs to or ought to take place concerning a patient's wishes and ensure one's wishes are empowered are part of the process involved as one fills out the advanced directive for themselves. In California the state has consolidated statutes for advanced directives and added some rights and included the best features of past laws. A…...

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REFERENCES WHICH I DID NOT USE (JUST for YOUR INFO, NOT to BE INCLUDED in THIS PAPER)

American Nurses Association. (1985). American Nurses

Association Code for Nurses with Interpretive Statements, Section 1.1. Washington, DC:ANA.

Docker, C. (1995). Deciding How We Die. The use Limits of Advance Directives. [Online]. Available:  http://www.finalexit.org/wfn27.3.html .

Fishback, R. (1996). Harvard Medical School Division of Medical Ethics. Care Near the End of Life. [Online]. Available: www.logicnet.com/archives/file2001.php.

Executive Assistant
This case study examines the decision making process from a collective viewpoint. It attempts to resolve issues within a community hospital that have arisen due to failed organizational management, ethical considerations and a poorly established communication system.

Framing the Problem:

Identify the Problem-

The primary problems that exist within Faith community hospital center around the following as outlined by the CEO: (1) a lack of organizational processes that ensure uniformity, (2) a lack of standardized procedures with regard to ethical considerations working in a medical environment, and (3) lack of appropriate communication systems to ensure that everyone is thinking alone the same lines.

At this point in time Faith Community Hospital has developed a mission statement that clearly identifies the organizations mission which is among other things to provide a quality continuum of service to community members.

However variant interpretations of the mission have led to a chaotic management style and organizational foundation…...

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References:

Mattison, M. (2000). "Ethical decision making: The person in the process." Social Work,

45(3): 201

Reamer, F. (1995). "Social work values and ethics." New York: Columbia University

Press.

Medical orders for life-sustaining treatment, such as advance directives and do not resuscitate (DNR) orders, are legal documents that allow individuals to specify their wishes for medical treatment in critical healthcare situations. By completing these orders, individuals can ensure that their preferences for care are clearly communicated to healthcare providers, families, and other decision-makers.

To ensure that an individual's wishes are respected and followed in critical healthcare situations, it is important for medical orders for life-sustaining treatment to be:

1. Written: Medical orders for life-sustaining treatment should be documented in writing to ensure that there is a clear record of the individual's....