hlth3100 walden university ETHICAL AND LEGAL ISSUES IN HEALTHCARE

Advance directives resulted from the controversy surrounding the case of Nancy Beth Cruzan, a young Missouri woman who suffered injuries in a car accident in January 1983 and who was kept alive in an irreversible vegetative state for almost eight years.

Cruzan’s parents went to court to order the hospital to remove the feeding tube that was keeping their daughter alive. The hospital appealed to the U.S. Supreme Court, spurring national debate about how and when families can allow a loved one to die. In 1990, the court recognized a constitutional right to forgo life-sustaining treatment when it is clear the patient would have wanted to do so. The feeding tube was removed, and Cruzan died, surrounded by her family.

While the decisions can be difficult, preparing for the end is an activity that has to happen before it is needed. Advance directives are documents that a person can complete which lets his or her wishes be known about healthcare, life saving measures, and designated people who can make decisions if the need arises.

In this Assignment, you will examine your state’s laws regarding end-of-life advance directives (do-not-resuscitate [DNR], durable power of attorney for healthcare, living will, etc.) and complete one of these documents. (Note: You will not be asked to share your completed document, only reflect upon it).

To prepare for this Assignment:

• Research your state or province’s laws regarding end-of-life advance directives such as do-not-resuscitate orders, durable power of attorney for health care, and living wills.
• Complete at least one of the end-of-life advance directives listed above. See the AARP website in the Learning Resource for the downloadable forms. (Note: You will not be asked to share your completed document, only reflect upon it).

To completethis Assignment, write a 2- to 3-page paper, which addresses the following:

• What types of end-of-life advance directives does your jurisdiction allow?
• After completing the document, assess your feelings about the process. Was the document simple to complete for you? Was it challenging? Expand on your feelings of planning ahead for end-of-life decisions.
• What factors contributed to you selecting the specific document that you completed?
• What legal issues did you consider when you were completing the end-of-life document?
• What ethical factors and principles did you consider when completing the end-of-life document?
• Should healthcare providers be required to honor advance directives regardless of personal belief and institutional settings?

Your written assignments must follow APA guidelines. Be sure to support your work with specific sources from this week’s Learning Resources and additional scholarly sources as appropriate.

VIRGINIA
Advance Directive
Planning for Important Healthcare Decisions
Courtesy of CaringInfo
www.caringinfo.org
800-658-8898
CaringInfo, a program of the National Hospice and Palliative Care Organization (NHPCO), is a
national consumer engagement initiative to improve care and the experience of caregiving
during serious illness and at the end of life. As part of that effort, CaringInfo provides detailed
guidance for completing advance directive forms in all 50 states, the District of Columbia, and
Puerto Rico.
This package includes:
• Instructions for preparing your advance directive. Please read all the instructions.
• Your state-specific advance directive forms, which are the pages with the gray
instruction bar on the left side.
BEFORE YOU BEGIN
Check to be sure that you have the materials for each state in which you may receive
healthcare. Because documents are state-specific, having a state-specific document for each
state where you may spend significant time can be beneficial. A new advance directive is not
necessary for ordinary travel into other states. The advance directives in this package will be
legally binding only if the person completing them is a competent adult who is 18 years of age
or older, or an emancipated minor.
ACTION STEPS
1. You may want to photocopy or print a second set of these forms before you start so you will
have a clean copy if you need to start over.
2. When you begin to fill out the forms, refer to the gray instruction bars — they will guide you
through the process.
3. Talk with your family, friends, and physicians about your advance directive. Be sure the
person you appoint to make decisions on your behalf understands your wishes.
4. Once the form is completed and signed, photocopy, scan, or take a photo of the form and
give it to the person you have appointed to make decisions on your behalf, your family,
friends, healthcare providers, and/or faith leaders so that the form is available in the event
of an emergency.
Copyright © 2005 National Hospice and Palliative Care Organization. All rights reserved. Revised 2023.
