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Psychiatric Advance Directives Versus Recipient Rights

1146 words - 5 pages

Introduction and Scenario Description
When a patient enters the hospital, he or she expects the health care professionals to treat him or her with respect and fairness. The hospitals, clinics, and other healthcare settings should deserve and be reputed with a strong set of ethical principles and respect in the face of the law. To John, a 35 year old schizophrenic who is experiencing a crisis situation, his mental health depends greatly on his health care team. He wrote an advance directive that states which medications he would prefer to receive and that he wants his parents to be involved in his care, but he currently exhibits paranoia against his parents. John’s health care team must decide on what course of action to take. The purpose of this paper is to examine the legal and ethical aspects of John’s advance directive and his recipient rights.
Ethical Principles
The ethical principles that most pertain to John’s situation are those of autonomy and beneficence. John deserves respect to his autonomy and his health care providers should consider beneficence in all of their interventions.

Autonomy
Autonomy is an important ethical principal that should be considered with great attention, especially with the limitation of personal autonomy one finds in hospitals. Burkhardt (2008) and Nathaniel define autonomy as self-governing and describe it as including four elements, the ability to determine personal goals, decide on a plan of action, to be respected, and to have freedom to act on choices. In John’s situation, his vulnerability in contrast to the power that the health care professionals hold over him put all four of these elements into jeopardy. Since his advance directive and his current choices differ, the matter of respect for John’s autonomy becomes difficult for his advocates in the hospital.
Consent, autonomy, and psychiatric advance directives.
Consent is the most important issue in a hospital situation when considering autonomy. John’s ability to consent to treatment could be compromised because of his mental state. Psychiatric advance directives are a tool that informs health care providers of clients’ treatment preferences for during crisis situations, such as the one in which John finds himself (Srebnik & Russo, 2007). This document facilitates autonomy for clients in the hospital and could make care decisions easier for those with psychiatric patients. The physician in John’s situation believes that the best way to respect John’s autonomy is to follow a different prescribed set of medications and to respect his current wish that his parents remain uninformed. John’s advance directive indicates that he knows his paranoia manifests against his parents and that this paranoia is only that, a paranoid delusion.
Beneficence
Stedman’s Medical Dictionary defines beneficence as “the ethical principle of doing good” (Stedman, 2000). This broadly defined principle does not assist in a decision whether to follow John’s advance directive...

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