After reading both cases, please discuss the following:

• As a health administrator, discuss the importance of securing advance directives at the time of inpatient registration or emergency care.
• As a health administrator, discuss how advance directives would have facilitated care in the Quinlan and Schiavo  cases.
• Include in your initial post, the reasons why patients neglect or overlook creating such instruments.
• Finally, who speaks for patients when the patient is not able to make their wishes known? Further, is this, in your view, patient self-determination? Explain.

In two different paragraph with no less than 100 words give your personal opinion to  Marivette Bedoya and Crystal Moore 

 Crystal Moore 

It is extremely important for healthcare administrators to implement a policy that requires every cognitively registered patient to complete/sign an advance directive of some sort. Advance directives are pertinent to the patients care while admitted and could be the deciding factor for life-saving measures such as blood transfusions or intubation. 

As a health administrator, I think that there were many issues with the care related to Quinlan and Schiavo. Regarding Quinlan, the patient was in a consistent vegetative state with no chance of recovering to live a good quality of life. Although there was no clear definition of the type of death related to Quinlan (death or brain death) the patients quality of life was greatly diminished (Showalter, 2017). Her father took actions to withdraw support so that his child would not live in such a state. In my opinion, I believe the physicians were not ethical by overruling the fathers decision to initially withdraw care. The patient lived in a suspended state of life unable to speak, eat or move. We must ask ourselves, what kind of living is that for someone?

In the care of Schiavo, my opinion is that the husband had the right to decide his wife’s care (Showalter, 2017). When a man and woman marry it is the spouse who ultimately has the right to make decisions unless stated otherwise. We do not know if Terri and her husband had conversations about what her wishes would be in the time of a medical crisis, conversations the parents probably did not know about. Both of these cases are sad but they raise awareness about the importance of advance directives. Ultimately, this is a grey area that causes great turmoil to the patient suffering.

I believe that many people overlook the importance of creating advance directives or a living will because it is an uncomfortable conversation. Discussing final wishes in the event that you are no longer able to decide for yourself when near death is scary to think of therefore, many people do not consider them.

In the event that a patient is unable to make a decision about their care the following should: spouse, adult child, parent or guardian then finally next of kin. In the event that a patient suffers from an illness that makes them incompetent a power-of-attorney should be established. For someone who suffers an illness like dementia for example, a dementia directive should be filled out and the patients wishes discussed thoroughly with the main people responsible for the patients care should the disease progress (Gaster, 2019). It is always best to have a plan in the event that you cannot make decisions for yourself, it is conversation that must be had with loved ones so they know what your wishes are in the end. 

~Crissy

References

Gaster, B. (2019). An Advance Directive for Dementia: Documents that can guide care as dementia patients’ minds gradually fade. Generations, 79–82.

Showalter, J. S. (2017). The Law of Healthcare Administration (8th ed.). Chicago, IL.: Health Administration Press.

Marivette Bedoya 

Advance directives address a number of issues concerning the directions if a patient wants to receive artificial respiration, dialysis, or any extraordinary measures in a situation that could result in death. Advance directives tend to help in avoiding disputes between family members regarding the treatment of a relative by giving direction to healthcare providers concerting the care to be provided to the patient (Advance Directives: Making Crucial Healthcare Decisions Before an Emergency, n.d.). As a health administrator it would be important that I follow through with the wishes of the patient, to make them feel satisfied and comfortable. 

In the Quinlan and Schiavo cases, the 22 year old woman is highly unlikely to even think about an advance directive. I personally have never thought of creating an advance directive. If Karen Quinlan did have an advance directive, then her parents and medical professionals would not have gone through the courts to make a decision in regard to the patients life because her wishes would have been pursued prior to her brain injury. With the Schiavo case, I feel and think the same as the Quinlan case. If she had her wishes done then possibly living her last 15 years in an unconsciousness state would have not happened. Again, they were both young and did not think of an advance directive. 

When a patient is not able to make their own wishes known, the immediate family members such as parents, siblings, husbands or wives normally make the decision involving healthcare. If the patient does not have any family members then I believe it is the physicians who chose the proper course of action of treatment to the patients. If the patient is not able to make their own decisions about their care, I believe it is patient self-determination. Self-determination encourages all people to make choices and decision about the type and extent of medical care one wants to accept or refuse should they become unable to make those decision due to illness (Gapna, 2013). 

References:

Advance Directives: Making Crucial Healthcare Decisions Before an Emergency. (n.d.). Retrieved from

https://www.heart.org/en/health-topics/consumer-healthcare/doctor-appointments-questions-to-ask-your-doctor/advance-directives-making-crucial-healthcare-decisions-before-an-emergency

Gapna. (2013, April 12). Patient Self-Determination Act (PSDA). Retrieved from

https://www.gapna.org/patient-self-determination-act-psda