Essay on "Patient Rights and Informed Consent"

Quoted Instructions for "Patient Rights and Informed Consent" Assignment:

Instructions requesting ***** to do this paper

Patient rights include the right to informed consent, which entails that patients receive adequate information to make medical decisions. But many questions can arise if patients appear to lack the capacity to understand their medical condition or options. How is capacity determined? Who decides on behalf of the patient if the patient is determined to lack capacity? How should a surrogate decide on behalf of a patient?

In this Application Assignment, you will analyze the legal and ethical issues around patient capacity and surrogate decision making by focusing on the following scenario:

An 83-year-old diabetic male, Mr. Jones, is brought in to the emergency department because of respiratory distress, by his care-giving daughter, with whom he lives. In examining him, the emergency department physician discovers that Mr. Jones has gangrene on his right foot up to his ankle.

Mr. Jones' daughter reports that her father has been diagnosed with Alzheimer's disease. A preliminary capacity assessment is consistent with mild dementia, but one of the nurses suggests that Mr. Jones' confusion might be the result of his respiratory distress, coupled with the disorienting atmosphere of the emergency department.

The clinical recommendation is to perform a below-the-knee amputation. The patient refuses this surgery, saying he has lived long enough and wants to die with his body intact. His daughter disagrees and says she wants everything done so that she can take him home as soon as possible, and says that she will sue the hospital if they do not perform the amputation. A social worker comments that the daughter might be afraid of an elder-neglect investigation if her father dies.

Mr. Jones does not have an advance directive of any kind and is not under guardianship. Assume that the applicable law in your state is the same as Sections 5, 7, and 11, of the Uniform Health-Care Decisions Act, available at http://www.law.upenn.edu/bll/archives/ulc/fnact99/1990s/uhcda93.htm

To prepare for the Application:

Review Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834–40. Also review the section of the Merck Manual on surrogate decision making, http://www.merck.com/mmhe/sec01/ch009/ch009f.html. Refer to these readings as well as to the laws as described in Sections 5, 7, and 11 of the Uniform Health-Care Decisions Act in order to identify legal and ethical issues that apply to the scenario above. Consider the role that capacity assessment must play in health care. Why is it important? What are the consequences of not adequately assessing a patient's capacity? Read Chapter 4, "Health Care Ethics Committee," in Legal and Ethical Issues for Health Professionals (required reading in Week 6). In what ways would a health care consultation or committee be able to address the ethical challenges in this scenario? How do you think a bioethicist would deal with this case in terms of the procedures he or she would engage in?

This is the question to be answered...in terms of the legal and ethical issue please define them and relate it to the scenario to answer the question. For eg is Malpractice is a legal aspect define it in answering the question.

To complete this Application Assignment, write a 3- to 4-page paper in which you would address the following questions: What are the relevant legal issues at stake? What are the legal rights of the patient and his daughter? What are the relevant ethical issues at stake? Why does capacity assessment matter? How might the hospital's ethics committee or ethics consultation service help in addressing this? Include a description of how an ethics consultant or committee might become involved in this case.

Please use these resources along with what you have

Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834–1840. Retrieved from http://proquest.umi.com.ezp.waldenulibrary.org/pqdweb?did=1375629681&sid=1&Fmt=4&clientId=70192&RQT=309&VName=PQD Also available at http://www.nejm.org/doi/pdf/10.1056/NEJMcp074045 as a PDF document.

This article discusses legal and ethical issues that arise in the challenge of assessing a patient's capacity or competence to understand health care options and give consent. Article: Coiera, E., & Clarke, R. (2004). e-Consent: The design and implementation of consumer consent mechanisms in an electronic environment. JAMIA: Journal of the American Medical Informatics Association, 11(2), 129–140. Retrieved from http://jamia.bmj.com.ezp.waldenulibrary.org/content/11/2/129.full.pdf

Caring Connections: What Are Advance Directives? http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3285

This website explains the meaning of advance directives and offers tips for personally developing an advance directive. Caring Connections: Download Your State's Advance Directives http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289

This website provides access to advance directives in states across the U.S. Use this site for one of this week's Discussion options. Merck Manual: Surrogate Decision Making http://www.merckmanuals.com/home/sec01/ch009/ch009f.html

Hampton, T. (2008). Groups push physicians and patients to embrace electronic health records. JAMA: Journal of the American Medical Association, 299(5), 507–509. Retrieved from http://jama.ama-assn.org.ezp.waldenulibrary.org/cgi/content/full/299/5/507?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=hipaa+health+information+patient+2009&searchid=1&FIRSTINDEX=10&resourcetype=HWCIT

Please use APA format for referencing.

This article discusses the unresolved issues, including privacy concerns, that have slowed the adoption of electronic health records by health care providers and organizations, as well as by patients. Article: Rothstein, M. A., & Talbott, M. K. (2006). Compelled disclosure of health information: Protecting against the greatest potential threat to privacy. JAMA: Journal of the American Medical Association, 295(24), 2882–2885. Retrieved from http://jama.ama-assn.org.ezp.waldenulibrary.org/cgi/content/full/295/24/2882?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=hipaa+health+information+patient+2009&searchid=1&FIRSTINDEX=10&resourcetype=HWCIT This article examines the challenges that the electronic health record poses to patient health information privacy and confidentiality.