Reproduction and distribution by an organization or organized group without the written permission of the National
Hospice and Palliative Care Organization is expressly forbidden.
5. You may also want to save a copy of your form in your electronic healthcare record, or an
online personal health records application, program, or service that allows you to share your
medical documents with your physicians, family, and others who you want to take an active
role in your advance care planning.
6. Virginia maintains an Advance Directive Registry. By filing your advance directive with
the registry, your health care provider and loved ones may be able to find a copy of
your directive in the event you are unable to provide one. You can read more about
the registry, including instructions on how to file your advance directive, at
https://www.connectvirginia.org/adr/.
INTRODUCTION TO YOUR VIRGINIA ADVANCE HEALTH CARE DIRECTIVE
This packet contains a Virginia Advance Directive, which protects your right to refuse
medical treatment you do not want or to request treatment you do want in the event you
lose the ability to make decisions yourself.
Part I, Appointment and Powers of My Agent, lets you name an adult, your “agent,” to
make decisions about your health care—including decisions about life- prolonging procedures—
if you can no longer speak for yourself. Part II, My Health Care Instructions, lets you state
your wishes about health care in the event you cannot speak for yourself, including if you
develop a terminal condition or you are in a persistent vegetative state. If you are an organ,
eye or tissue donor, your instructions will be applied so as to ensure the medical suitability of
your organs, eyes and tissues for donation. Part III allows you to record your organ and tissue
donation wishes. Part IV contains the signature and witnessing provisions so that your
document will be effective.
You may complete Part I, Part II, Part III, or all parts, depending on your advanceplanning needs. You must complete Part IV.
How do I make my Virginia Advance Health Care Directive legal?
You must sign your advance directive in the presence of two adult witnesses. Any person
over the age of 18—including a spouse, other relative, or health care provider—can witness
your Virginia Advance Directive.
Whom should I appoint as my agent?
Your agent is the person you appoint to make decisions about your healthcare if you become
unable to make those decisions yourself. Your agent may be a family member or a close friend
whom you trust to make serious decisions. The person you name as your agent should clearly
understand your wishes and be willing to accept the responsibility of making healthcare
decisions for you.
2
Should I add personal instructions to my advance directive?
Yes! One of the most important reasons to execute an advance directive is to have your voice
heard. When you name an agent and clearly communicate to them what you want and don’t
want, they are in the strongest position to advocate for you. Because the future is
unpredictable, be careful that you do not unintentionally restrict your agent’s power to act in
your best interest. Be especially careful with the words “always” and “never.” In any event, be
sure to talk with your agent and others about your future healthcare and describe what you
consider to be an acceptable “quality of life.”
When does my agent’s authority become effective?
Part I, Appointment and Powers of My Agent, goes into effect when your doctor and one
other qualified doctor or clinical psychologist certify in writing that you are incapable of making
an informed decision regarding health care.
Part II, My Health Care Instructions, goes into effect when your doctor and one other
qualified doctor or clinical psychologist certify in writing that you are incapable of making an
informed decision regarding health care and a condition you have given instructions for arises.
Agent Limitations
Your agent does not have the authority to consent to nontherapeutic sterilization, abortion, or
psychosurgery.
Your agent will be bound by the current laws of Virginia as they regard pregnancy and
termination of pregnancies.
What if I change my mind?
You may revoke your Virginia Advance Directive at any time by:
• signing and dating a written revocation,
• physically cancelling or destroying your document, or directing another to do so in
your presence, or
• orally expressing your intent to revoke the document.
Your revocation becomes effective when you notify your attending physician.
Also, make certain that you file any updates or changes to your Virginia Advance Directive with
the Virginia registry.
