History of Decision Making and Advanced Directives
-1969- human rights lawyer from Chicago, Luis Kutner, wrote an article that described the challenge of how patients should be treated when they are no
longer capable of making health care decisions.
-suggested individuals should indicate in writing, a head of time, the extent to which they would consent to treatment.
-a “living will.”
-embraced by the states
-advanced directive legislation
-1986- 41 states had adopted advanced directives laws
-1997- every state had advanced directive laws that included the need for a health care proxy provision.
self respect
- to hold yourself in high regard
- awareness that we are contributing to society’s wellbeing
self care
-finding a caring response for yourself
responsibilities of self care
-The development of self-respect is an engine that can
drive our daily activities toward human flourishing.
-Research shows that professionals who find
meaning in their job view their work as being deeply connected to their core values and moral orientation.
responsibilities to yourself
- “The rising rate of burnout in the health professions has led many to refer to it as a public health crisis.”
- Be kind and gentle to yourself
- You don’t have to grin and bear stress quietly
- Develop personal health habits, skills and interests
- 3 hallmarks of burnout are:
- Emotional exhaustion- being emotionally depleted or overextended
- Lack of personal accomplishment- feeling one cannot make a difference
- Depersonalization- characterized by difficulty making personal connections -> if values dont align with work you may feel depersonalized
duty of self care
- Develop personal health habits, skills and interests
- A moral obligation
- To do good for others, you must commit to yourself
- Duty of self-improvement
aspirations of self care
- Strive for an ideal standard of life
- Reward yourself for success
patient self determination act of 1990
- requires hospital, skilled nursing facilities etc:
- inform pts of their rights to make decisions concerning their care
- regularly inquire to whether a pt executed an advanced directive to document the pts wishes regarding their medical care
- not discriminate against persons who have executed an advance directive
- ensure that legally documented directive wishes are granted
- provide education program for staff, pt, and community on ethical issues
conscientious objection
- act of resistance of defiance against practices, laws in place
- asking to be exempt
- can never be used to discriminate others (saying no to an abortion because of race)
- cant be used if you applied knowing their practices
- if it is an emergency and everyone is needed you cant object
- health care workers refuse to participate in lethal injection
- clinical suicide
- abortion
- force feeding
material cooperation
- cooperation with wrongdoing is easier to justify if the wrongdoing will happen with or without the persons cooperation
- the more remote the cooperate personal the better
- going against company policy -> agree to cooperate
- ex. if the fire alarm is going off someone may say lets just stay back -> other people that say they are right are practicing material cooperation
- benefit must be greater than the wrongdoing itself
