Module V

In the Hoffman-Nelson book this week they discuss institutional advanced directives as well as the executive's role in clinical matters. I absolutely agree that advanced directives/ power of attorneys should be encouraged no matter what your health status is. However, why wait until the pre-admissions process at the hospital? I think that persons should be encouraged to write advanced directives as they are encouraged to keep an updated will. Physicians could take an active role in this initiative by educating their patients on the value of it especially when treating them for a chronic disease. One interesting point I saw was from this article http://www.msnbc.msn.com/id/7289351/page/2/ where it discusses what Americans have learned from the Schiavo case and how it was a missed opportunities for other health care groups (organizations for Alzheimers, Parkinsons, Huntington's disease etc.) to speak up on the topic and debate the real ethical issues to inform the public.

As far as institutional advanced directives are concerned, as a patient I would be concerned. If an institution has broad guidelines based on general situations I would be worried that they would not be flexible enough for situational scenarios and I might be limited certain care. Medicine is as much of an art as it is a science. Although I agree that having some guidelines in place to prevent extraordinary treatment that has little chance of working is financially sound and fair to the greater community it does technically limit access. It reminds me of facilities self-imposing rationed health care. If a patient has the right to refuse care should they have the right to ask for more care? Patients often defy odds and one can never really predict exactly what will happen in response to treatment. Last week there was a man in the news that had woken up from a coma lasting several years. What helped revive him? Standard care for pneumonia. When he first received the care would it have been seen as a complete waste of resources? Absolutely. However a woman got her husband back.

Finally the next section was about how much involvement should a manager have in clinical matters. I think it is very important for managers to have enough clinical knowledge as possible. Just because a manager may not be able to do a procedure or treat a patient does not mean he or she does not have an opinion about it ethically. In the long term care facility I work at managers make informal rounds daily and attend clinical staff meetings. I think that the more familiar clinical staff are to managers the more effective managers can be. Also, the more clinical meetings managers observe the more respect they will receive from clinical staff which can facilitate open communication regarding ethical issues.