Mental Health Issues
These forms do not expressly address mental illness, although you can state your wishes and
grant authority to your agent regarding mental health issues. The National Resource Center on
Psychiatric Advance Directives maintains a website (https://nrc-pad.org/) with links to each
state’s psychiatric advance directive forms. If you would like to make more detailed advance
3
care plans regarding mental illness, you could talk to your physician and an attorney about a
durable power of attorney tailored to your needs.
What other important facts should I know?
You may expressly provide in your Advance Directive that, in the event you are incapable of
making an informed health care decision, your agent may authorize or withhold health care
over your objection. In order for this provision to be effective, the following must occur:
1. You must name an agent in your Advance Directive;
2. You must specify the treatments to which this provision applies;
3. Your physician or licensed clinical psychologist must attest in writing at the time
your Advance Directive is made that you are capable of making an informed
decision and understand the consequences of the provision;
4. The health care decision does not involve withholding or withdrawing lifeprolonging procedures; and
5. The health care that is to be provided, continued, withheld or withdrawn is
determined and documented by your attending physician to be medically
appropriate and is otherwise permitted by law.
If you decide to include language regarding care given over your objection, you may wish to
speak with your health care provider or an attorney with experience in drafting advance
directives regarding this language. Any such language may be included in Part I, No. 11 of
your Virginia Advance Directive.
Be aware that your advance directive will not be effective in the event of a medical emergency,
except to identify your agent. Ambulance and hospital emergency department personnel are
required to provide cardiopulmonary resuscitation (CPR) unless you have a separate physician’s
order, which are typically called “prehospital medical care directives” or “do not resuscitate
orders.” DNR forms may be obtained from your state health department or department of aging
(https://www.hhs.gov/aging/state-resources/index.html). Another form of orders regarding CPR
and other treatments are state-specific POLST (portable orders for life sustaining treatment)
(https://polst.org/form-patients/). Both a POLST and a DNR form MUST be signed by a
healthcare provider and MUST be presented to the emergency responders when they arrive.
These directives instruct ambulance and hospital emergency personnel not to attempt CPR (or
to stop it if it has begun) if your heart or breathing should stop.
4
VIRGINIA ADVANCE DIRECTIVE — PAGE 1 OF 8
Virginia Advance Directive
PRINT YOUR NAME
I,
,
willingly and voluntarily make known my wishes in the event that I am
incapable of making an informed decision about my health care, as follows
in this document.
This advance directive shall not terminate in the event of my disability.
PART I: APPOINTMENT OF AGENT
(CROSS THROUGH AND INITIAL IF YOU DO NOT WANT TO APPOINT AN
AGENT TO MAKE HEALTH CARE DECISIONS FOR YOU)
PRINT THE NAME,
ADDRESS AND
TELEPHONE
NUMBER OF
YOUR PRIMARY
AGENT
PRINT THE NAME,
ADDRESS AND
TELEPHONE
NUMBER OF
YOUR ALTERNATE
AGENT
I hereby appoint
of
(primary agent)
,
(address and telephone number)
as my agent to make health care decisions on my behalf as authorized in this
document. If the person I have appointed above is not reasonably available or
is unable or unwilling to act as my agent, then I appoint
_,
(alternate agent)
of
(address and telephone number)
to serve in that capacity.
,
I grant to my agent, named above, full power and authority to make health
care decisions on my behalf, as described below, whenever I have been
determined to be incapable of making an informed decision. My agent’s
authority hereunder is effective as long as I am incapable of making an
informed decision.
© 2005 National
Hospice and
Palliative Care
Organization.
2023 Revised.
In making health care decisions on my behalf, I want my agent to follow my
desires and preferences as stated in this document or as otherwise known to
him or her. If my agent cannot determine what health care choice I would
have made on my own behalf, then I want my agent to make a choice for me
based upon what he or she believes to be in my best interests.
VIRGINIA ADVANCE DIRECTIVE — PAGE 2 OF 8
POWERS OF MY AGENT
(CROSS THROUGH AND INITIAL ANY LANGUAGE YOU DO NOT WANT AND ADD ANY
LANGUAGE YOU DO WANT)
POWERS OF YOUR
AGENT
The powers of my agent shall include the following:
1.
