Tell your friends about this page!   On-Site Training Seminars Challenging Patient Situations Book Video Training Programs Healthcare Workplace Issues Ask Mary Rau-Foster's Advice Events Calendar Our Services Articles and White Papers Whose Life Is It Anyway? About Us Contact Us Home     Want help on general workplace issues like conflict resolution, employee motivation and communication? Visit our sister site workplaceissues.com	Articles and White Papers Concerning Healthcare Workplace Issues   Whose Life Is It Anyway? by Mary Rau-Foster, RN BS ARM JD   Published in the "ANNA Journal," December 1998   She is 84 years old, combative, confused, and yells throughout dialysis. A successful dialysis treatment requires physical and/or chemical restraints. This thrice-weekly scene dreadfully impacts the other patients. The physician and staff are reluctant to approach her family regarding discontinuing dialysis because of concern about how the family might react to the suggestion. There have been no attempts to meet with the family to discuss their feelings or what they believe that the patient would have wanted to occur at this point.   He is 50 years old with numerous health problems. He has given written directions that he not be "coded" should he have a cardiac arrest while on dialysis. The dialysis staff states, "We have to code him while he is in our unit," ignoring the patient's directive and his legal right to decide his own fate.   The 24-year-old male across the room has undergone his thirteenth scheduled dialysis treatment. He continues to assert that he does not want to dialyze, or live such a restrictive life. No attempt is made to assess whether the patient is suffering from depression, which if chemically treated, could result in a different decision. The dialysis staff insists that he must dialyze and dismisses his feelings by assuring him that he "will adjust."   All three situations are common and problematical. They beg for answers to the questions: "What is the right thing to do in this situation? Will any action or inaction result in a violation of the patient's rights? Can we get sued? What if I am morally opposed to terminating dialysis treatments or to not resuscitating a patient?"   The social, ethical, and legal issues abound in these scenarios (including questions of the patient's competency and appropriate state of mind to make life and death decisions). The typical manner of addressing such issues is through creative avoidance, the path of least resistance. Regardless of our steadfast commitment to avoid that, which is uncomfortable or threatening, we must face these issues. This will require an honest, personal, and professional self-assessment. This is done by posing some of the following questions to ourselves and to other members of our team:   • What makes these situations so difficult to address? • Do we have the right to make decisions for a patient or in contradiction to a patient's decision and directive? • Do we have the right to force our belief or value systems upon others? • Can we accept that someone's decision to terminate dialysis is not a rejection of us personally or as healthcare professionals? • Can we accept that "letting go" (in terms of supporting the patient's decision) is not the same as "giving up"? • Do we know when it is appropriate to "let go" and when to encourage our patient's to continue on with dialysis? • Do we really understand our roles as healthcare professionals? • Can we give up a need to control our patient's lives and to make decisions for them? • Are we focusing on our own needs (to feel free from fear, discomfort, and guilt) to the exclusion of our patient's needs?   While we are struggling with death and dying issues or what our patients can and can not do, we should remember this: Our laws are quite clear! The healthcare consumer has the right to make decisions about any treatment options, or to have someone make those decisions for him or her if he or she is unable to do so. (See also, The Patient Self-Determination Act of 1991). We should also be quite clear that our role is that of a patient advocate. Our responsibility is to assist the competent patient in making the right decision for him or her. And then, comply with that decision.   Providing care to our patients requires that we listen to and support their decisions. Above all, it is important that we respect their right to make healthcare decisions. After all, whose life is it anyway?     About the Author Mary Rau-Foster is a former dialysis nurse and corporate lawyer with a special interest in workplace issues. She is president of Foster Seminars and Communications LLC in Brentwood, TN. Mary also is an author, a nationally known speaker, and has an extensive background in medical malpractice. Mary has written a book titled "Dealing with Challenging Dialysis Patient Situations" and written and produced three video based training program specifically for dialysis staff training. For information on this topic contact Mary.   © 1998-2000 Mary Rau-Foster.       More Articles and White Papers   Mary Rau-Foster, RN BS ARM JD     “All three situations are common and problematical. They beg for answers to the questions: “What is the right thing to do in this situation? Will any action or inaction result in a violation of the patient's rights? Can we get sued? What if I am morally opposed to terminating dialysis treatments or to not resuscitating a patient?”
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