Advance Medical Directives
An advance medical directive (AMD) is a legitimate manuscript used to highlight particular prospect clinical care resolutions only when a patient is not healthy physically or mentally to make medical care decisions. The form authorizes a health care representative or an attorney to make treatment and other medical selections for a person in a critical health state. Similarly, the directive can be a will written by a patient with the direction and discussion of a physician on their end-of-life wishes (Butts & Rich, 2019). The AMD is strictly employed at a critical time when an individual is incurably sick or is permanently unconscious. According to Carr and Luth (2017), the living will state the medicinal management kinds the person would either like or not to obtain in these circumstances. The document defines under which situations an effort to prolong life should be executed or denied. The above-stated might include dialysis, percutaneous endoscopic gastrostomy (PEG), and life support equipment, among other services. This paper discusses the tube feeding part of an advance medical directive at St. John’s hospital in Oklahoma.
Christian Healthcare Organization and Rights of Patients
It would be assumed that all hospitals and healthcare facilities will follow the latter patient’s end-of-life wishes as directed by the state jurisdictions in which the health institution operates. However, some Christian-based hospitals like St. John’s medical center might have policies and moral obligations that sometimes conflict with clients’ AMD. The St. John’s hospital is entrenched in the devoted ministry of Jesus Christ as the true healer. The facility commits itself to help all individuals with particular consideration for the underprivileged and defenseless. The health care system offers spiritually centered, holistic care that sustains and advances persons and society’s health. The institution advocates for compassionate and just humanity through information and engagements. It is situated in the midtown center and has about seven hundred physicians with additional branches throughout Oklahoma.
St. John’s Hospital Policy on PEG
The hospital policy states that every patient that cannot feed normally has to be put on PEG. Second, the directive applies to all patients and the facility cannot admit a client who cannot accept tube feeding when not able to be fed orally. When the institution receives a patient with a directive conflicting with the policy, the law offers referral as the best way for the customer (Howland, 2017). However, the policy excuses the use of tube feeding in cases where it will not prolong life, it is tiresome, and it brings discomfort to the patient. The hospital operates under Oklahoma’s AMD which gives the citizens the liberty to accept or reject tube feeding (Fleuren et al., 2020). The physicians have faced an ethical dilemma while implementing this hospital policy, particularly for the individuals with advance directives rejecting PEG.
The hospital believes that life is sacred and people should be given a chance to fight for life. The policy argues that many individuals reject tube nutrition and hydration because they want to die. St. John’s hospital views the above act as murder against the Bible and the Catholic doctrines. The policy is in line with various biblical teachings that argue that only God has the right to take life. For example, Exodus 20:13 and Psalm 31:15 command Christians not to kill (NIV Faith and Work Bible, 2016). According to the above verses, Christians follow the sanctity of life which is God-given and only Him should control who lives and who dies.
Advance Directive Ethical Policy Dilemma Case at St. John’s hospital
When a critical patient who cannot feed themselves comes to St. John’s hospital with an ADM that rejects tube feeding, clinicians face an ethical dilemma. In such cases, the hospital administration allows the referral of the client to another facility that accepts the condition (Howland, 2017). In 2009, an older woman arrived at the Catholic-based medical center, the St. John’s Hospital, in Tulsa, Oklahoma. The lady was suffering a severe stroke: she was not speaking, eating, or drinking anything. The patient had the advance directive that indicated the need for artificial feeding for her to survive. However, her nephew, who was the designated proxy, insisted on applying for the resident bishop’s order on the utilization of nourishing tubes as mandated by the Catholic clinic’s policies. The patient’s physicians and St. John’s representatives discussed how to advance, struggling with an ethical dilemma because the hospital does not necessitate tube feeding, which was what the health representative wanted for the patient. However, her directive rejected it, yet it was Oklahoma’s law to obey the patient’s wishes.
The Hospital Decision to Protect the Patient’s Rights
The medical facility considered transferring the patient where the feeding tube will be installed. The lady’s doctors believed she had several months to live but could die earlier without PEG. Nevertheless, the medical team hesitated in doing that since the client’s advance directive wished for no simulated nourishment or even hydration. The hospital administration chose to obey Oklahoma’s advance directives and honor the patient’s rights and wishes by not providing tube feeding (Fleuren et al., 2020). Amid the whole confusion and efforts to make the decision, the patient died.
Summary
After the above-discussed scenario, the hospital made sure that it educated patients on AMD. The managers have also ensured that their clients understand the Christian morals and policies they stand for to avoid confusion and controversies. The nurses and social workers assist the customers to fill the advance directives with proper education and ensure they make informed decisions. Additionally, patient education is conducted during admission to family and the healthcare representatives on the Oklahoma and St. John’s AMDs to avert a conflict of interests.
References
Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Jones & Bartlett Learning.
Carr, D., & Luth, E. A. (2017). Advance care planning: Contemporary issues and future directions. Innovation in Aging, 1(1), 1-10. Web.
Fleuren, N., Depla, M. F., Janssen, D. J., Huisman, M., & Hertogh, C. M. (2020). Underlying goals of advance care planning (ACP): a qualitative analysis of the literature. BMC palliative care, 19(1), 1-15.
Howland, J. (2017). FAQs from the 2012 CMA annual conference. Linacre Quarterly, 84(3), 296-314. Web.
NIV Faith and Work Bible (New International Version). (2016). Zondervan. Web.