A clinical decision is regarded as a process that involves such steps as making a diagnosis, providing assessment, and determining an appropriate treatment. The current health care system is oriented to a patient-oriented approach which includes a shared decision-making philosophy to increase the involvement of patients in clinical decisions about their care and treatment. The advance health care directive and the physician orders for life-sustaining treatment form are two important pieces of legislation related to planning an end-of-life treatment and based on the right of an individual to decide what kind of medical treatment they would like to receive.
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The Advance Health Care Directive
An advanced health care directive is a document legally valid in all the American states. It allows a person to describe what kind of medical treatment one wants or does not want to receive in case of vegetative state or losing an ability to make decisions. It is stated that “advance healthcare directives (AHDs), also known as living wills, can assist decision-making by emergency physicians when managing critically ill patients presenting to the Emergency Department (ED)” (Richardson et al., 2015, p. 31). Sometimes, life-sustaining activities are not appropriate for patients who are dying from serious chronic diseases. Therefore, it is crucial to document a patient’s wishes regarding end-of-life care and treatment beforehand when one is still active and capable to make decisions.
The advanced health care directive obtained for this assignment was downloaded from the official website of National Hospice and Palliative Care Organization. According to Florida legislation, a competent adult has a right to instruct one’s physician in withholding, providing, and withdrawing life-sustaining interventions, as well as to select a person who is allowed to make decisions for oneself (“Consumer Guides: Health Care Advance Directives,” 2017). It also allows expressing one’s will towards making an anatomical donation in case of death. The form of advance health care directive filled for this assignment was produced in the compliance with the state law and included three sections such as designation of a health care surrogate, a living will, and anatomical donation.
It is believed that some people fill in advanced directives when they are diagnosed with chronic and incurable diseases. Still, many individuals prefer to state their wishes in a written form as a part of an estate planning while they are still healthy. By Florida laws, it is not obligatory to complete such advanced directive. The procedure of registering the advanced directive is simple and does not require the legal assistance of an attorney. However, it should be signed in the presence of two witnesses, one of which is not a relative (“Consumer Guides: Health Care Advance Directives,” 2017). The advanced directive can be changed anytime, and these changes should be also signed, dated, and witnessed. It can be completed in any state to be legally accepted in Florida.
Completing an advanced health care directive was simple but involved an advanced reflection towards desirable methods of treatment at the end of one’s life. Florida living will allows selecting the clinical activities in case of terminal or end-stage condition, as well as a persistent vegetative state. It will be used if a physician diagnoses one of these conditions. Otherwise, a physician should follow health care decisions made by a patient in advanced instructions of the directive or oral form in a patient is conscious (“Consumer Guides: Health Care Advance Directives,” 2017). It was also difficult to make a proper decision related to selecting a surrogate while completing a form.
When one is still healthy, it is impossible to predict when the death comes and how many relatives will be close, alive, and informed enough to make decisions. Some researchers state that “the challenge has been to identify or develop a tool with a clinical utility that is accurate in identifying patients who would benefit from advance care planning” (Richardson et al., 2015, p. 31). Thus, it is possible to say that advance health care directive is more useful for those who experience incurable and chronic diseases. Still, it might be beneficial if one wishes to avoid life-sustaining procedures in case of permanent vegetative state or wants to donate one’s organs for clinical research or donor implantation.
Physician Orders for Life-Sustaining Treatment (POLST) Form
Physician Orders for Life-Sustaining Treatment Form is another approach to the planning of end-of-life activities that are filled on the basis of the current medical condition of a patient and one’s preferences. It assists in ensuring that a patient’s wishes are heard and honored to avoid any excessive, unwanted, and burdensome treatment. Usually, it involves shared decision-making after a conversation with a health care professional and allows a patient to state one’s values and goals while a physician presents a diagnosis and treatment alternatives (“POLST Paradigm Fundamentals,” 2018).
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This form is completed in a hospital when a patient experiences a serious disease and might die within a year or might not approve standard care in case of any complications. Still, completing this form is voluntary. It assists in reaching an informed-decision practice and indicating the desired methods of treatment during a medical crisis. It also helps to indicate the activities to improve a patient’s comfort and clarifies permission to perform such procedures as artificially administrated nutrition or cardiopulmonary resuscitation. The form is completed by a health care professional based on health treatment discussions and diagnosis, and the patient or one’s surrogate signs it to make it legally valid.
The advance health care directive is usually completed by a healthy person or an individual who experience life-long chronic disease and wishes to make one’s planning of end-of-life interventions legal and known to relatives and physicians. The reasons for completing it might include personal religious beliefs that prevent certain procedures, as well as an individual’s values and views on artificial prolonging of life. Still, if a person does not have an advanced health care directive legally valid and finds oneself in a hospital as a result of some accident, one might be suggested to sign a Physician Orders for Life-Sustaining Treatment Form. It helps health care professionals to understand what kind of treatment to provide in a case of medical crisis or complications. This form is completed by a physician while an advance health care directive can be completed by a patient beforehand and is made legal when signing in the presence of two witnesses. A patient might also describe the preferred treatment methods and interventions in the advanced form, while life-sustaining treatment form is mainly oriented to selecting end-of-life activities.
Nurses play a crucial role in the process of shared decision-making by helping the patients to decide what kind of interventions is better to select. They also assist in educating patients by providing them relevant information about diseases and available treatment methods, as well as the risks and benefits of selecting a certain kind of intervention. Thee help patients to set goals towards health care and provide necessary support to an individual and one’s relatives.
The purpose of this paper was to provide information about options in shared decision-making related to end-of-life condition and medical crisis. The benefits and differences of the advance health care directive and the physician orders for life-sustaining treatment form were indicated. The role of a nurse in helping a patient to participate in shared decision-making was described.
Consumer Guides: Health Care Advance Directives. (2017). Web.
POLST Paradigm Fundamentals. (2018). Web.
Richardson, P., Greenslade, J., Shanmugathasan, S., Doucet, K., Widdicombe, N., Chu, K., & Brown, A. (2015). PREDICT: A diagnostic accuracy study of a tool for predicting mortality within one year: Who should have an advance healthcare directive? Palliative Medicine, 29(1), 31-37.