To consent to or refuse or withdraw consent to any type of health care,
including, but not limited to, artificial respiration (breathing machine),
artificially administered nutrition (tube feeding) and hydration (IV fluids),
and cardiopulmonary resuscitation (CPR). This authorization specifically
includes the power to consent to dosages of pain-relieving medication in
excess of recommended dosages in an amount sufficient to relieve pain.
This applies even if this medication carries the risk of addiction or of
inadvertently hastening my death.
2.
To request, receive, and review any oral or written information regarding
my physical or mental health, including but not limited to medical and
hospital records, and to consent to the disclosure of this information as
necessary to carry out my directions as stated in this advance directive.
3.
To employ and discharge my health care providers.
4.
To authorize my admission, transfer, or discharge to or from a hospital,
hospice, nursing home, assisted living facility, or other medical care
facility.
5.
To authorize my admission to a health care facility for treatment of
mental illness as permitted by law. (If I have other instructions for my
agent regarding treatment for mental illness, they are stated in a
supplemental document.)
6.
To continue to serve as my agent if I object to the agent’s authority after
I have been determined to be incapable of making an informed decision.
7.
To authorize my participation in any health care study approved by an
institutional review board or research review committee according to
applicable federal or state law if the study offers the prospect of direct
therapeutic benefit to me.
8.
To authorize my participation in any health care study approved by an
institutional review board or research review committee according to
applicable federal or state law that aims to increase scientific
understanding of any condition that I may have or otherwise to promote
human well-being, even though it offers no prospect of direct benefit to
me.
CROSS THROUGH
AND INITIAL ANY
LANGUAGE YOU DO
NOT WANT AND
ADD ANY
LANGUAGE YOU DO
WANT
© 2005 National
Hospice and
Palliative Care
Organization.
2023 Revised.
VIRGINIA ADVANCE DIRECTIVE — PAGE 3 OF 8
POWERS OF YOUR
AGENT (continued)
PRINT ANY
ADDITIONAL
POWERS YOU
WANT YOUR AGENT
TO HAVE OR ANY
LIMITATIONS ON
THE POWERS OF
YOUR AGENT, IF
ANY
ADD OTHER
INSTRUCTIONS, IF
ANY, REGARDING
YOUR ADVANCE
CARE PLANS
THESE
INSTRUCTIONS CAN
FURTHER ADDRESS
YOUR HEALTH
CARE PLANS, SUCH
AS YOUR WISHES
REGARDING
HOSPICE
TREATMENT, BUT
CAN ALSO ADDRESS
OTHER ADVANCE
PLANNING ISSUES,
SUCH AS YOUR
BURIAL WISHES
9.
To make decisions regarding visitation during any time that I am
admitted to any health care facility, consistent with the following
directions:
11. Additional powers or limitations, if any:
I give the following instructions to further guide my agent in making health
care decisions for me:
ATTACH
ADDITIONAL PAGES
IF NEEDED
© 2005 National
Hospice and
Palliative Care
Organization.
2023 Revised.
(attach additional pages if needed)
VIRGINIA ADVANCE DIRECTIVE — PAGE 4 OF 8
PART II: HEALTH CARE INSTRUCTIONS
[YOU MAY USE ANY OR ALL OF PARTS A, B, OR C IN THIS SECTION TO
DIRECT YOUR HEALTH CARE EVEN IF YOU DO NOT HAVE AN AGENT. IF YOU
CHOOSE NOT TO PROVIDE WRITTEN INSTRUCTIONS, DECISIONS WILL BE
BASED ON YOUR VALUES AND WISHES, IF KNOWN, AND OTHERWISE ON
YOUR BEST INTERESTS. IF YOU ARE AN ORGAN, EYE OR TISSUE DONOR,
YOUR INSTRUCTIONS WILL BE APPLIED SO AS TO ENSURE THE MEDICAL
SUITABILITY OF YOUR ORGANS, EYES AND TISSUES FOR DONATION.]
