Do Not Resuscitate Request - Case Study Example

Do Not Resuscitate requests/issues (DNR) Do Not Resuscitate request (DNR) are normally issued in instances whereby the medical staff need to withhold the administration of Cardiopulmonary Resuscitation (CPR). In addition, the medical staff may also need to withhold the administration 0f advanced cardiac life support (ACLS) in cases whereby patients are affected by cardiac or respiratory arrest. However, the medical staff often does not withhold their services aimed at providing comfort and analgesia to the patient. DNR orders are normally requested by patients or by their health care providers in situations whereby the patients are terminally ill or are suffering from a condition that is not reversible. The contents of the DNR order may contain clauses that allow the medical staff to administer CPR in situations whereby the patient is experiencing chocking or in cases whereby patients are going through trauma that may come as a result of a serious motor vehicle accident (Blankenship, 2008). The application of DNR varies. Different states have different regulations. There are some states whereby the DNR order only applies to the patients under health care facilities such as a hospital or a skilled nursing facility. It should be noted that the DNR must be signed by both the patient and the health care provider or the physician. Some states nave put regulations requiring that the DNR have the sign of other witnesses. Further, some states have regulations allowing the use of properly signed DNR to apply in the pre-hospital care in case there is emergency. In most cases, patients are required to put on a bracelet or a necklace with the information concerning his or her wishes on the DNR so that the emergency responders may act appropriately. Some states normally have a database of patients that have DNR orders so that they can make informed choices while dealing in emergency cases (Blankenship, 2008). Health care providers are also required to be ware of patients that have DNR orders. Some states have put regulations requiring the DNR order to be signed by the health care provider. In cases whereby the care provider does not have the moral principles to carry out the order, the care of the patient is normally transferred to other carte providers who may follow the rules of the order. There are instances whereby some states have suspended the DNR order during surgery, only for it to be reinstated later. The argument is that the consent to perform surgery is superior than the DNR order. The surgery is seen as a life saving exercise that cannot be avoided (Blankenship, 2008). Laws pertaining medical care are very important in ensuring that physicians conform to the ethical considerations while performing their duties. In the current world, the patient, the family and friends have got the chance to sue health care providers if services are not offered to patients according to their wishes. Individuals may also sue health care facilities, and medicine manufactures when the results of the medical care administered to an individual does not yield acceptable results. Medical professionals are therefore required to understand medical law, ethics, and other regulations contained in the Health Insurance Portability and Accountability Act (HIPAA) (Orr, 2010). There are very important reasons why medical practitioners should understand law and ethics concerning the provision of medical service to patients. The first reason is to enable health practitioners provide effective and competent service to patients. Secondly, the laws and ethics should be able to assist medical practitioners avoid legal problems since they can affect the ability of health individuals to earn living (Orr, 2010). Patient rights and responsibilities Even though managed care plans may limit the patient’s ability to choose a physician, patients still have the right to choose who should administer health services to them. In addition, patients also have the power to stop the services of the physicians any time they wish. There are also some responsibilities that the patient is expected to carryout in the process of treatment as outlined in the patent bill of rights (Dennis, 2008). Patients are important part of the medical team during the treatment process. They have the responsibility to follow instructions that may be given by the physician; patients are than required to follow the instructions of the physician by providing the necessary cooperation as possible. In addition, patients should also avail all necessary information to the physician so as to be given the correct diagnosis. There are serious implications when patients decide to give misleading information concerning their health status. The physician may administer an incorrect diagnosis; in such a situation, the physician is not liable to any consequences. Further, the patient has the responsibility to follow the physician’s orders for the treatment and to pay fees that are reasonable to the type of service provided (Dennis, 2008). Consent Consent refers to the situation whereby the patient has allowed the physician to perform medical tests and examination so as to determine the cause of the problem. The physician is then allowed to perform diagnosis tests after the patient has given him or her consent. Making appointments to be treated or diagnosed by the physician often indicated an implied consent for any diagnostic procedure that may be carried out by the physician. Apart from the implied consent, there is also the informed consent. Informed consent refers to the situation whereby the client has the right to be given all facts concerning his or her health situation as examined by the physician. The patient is then required to make decision on the method of treatment after receiving the information from the physician (Pozgar, 2011). Informed consent means that the patient has understood the proposed treatment methods to be used by the health practitioner and the risks that may arise in each method of treatment. In addition, the patient is also expected to understand the reason as to why the treatment method is necessary. Physicians have the duty to inform patients of the available alternatives to the method of treatment and ensure that the patient understand each alternative and the risks associated with them. Further, the patient should also understand the risks that can arise if they refuse treatment (Pozgar, 2011). Informed consent is only applicable to adults since they can give informed consent. However, minors are not expected to give informed consent. Minors can be defined to be those individuals below the age of majority. Other individuals who may not be able to offer informed consent include the mentally ill persons and those who speak a foreign language. Foreign language speaker may require the services of interpreters (Pozgar, 2011). Implications of the Patient's Bill of Rights Lack of strict adherence to patient’s bill of rights