The recent Schiavo case is on my mind as this issue goes to press. As luck would have it, I was recently sent a copy of a publication by the American Bar Association entitled Advance Health Care Directives-A Handbook for Professionals. This book is ostensibly written for the attorneys who draft such documents. However, it contains a wealth of information that is also useful to nurse executives about these documents and their implications for both patients and healthcare providers. One of the great features of this book is that it addresses many widely held misconceptions regarding what these documents really accomplish and how they are used in making decisions related to patient care. The book covers topics such as the ethics of advance healthcare directives, explains competence, and contains chapters on the perspective of the family, the attorney, and the healthcare provider. Is also contains a helpful chapter dealing with special circumstances such as divorce, domestic partners, and pregnancy. This book is authored by Carol Krohm, MD, and Scott Summers and is available at http://www.ababooks.org.
As healthcare providers, we are sometimes accused of not practicing what we preach in terms of taking care of ourselves with regular checkups and attention to our personal health matters. In speaking with colleagues, it appears that we have the same issues with our own healthcare directives. The Schiavo case, if nothing else, has brought the issue of advanced directives to the attention of the nation. As nurses, we need to be sure that we have our own affairs in order should the need arise, and we need to encourage our nursing staff to do the same. Robert Cowart, the president of the American Bar Association, suggests the following actions:
1. Make sure that you have a living will, advanced directives, and durable power of attorney.
2. Consider writing a letter of instruction detailing specific desires not covered in the advance directive (such as anatomical gifts).
3. Collect and organize important documents in one location that is known by a responsible party who has access to them. (Do not put these documents in your safe deposit box!).
4. Have an open conversation with your parents, spouse, siblings, and adult children about your wishes and the legal processes that are available in your state.
In addition to making sure you and your staff have your personal affairs in order, nurse executives have an important role to play in the discussion now taking place in this country regarding end-of-life care and decision making. Some things you might consider doing in this regard are:
1. Ask an attorney familiar with these issues to come to your facility to conduct a discussion of these legal documents and the problems that can arise. Include discussions of actual incidents that have occurred in your facility and ask the attorney to explain how they could have been prevented or handled differently.
2. Volunteer to lead a discussion at your place of worship regarding these documents and the perspective of healthcare providers who have to deal with cases in which there is a conflict among family members regarding decision making at the end of life.
3. Review your facility's policies and procedures regarding end-of-life decision making and the handling of conflicts among family members with your facility's attorney to brainstorm how your facility would have responded to a case such as the Schiavo case.
4. Review your facility's policies and procedures regarding dealing with crowd control and the media to determine how you would handle a case with large public involvement.
5. Consider whether your facility should sponsor a seminar for the public regarding end-of-life decision making processes and the legal documents available to assist them with making their wishes clear.
6. Consider whether your facility should start a public service announcement campaign to educate your demographic population about end-of-life decision making.