INITIAL ONLY ONE
YOU MAY WRITE
HERE YOUR OWN
INSTRUCTIONS
ABOUT YOUR CARE
WHEN YOU ARE
DYING, INCLUDING
SPECIFIC
INSTRUCTIONS
ABOUT
TREATMENTS THAT
YOU DO WANT, IF
MEDICALLY
APPROPRIATE, OR
DON’T WANT.
IT IS IMPORTANT
THAT YOUR
INSTRUCTIONS
HERE DO NOT
CONFLICT WITH
OTHER
INSTRUCTIONS YOU
HAVE GIVEN IN
THIS ADVANCE
DIRECTIVE
ATTACH
ADDITIONAL PAGES
IF NEEDED
© 2005 National
Hospice and
Palliative Care
Organization.
2023 Revised.
A. Instructions If I have a Terminal Condition
I provide the following instructions in the event my attending physician
determines that my death is imminent (very close) and medical treatment will
not help me recover:
I do not want any treatments to prolong my life. This includes tube
feeding, IV fluids, cardiopulmonary resuscitation (CPR), ventilator/respirator
(breathing machine), kidney dialysis or antibiotics. I understand that I still will
receive treatment to relieve pain and make me comfortable.
OR
I want all treatments to prolong my life as long as possible within the
limits of generally accepted health care standards. I understand that I will
receive treatment to relieve pain and make me comfortable.
OR
I direct the following regarding health care when I am dying:
VIRGINIA ADVANCE DIRECTIVE — PAGE 5 OF 8
B. Instructions if I am in a Persistent Vegetative State
I provide the following instructions if my condition makes me unaware of
myself or my surroundings or unable to interact with others, and it is
reasonably certain that I will never recover this awareness or ability even with
medical treatment:
INITIAL ONLY ONE
YOU MAY WRITE
HERE YOUR
INSTRUCTIONS
ABOUT YOUR CARE
WHEN YOU ARE
UNABLE TO
INTERACT WITH
OTHERS AND ARE
NOT EXPECTED TO
RECOVER THIS
ABILITY.
THIS INCLUDES
SPECIFIC
INSTRUCTIONS
ABOUT
TREATMENTS YOU
DO WANT, IF
MEDICALLY
APPROPRIATE, OR
DON’T WANT. IT IS
IMPORTANT THAT
YOUR
INSTRUCTIONS
HERE DO NOT
CONFLICT WITH
OTHER
INSTRUCTIONS YOU
HAVE GIVEN IN
THIS ADVANCE
DIRECTIVE
ATTACH
ADDITIONAL PAGES
IF NEEDED
© 2005 National
Hospice and
Palliative Care
Organization.
2023 Revised.
I do not want any treatments to prolong my life. This includes tube
feeding, IV fluids, cardiopulmonary resuscitation (CPR), ventilator/respirator
(breathing machine), kidney dialysis, or antibiotics. I understand that I still
will receive treatment to relieve pain and make me comfortable.
OR
I want all treatments to prolong my life as long as possible within the
limits of generally accepted health care standards. I understand that I will
receive treatment to relieve pain and make me comfortable.
OR
I want to try treatments for a period of time in the hope of some
improvement of my condition. I suggest
(insert time period) as
the period of time, after which such treatment should be stopped if my
condition has not improved. The exact time period is at the discretion of my
agent or surrogate in consultation with my physician. I understand that I still
will receive treatment to relieve pain and make me comfortable.
OR
I direct the following regarding when I am unaware of myself or my
surroundings or unable to interact with others, and it is reasonably certain
that I will never recover this awareness or ability even with medical
treatment:
YOU MAY WRITE
HERE STATEMENTS
AND INSTRUCTIONS
ABOUT
TREATMENTS THAT
YOU DO WANT, IF
MEDICALLY
APPROPRIATE, OR
ABOUT
TREATMENTS YOU
DO NOT WANT
UNDER SPECIFIC
CIRCUMSTANCES
OR ANY
CIRCUMSTANCES.