leads to law suits. Patients often file suits commonly referred to as malpractice litigation. Medical practitioners should understand that malpractice litigation only leads to high costs of health care. They should always ensure that they follow the patient’s bill of rights. Malpractice litigation has diverse consequences affecting the psychological well being of the patient and the health care provider. Patients and health care providers agree that prevention is the best solution to litigation. Health care providers who ensure that they follow the patient bill of rights are able to prevent professional liability when it comes to lawsuits. They are likely to have solid defense while defending their selves against claims of malpractice (Miler, 2010). Malpractice cases often arise due to the inability of physicians to carry out the diagnosis treatment without causing errors. Physicians often become negligent when they decide to perform improper diagnosis on patients, thus harming the patient. Lack of strict following to the patient bill of rights leads post operative complications. This is evident when patients develop signs of internal bleeding in the process of recovery. This is evident in cases whereby the surgeon did not complete the closure of the operation site. Further, negligence can occur in situations whereby the surgeon accidentally leaves a surgical instrument inside the patient (Miler, 2010). The American medical association has come up with some negligence monitoring systems that they use to show that the physician acted unethically while treating the patient. The first monitoring system is in the situation whereby the patient shows that a physician-patient rapport existed in which the physician allocated the patient some duty (Miler, 2010). Further, in order to monitor and solve the ethical issues, the patients must be able to provide evidence that the physician refused to follow some set of procedures as outlined in the profession. In addition, the patient should also present evidence that can determine whether the damage was due to the physician’s inability to perform duty effectively and according to the required standard. Patients may also present evidence that they suffered injury while using the physician’s instructions of other instruments provided to assist in the recovery process (Miler, 2010). Monitoring systems Physicians are required to fulfill ethical standards through the provision of standard care to patients. They should also be able to understand the legal concepts of medical practice. To ensure that there is strict following of the legal requirement, the physicians should ensure that they maintain the confidentiality of the patients. Other medical assistants should ensure that they perform their duties within the scope of training capabilities. In addition, physicians as well as medical assistants should prepare and maintain medical records and be able to document the records accurately (Mullahy, 2010). Physicians and medical assistants are required to use standard procedures when they decide to release information concerning the health status of patients. Other monitoring systems that they have to follow include following guidelines and maintaining awareness of the rules and regulations governing the health care. Consequently, they should ensure that they maintain and dispose of harmful substances according to the rules and regulations put in place by the government. Physicians and medical assistants should understand that they should follow the current established risk management and safety procedures as well as meet the requirements of professional health practice (Mullahy, 2010). Confidentiality Physicians are required to keep any information concerning the health of the patient confidential. All information concerning the patient health must be discussed with the patient privately. However, such information can only be share with other staff members in situations whereby they need to find a solution that is binding. Other department, such as the billing department will always want to see the information concerning the treatment of the patient so that they can charge the patient appropriately. Further, physicians bare advised not to discuss information concerning the patient with any individual outside the office, even in cases whereby the name of the patient is not mentioned. It is only the patient who has the right to waive confidentiality (Algiure, 2008). Future ethical issues that will arise as a result of negligence from physicians can be solved through caring, communication, competence, and charting. Physicians need to care for the patients and colleagues. Showing the patients that you care about their health condition is very important in helping them recover from their illness. It also decreases any chance that the patient may sue the physician in any case the treatment does not conform to the wishes of the patient. Communication ensures that professional clearly understand the needs of their clients. In case there is lack of communication, physicians should ask for clarification and confirmation before continuing with the diagnosis. Medical practitioners often earn respect and trust when they communicate effectively with their clients. Further, medical practitioners need to be competent. Competency can be ensured through the improvement of skills and job knowledge. This can be achieved through constant update on the career requirements due to the ever changing environment in terms of technology and knowledge. Finally, physicians need to have proper documentation skills. Documentation is a good show of how competent physicians are. Every conversation and interaction with the clients must be properly documented (Algiure, 2008). Conclusion Ethical standards are very important in ensuring that physicians follow the patient bill of rights. Without strict following of the patient bill of rights, there can be several law suits filed due to negligence on the part of medical practitioners. On the contrary, patients also need to understand the need to follow the instructions as outlined by the physician. Patients have a role to play in ensuring that they receive the correct diagnosis by providing the physician with the correct information concerning their health status. References Algiure, P (2008), The International Medical Graduate’s Guide to US Medicine & Residency Training, New York: ACP Press. Blankenship, M (2008), Patients With Do Not Resuscitate Orders Undergoing Surgery, New York: ProQuest. Dennis, D (2008), Living, Dying, Grieving, New York: Jones & Bartlett Learning. Miler, K (2010), Constituency Representation in Congress; the View from Capitol Hill, New York: Oxford University Press. Mullahy, C (2010), The Case Manager’s Handbook, New York: Jones & Bartlett Publishers. Orr, D (2010), Medical Ethics and the Faith Factor, New York: Wm. B. Eerdmans Publishing. Pozgar, G (2011), Legal Aspects of Health Care Administration, New York; Jones & Bartlett Publishers. Read More