Health Care Ethics Paper
University of Phoenix
HCS 435

Health Care Ethics In our society, health care professionals are bombarded with ethical issues in health care which we must firmly know the difference between right and wrong. However, in health care, there are many circumstances which health care professionals do not always make the correct ethical decisions. Theses ethical decisions affect society and the next generation to come. Therefore, the Patient Self-Determination Act is the main issue which affects our society. Generally speaking, the Patient Self Determination Act (PSDA) in most hospitals, nursing homes, home health agencies, and HMO’s routinely provide information on advance directives at the time of admission. They are required to do this by federal law.
The PSDA simply requires that most health care institutions do the following: give you at the time of admission a written summary of your health care decisions-making rights, the facility’s policies with respect to recognizing advance directives, and ask you if you have an advance directive, and document that fact in your medication record. On the contrary, many physicians were not in favor of a policy for patient self determination because they felt that this would decrease their authority regarding medicine, interfere with the patient-physician relationship, and be one more legal regulation (General Accounting Office (GAO) Letter Report, 1995). However, the American Medical Association supported the policy. Some hospitals were concerned about the execution of the policy as they believed that it was appropriate to give medical advice but not legal advice. Although most maintstream religions do not feel that withdrawing life support is in opposition to their beliefs, there were concerns about appropriate stopping points. First of all, the current medical practice in the United States is to assume that a patient desires all possible medical interventions to sustain life. This medical practice is due partly to potential legal concerns if a physician does not do all that is medically possible for a patient. However, many people do not want to receive all possible medical treatments, especially if the treatments are given only to prolong life. This act is intended to give American a constitutional right to determine in advance their health care decisions, especially end-of-life decisions, should they become unable to make those decisions. This is done through an advance directive ( a living will or a durable power of attorney for health care). Next, advanced technology has contributed to the ability to prolong life, thus prompting the development of this policy (GAO, 1995). In addition, the following legal cases contributed to the development of this policy. Quinlan (1976)—In 1975, Karen Ann Quinlan ceased breathing and was put on a respirator. The New Jersey Supreme Court allowed Ms. Quinlan’s parents to discontinue the use of a respirator to sustain her life. It was felt that this was a choice she would have made herself (Death with Dignity, 2001). Cruzan v. Director, Missouri Dept. of Health (497 U.S. 261 (1990))—Nancy Cruzan was in a persistent vegetative state following a 1983 automobile accident. Ms. Cruzan’s husband requested that a feeding tube be placed in her. In 1988, Ms. Cruzan’s parents requested that the feeding tube be removed as they had heard her state verbally that she would not want her life sustained if she was ever in a vegetative condition. The U. S. Supreme Court upheld the Missouri Supreme Court’s decision that prevented the removal of her feeding tube. The Missouri Supreme Court did not feel that Ms. Cruzan’s verbal message was adequate (Brett, 1991 and Mitalas, 1997). Moreover, this act amends XVIII (Medicare) and XIX (Medicaid) of the Social Security Act. This law requires that all institutions (hospitals, nursing facilities, hospices, home care programs, HMOs) that receive Medicare and Medicaid funds provide patients with written information about advance directives (living wills or durable power of attorney). The medical institutions listed above are to determine whether patients have advance directives (under the appropriated state law), and indicate such in a patient’s medical record. In any case , the Patient Self-Determination Act (PSDA) mandates that those institutions provide training about advance directives to health care providers, and education to patients and the community. As a result, most studies indicate that several things are needed to make the policy more successful. First, improved communication is needed to inform people about advance directives. Second, there is a need for better notation of an existing advance directive in medical records. Finally, the medical profession needs to abide by the directives in an individual’s living will and durable power of attorney for health care (GAO, 1995).

References
Brett, A. (1991). Limitations of Listing Specific Medical Interventions in Advance Directives. Journal of the American Medical Association, 266, 825-828
Death with Dignity’s Timeline of the Issue. (2001). Retrieved September 28, 2005 from site http://www.deathwithdignity.org/resources/timeline.htm
General Accounting Office (GAO) Letter Report, 9/1/95: Patient Self Determination Act: Providers Offer Information on Advance Directives but Effectiveness Uncertain. Retrieved September 28, 2005 from site http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=gao&docid=f:he95135.txt
Mitalas, S. (1997). Living wills: An investigation of history, practice, and future implications. In R. Stone (Ed.) Gerontology Manual. Retrieved September 28, 2005 from site http://otpt.ups.edu/Gerontological_Resources/Gerontology_Manuary/Living