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The use of advanced directives in health care has posed a significant challenge in striking a balance between honoring the patient’s wishes and following principles governing health professionals’ practice. Patient Self-Determination Act, which was passed in 1990, calls for health care providers receiving Medicaid and Medicare funding to inform patients regarding the need to participate in decisions that affect their treatment. This includes exercising their right to refuse or accept certain treatment options through writing a living will. In some instances, this autonomy has contributed to poor patient health outcomes. The article, “Factors Influencing Individuals’ Capacity Decisions for Patients Requesting Medical Aid in Dying” by Bussell (2020) points out that religion and traditions have significantly influenced patients’ wishes concerning the care they want to receive when they are on the verge of death. For this legal document to have a positive impact on the health care delivery systems, patients should be sensitized to the need to make well-versed decisions, which work for the best interest of their health.
Moreover, the patients should be informed about the importance of separating traditions and religion from healthcare decisions. According to a recent CDC report, 97% of Americans cited the need for educating the citizens on the importance of making appropriate decisions for effective management of their health conditions (Nedjat-Haiem et al., 2019). The article “Knowledge Regarding Advance Care Planning: A Systematic Review” by Kermel-Schiffman and Werner (2017) also supports the view that patients should be educated on the significance of giving care instructions that do not compromise their health. Although advance care planning is slowly gaining popularity among Americans, it remains under-utilized, more so in surgical and other advanced care settings.
Based on the report mentioned above, doctors in the country have difficulty respecting the patient’s will, especially if it contravenes the health professional’s principles on quality health care delivery. As has been evidenced in some of these legal documents, a number of patients may be forbidden from the use of various medications based on their perceptions (Nedjat-Haiem et al., 2019). The living will, therefore, limits the doctor’s ability to exercise autonomy in the choice of drugs or care to administer to the patient. Adhering to the patient’s wish, which contravenes the principles of healthcare delivery practices, means playing an active role in the deterioration of the sick person’s health.
In the U.S., advanced directives have been used to give instructions prohibiting the use of painkillers to relieve patients from excruciating pain experienced during the last stages of chronic ailments. In his article, Bussell (2020) argues that this standpoint can be the result of cultural and religious beliefs concerning the use of certain drugs. Indeed, some cultures and religious groups do not believe in the use of medicine to manage or cure a health condition (Kermel-Schiffman & Werner, 2017). On the other hand, medical professionals perceive painkillers as crucial in making the patient’s condition more bearable. Therefore, an advanced directive that prohibits analgesics for terminally ill patients at their last stages of illness subjects them to painful experiences that can hasten their demise. The undesirable outcomes of adhering to some directives of a living will form the basis of a debate on whether all these legal instructions meet the objective of improving patients’ quality of care.
The second-generation advanced directives which allow the patient to appoint a representative to make decisions on their behalf have also been widely used in the U.S. This legislation safeguards the sick person’s right to ask for aid when they are on the verge of death and cannot take part in their health care decisions (Bussell, 2020). While some people may see this move as crucial in upgrading health care levels in the country, those of opposing views see it as complicating the system. Convincing a medical professional to desist from applying some of the life-prolonging or sustaining measures to a terminally ill patient may seem inappropriate based on the principles governing their practice.
In some cases, the patient, through their representative, may give directives that they should not be allowed to eat or drink anything once they know that their condition is irreversible. Lack of eating or drinking denies the patient’s body essential minerals, vitamins, and crucial elements for the sick person’s survival (Kermel-Schiffman & Wener, 2017). Complying with this directive implies that medical practitioners play an active role in shortening the patient’s lifespan.
Due to some of the deficits that have been highlighted in advanced directives, it is evident that relying on them may not adequately address the majority of healthcare decisions. As noted earlier, some of the patient’s wishes may conflict with medical practices for quality care. For instance, the sick person’s care and comfort at the end of life may largely depend on what is included in their requests. Medically managing conditions has been proven to prolong the life of patients and enhance the quality of their wellbeing. The lack of a clear idea of how this can be achieved has also been cited as one of the challenges of writing living wills that serve the ailing person’s best interest. It, therefore, requires the patient to be adequately educated on the consequences of this document before they write their wishes (Kermel-Schiffman & Wener, 2017). However, this may be inapplicable if the ailing person does not want to extend their lifespan.
Moreover, a decision to use cardiopulmonary resuscitation also forms one of the critical choices to be made in advanced directives. The procedure is part of technological advancements witnessed in the health sector in the last few decades. Although this method has succeeded in prolonging patients’ lives with life-threatening conditions, some of the patients may not opt for it. The varying views of medical professionals and patients may make it impossible to agree on its use. The fact that science and technology, in most cases, conflict with cultural beliefs and religions explains why some of the life-saving procedures may be rarely included in many peoples’ living will. The fact that some Americans have conservative cultures is partly why this legislation has not been easily embraced in the country. A study conducted by CDC in 2017 shows that only 30 % of the population is willing to issue advanced directives to guide their treatment decisions in the event of a terminal illness (Nedjat-Haiem et al., 2019). Based on one of the respondents’ arguments, planning for such unfortunate occurrences is unwelcome based on their religious faith. Besides, some of them gave different views on how advanced directives should be carried out in the health sector without considering the health professionals’ principles governing their practice.
Although the advance directive is a noble idea of upholding a patient-centered approach to health care in the country, the citizens should be educated more on its implications for their care procedures when they cannot take part in making key decisions. Through this, they will be able to make conscious decisions that will not jeopardize the healthcare professional’s efforts to ensure the patient’s well-being while staying within the boundaries of their wishes. As highlighted in the paper, the sick person’s cultural and religious backgrounds who are on the verge of death significantly affect their decisions on the course of medication and care. Respecting other people’s cultures, which shape their perception of health care delivery, is crucial in addressing ethnocentrism, which may interfere with inclusivity.
References
Bussell, C. A. (2020). Factors influencing individuals’ capacity decisions for patients requesting medical aid in dying. Doctoral dissertation, University of Colorado.
Kermel-Schiffman, I., & Werner, P. (2017). Knowledge regarding advance care planning: A systematic review.Archives of Gerontology and Geriatrics, 73(5), 133–242.
Nedjat-Haiem, F. R, Cadet, T. J, & Amatya, A. (2019). Mishra, S. Healthcare providers’ attitudes, knowledge, and practice behaviors for educating patients about advance directives: A national survey. American Journal of Hospice and Palliative Medicine, 36(5), 387–495.
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