Biomedical subjects
Publications and source records attributed to S R Huntington.
The expansion of nurse advice lines by health plans has exposed them to a new area of liability. The author explores several recent cases in which health plans have been found accountable for actions of their nurse advice lines, and offers a series of suggestions for reducing health plan liability.
Home care and hospice providers participating in Medicare or Medicaid are subject to the new obligations created by the Patient Self-Determination Act, and therefore must be familiar with their states' laws on patients' rights to direct medical care.
The traditional, informal approach to making medical decisions for incapacitated patients is often inappropriate today. Guidelines are needed in two major areas: assessing incapacity and seeking surrogate decision makers. Judicially declared incompetency does not necessarily imply incapacity to make medical choices. Proposed standards for determining incapacity require a multistep evaluation of the patient's abilities to understand, reason, and communicate. When decisions must be made for an incapacitated patient, priority is given to the patient's previously stated preferences. An advance directive--living will or durable power of attorney--simplifies the process. If no advance directive was prepared, a surrogate decision maker may be designated according to applicable state statutes. Standards are still evolving for protecting the autonomy and best interests of vulnerable, incapacitated patients.
The growing elderly population and the acquired immunodeficiency syndrome (AIDS) epidemic have focused attention on ethical and legal issues surrounding health-care decision making. It is becoming increasingly critical to involve patients in the decisions that affect their care. Legal frameworks are evolving to protect the rights of both "competent" and "incompetent" patients. By writing instructions in advance, patients can increase their control and autonomy over health-care decisions. Physician assistants can facilitate the process by incorporating a patient value history into the chart and explaining legally recognized documents. Living wills generally apply in the context of terminal illness or irreversible coma; however, definitions of terminal conditions, imminent death, or life-sustaining procedures can be problematic. A number of states recognize the health-care durable power of attorney, which establishes a surrogate decision maker to act with specific instructions and limitations should the patient become incompetent or incapacitated.