VIRGINIA ADVANCE DIRECTIVE — PAGE 6 OF 8
C. Other Instructions Regarding My Health Care
I further direct the following regarding my health care when I am incapable of
making my own health care decisions:
IT IS IMPORTANT
YOUR
INSTRUCTIONS
HERE DO NOT
CONFLICT WITH
OTHER
INSTRUCTIONS YOU
HAVE GIVEN IN
THIS ADVANCE
DIRECTIVE
THESE
INSTRUCTIONS CAN
ADDRESS YOUR
HEALTH CARE
PLANS, SUCH AS
YOUR WISHES
REGARDING
HOSPICE
TREATMENT, BUT
CAN ALSO ADDRESS
OTHER ADVANCE
PLANNING ISSUES,
SUCH AS YOUR
BURIAL WISHES
ATTACH
ADDITIONAL PAGES
IF NEEDED
© 2005 National
Hospice and
Palliative Care
Organization.
2023 Revised.
(attach additional pages if needed)
VIRGINIA ADVANCE DIRECTIVE — PAGE 7 OF 8
PART III: ORGAN DONATION
[YOU MAY USE THIS DOCUMENT TO RECORD YOUR DECISION TO DONATE
YOUR ORGANS, EYES AND TISSUES OR YOUR WHOLE BODY AFTER YOUR
DEATH. IF YOU DO NOT MAKE THIS DECISION HERE OR IN ANY OTHER
DOCUMENT, YOUR AGENT CAN MAKE THE DECISION FOR YOU UNLESS YOU
SPECIFICALLY PROHIBIT HIM/HER FROM DOING SO, WHICH YOU MAY DO
IN THIS OR SOME OTHER DOCUMENT. CHECK ONE OF THE BOXES BELOW
IF YOU WISH TO USE THIS SECTION TO MAKE YOUR DONATION DECISION.]
IF YOU WISH TO
DONATE YOUR
ORGANS, EYES, OR
TISSUES, INITIAL
THE OPTION THAT
REFLECTS YOUR
WISHES
I donate my organs, eyes, and tissues for use in transplantation,
therapy, research and education. I direct that all necessary measures be
taken to ensure the medical suitability of my organs, eyes, or tissues for
donation. I understand that I may register my directions at the Department of
Motor Vehicles or directly on the donor registry, www.DonateLifeVirginia.org,
and that I may use the donor registry to amend or revoke my directions;
OR
I donate my whole body for research and education.
INSERT ANY
SPECIFIC
INSTRUCTIONS YOU
WISH TO GIVE
ABOUT
ANATOMICAL
GIFTS, IF ANY
ATTACH
ADDITIONAL PAGES
IF NECESSARY
© 2005 National
Hospice and
Palliative Care
Organization
2023 Revised.
I direct the following regarding donation of my organs, eyes, and tissues:
VIRGINIA ADVANCE DIRECTIVE — PAGE 8 OF 8
PART IV: EXECUTION
Affirmation and Right to Revoke: By signing below, I indicate that I am
emotionally and mentally capable of making this advance directive and that I
understand the purpose and effect of this document. I understand I may
revoke all or any part of this document at any time.
SIGN, DATE, AND
PRINT YOUR NAME
HERE
(signature of declarant)
(date)
(printed name)
The declarant signed the foregoing advance directive in my presence.
YOUR TWO
WITNESSES MUST
SIGN, DATE, AND
PRINT THEIR
NAMES HERE
Witness Signature
Date
Printed name
Witness Signature
Date
Printed name
© 2005 National
Hospice and
Palliative Care
Organization.
2023 Revised.
Courtesy of CaringInfo
www.caringinfo.org