Advance Directives
An advance directive is a document in which competent individuals express their wishes concerning future acceptable medical care (Halinski, 2020). The document may include decisions concerning lifesaving measures such as intubation and resuscitation. Even though advance directives offer a legal basis for doctors to carry out medical interventions using a proxy, they must also reflect the preferences and values of the patient (Higel et al., 2018).
The role of the doctors in deciding whether or not to respect Mr. Gomez’s advanced directive
The physician should incorporate his medical knowledge and the patient’s wishes when providing care. The physician should respect the patient’s right to autonomy. The patient did not want dialysis. He only wanted tube feeding until he died. The physician has no option but to follow this directive since it is a legal document (Halinski, 2020).
Does Mr. Gomez’s estranged wife have the authority to step in and ignore Mr. Gomez’s advanced directive?
The patient’s estranged wife has no authority to question the advance directive since she is not the patient’s medical proxy. An advance directive is a legal document, and hence, the patient’s wife cannot alter any decisions made by Elena. Physicians and other healthcare professionals are legally mandated to follow the advance directive (Hegel et al., 2018). They should act as the patient’s advocate in case of conflicts and explain the patient’s wishes to the wife. The decisions of the medical proxy should be respected.
Gomez’s estranged wife has filed a temporary order to ignore the advanced directive. If you were Elena, how would you handle this dilemma?
Elena has a legal responsibility to honor her father’s wishes since she is the medical proxy in his advance directive. She is mandated to act as her father’s advocate and respect his wishes. Elena can talk with her mother and educate her on the role of advance directives. She can also request the input of the hospital’s ethical committee.
The role of the ethics committee and how they can best support the client and his family
The ethical committee educates medical professionals on ethical principles, helps healthcare professionals make ethical decisions, helps families make medical decisions, and develops organizational skills. The ethical committee can educate Elena and her mother on the role of advance directives and help them make a decision.
References
Halinski, D. (2020). Professional issues: Advance directives and health care planning: Are all the pieces in place? Nephrology Nursing Journal, 47(4), 367. https://doi.org/10.37526/1526-744x.2020.47.4.367
Higel, T., Alaoui, A., Bouton, C., & Fournier, J. (2018). Effect of living wills on end-of-life care: A systematic review. Journal of the American Geriatrics Society, 67(1), 164-171. https://doi.org/10.1111/jgs.15630
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Question 
Step 1: Read attached article entitled, Advance Directives and Health Care Planning-Are all the pieces in place.pdf Download Advance Directives and Health Care Planning-Are all the pieces in place.pdf
Step 2: Read the following article: Effect of Living wills on End of Life Care.pdf Download Effect of Living wills on End of Life Care.pdf
Advance Directives
Step 3: Watch the video “Advanced Directives: Important Healthcare Tools for Supporting You and Your Family”
https://www.youtube.com/watch?v=GOIrnjqP5_M (Links to an external site.)
Step 4: Watch the video, “How to Have an End of Life Discussion”
https://www.youtube.com/watch?v=JtkgTzCSzqk (Links to an external site.)
An Advanced Directive is a document in which a client who is competent is able to express wishes regarding future acceptable health care. The document may include decisions including the desire for extraordinary lifesaving measures, such as resuscitation, intubation, and artificial hydration, and nutrition. The advanced directive may also be used to designate another person to make decisions when the client becomes physically or mentally unable to do so. The Patient-Determination Act requires all clients admitted to a health care facility be asked if they have advanced directives.
Planning guides for seriously ill clients includes:
Living will: Legal document that instructs health care providers and family members about what, if any, life-sustaining treatment an individual wants if at some time the individual is unable to make decisions.
Durable power of attorney for health care: Legal document that designates another person to make health care decisions for the client when the client becomes unable to make decisions independently.
Nursing intervention in these types of situations is to ensure to communicate to the interdisciplinary health care team that the client has provided and advanced directive and that it has been placed in the client’s medical record. Clients who do not have advanced directives must be given written information outlining rights related to health care decisions.
Initial Discussion scenario:
Mr. Gomez is a 73-year-old man who is estranged from his wife. Since he prefers that she doesn’t make any medical decisions for him should the need arise, he has filled out an advance directive naming his daughter Elena as his health care proxy. He has suffered from diabetes for many years and is adamant that he does not want dialysis, even if it would sustain his life. He does, however, wish to have tube feeding for however long it will sustain him.
One evening while at home with his daughter, Mr. Suarez has a seizure. He is taken to the hospital immediately, but never regains consciousness and doctors do not expect him to do so. Elena contacts her mother Mr. Gomez’s estranged wife and she quickly joins her daughter at the hospital. They want to put him on dialysis (as his diabetes is worsening) and a feeding tube (as there is no other way for him to receive nutrients). His daughter informs the doctors of her father’s end-of-life wishes. The doctors warn her that without dialysis her father will pass away more quickly, even with the feeding tube. Mr. Gomez’s estranged wife informs Elena that she needs to follow the advice received from the doctors in order to save her father’s life. Elena says that although she is aware of the consequences, she wants them to carry out her father’s wishes.
The clients estranged wife immediately has her attorney file an order to stop Elena from following her father’s wishes that are in his advanced directive. She feels that even though they are estranged, she still should have the right to make decisions regarding Mr. Gomez’s care. This action delays Elena’s ability to honor her father’s wishes and the doctors feel that it is necessary to inform the hospital’s ethics committee about the ongoing issue.
Assignment: Discuss the following questions
What is the role of the doctors in deciding whether or not to respect Mr. Gomez’s advanced directive?
Does Mr. Gomez’s estranged wife have the authority to step in and ignore Mr. Gomez’s advanced directive. Explain your reasoning while providing evidence-based solutions in your conclusion.
Gomez’s estranged wife has filed temporary order to ignore the advanced directive. If you were Elena, how would you handle this dilemma? What rights does Elena have that allow her to honor her father’s wishes?
What is the role of the ethics committee and how can they best support the client and his family?