Learning Objective #1: Discuss HIPPA regulations, hospital policy, real life practices, and their own personal feelings about end-of-life care and family involvement

Learning Objective #2: Identify methods to dialogue with healthcare practitioners and families to allowing current regulations and patient initiated directives to be followed

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The Joint Commission for Accreditation of Hospitals Organization (JCAHO) requires that each hospital provide information to every patient regarding advanced directive and do not resuscitate orders. The majority of institutions the United States today comply with this requirement by placing the information into the hospital's admission information packets. Most institutions include questions about living wills, do not resuscitate orders, and power of attorney in their admission assessments. Following JCAHO's guidelines is an attempt to comply with the 1990 Self Determination Act (SDA) passed by Congress (Omnibus Budget Reconciliation Act of 1990). Compliance to the statues however does not insure patient or physician compliance. Studies have shown that physicians are influenced more by their own beliefs, loved ones' experiences and clinical preparation than the patient's end-of-life (EOL) care planning (Asch, Hansen-Flaschen, & Lanken, 1995 and Vincent 1999). The privilege to refuse care is listed on the “Patient Bill of Rights” that patients also sign on admission to the hospital, even if only registering for an outpatient lab test. Yet every day this basic human right is overturned by family members or persons appointed medical power of attorney. Even if a physician is attempting to follow a patient's directive, family members are allowed to “revoke” a directive and demand that all heroics and support be utilized regardless of the patient's condition, physician opinion, or legality of the directive. Physicians routinely treat futile patients in fear of litigation from family members. As nurses, our stand should be strong on the cause of the patient's right to refuse or deny treatments and care. We should rally to remove the threat of legal proceedings for healthcare workers following a legal, patient initiated directive to physicians and health care workers.