Dicussion questions Modular 7 - Assignment Example

Law Number: Module 7 DQ That many complexities characterize healthcare services provision is exemplified by the complex task of determining patients’ mental competence. The complexity of the matter is underpinned by fundamental ethical issues such as the best interest of the patient and his or her autonomy. The patient’s best interests are epitomized by the need to treat him or her or succor his or her life through medical intervention, on one hand. On the other hand, the need to maintain the patient’s autonomy means that his or her right of self-determination must be respected.

Because of this, several measures have been set to balance these somewhat conflicting values. When the patient’s mental competence is in question, the patient’s rational ability (the ability to make sound decisions) will be examined. Secondly, the medical staff will have to ascertain the patient’s performance competence (whether or not the patient is able to make decisions and to perform skills in a manner that is commensurate with specific external standards). Physicians may also analyze the patient’s reflective competence, as a way of determining the patient’s ability to formulate and evaluate his or her own internal values and standards in relation to his actions and decisions.

When the absence of mental competence is obvious, it becomes inevitable that the patient’s next of kin is involved. It is the next of kin that is to append his or her signature in order to authorize medical intervention. At times, the standpoint taken by the patient may be weighed against the gravity of his or her medical condition. For instance, physicians cannot just honor a tetraplegic patient’s whimsical request to be disconnected from the ventilator (McLean, 2009). Module 7 DQ 2Differences between a Permanent Vegetative State and a Coma Coma is a medical state characterized by unarousable unresponsiveness.

In this state, the patient is not aware of both self and surroundings. Though a coma persists for at least an hour, comatose patients begin to come around after 2-4 weeks. A patient may progress from being comatose to being vegetative. On the other hand, when a patient opens his or her eyes without being aware of self and the environment, he or she is in a vegetative state. This means that the vegetative state acts as a transition to further recovery. When four weeks elapse without the patient having recovered, the patient is said to be in a persistent vegetative state.

When six months elapse since the onset of the vegetative state, the patient is considered to be in a permanent vegetative state. How the Differences Affect the Ethical Choices Faced By the Family and Caregivers of the Patient When a patient is still in a coma, the physicians and nurses are still to accord him all the medical attention that is due to all patients. Alongside the services due to the patient, physicians and nurses are obligated to assist the patient’s family members to understand the patient’s condition and to carry on through the difficult time.

However, when the patient is in a vegetative state, matters may prove different. The law is mostly silent as regards permanent vegetative state (PVS) and, therefore, gives a leeway for healthcare services providers to use their discretion. There have been cases where PVS patients were left to die, as the support from life supporting machines was denied them. Another rationale advanced to legitimize this practice is that while PVS patients raise ethical concerns on the quality of life, the essence of consciousness, handling of uncertainty, and the extent to which society values human life – increasing demand is incessantly being made to the effect that healthcare is a limited resource which should be wisely distributed.

Impacts That a Patients Own Wishes Have According to Wade (2001), a patient’s wish is binding on the operations of nurses and physicians. This means that, basically, a PVS patient can have his or her life being sustained or snuffed out by physicians, if he or she communicates such a wish, for instance. However, a patient’s wish must have concomitance with the law for physicians to grant it. For instance, if by any means the PVS patient in America is able to communicate a desire for euthanasia, such a wish may not be honored since euthanasia is illegal in America.

Instead, PAD (physician aid-in-dying) may be applied, if the development is taking place in Washington, Montana, or Oregon. This means that however sacrosanct a patient’s wish may be, the feasibility of executing that wish will have to be weighed against the law. How the Presence of a Living Will Impacts Decision A living will directly binds physicians’ decision as a legal document, since it both embodies the patient’s desire to continue living and also makes known the patient’s choice on the kind of life-prolonging medical intervention.

Thus, a living will serves as a healthcare directive, an advance directive and a physician’s directive. ReferencesMcLean, S. A. (2009). Legal and ethical aspects of the vegetative state. Journal of Clinical Pathology, 52 (7), 490-3. Wade, D. T. (2001). Ethical issues in diagnosis and management of patients in permanent vegetative state. BMJ Helping Doctors Make Better Decisions, 322 (7282), 352-4.