1. Advance Directives

When a patient is in a situation where they are not able to make certain health care decisions, advance directives come into play. The best gift you can give your family is to already have these decisions made for them so the fighting is eliminated or at least reduced. I have 2 large families and have been through this more times than I would've liked unfortunately. It is one of the most unsettling experiences. I also think we need to change the culture when it comes to these decisions. Every time you get on a plane, you are warned of what to do should it crash. This doesn't stop anyone from flying.

We need to think about the talk of advance directives the same way. A necessary discussion that hopefully is not needed, but just in case..........They are not foolproof and there will still be conflict and disagreement at times, but it is still better to have something than nothing. The truth is it is impossible to account for every possible situation.

Are you aware of the Five Wishes?

2. Death With Dignity/Aid in Dying

We would remiss if we did not discuss the recent case of Brittany Maynard, the 29 year old with terminal glioblastoma (brain cancer) who moved to Oregon before dying to be able to use the law to end her life to benefit her own wishes about choosing to die rather than dying painfully in front of her family. She died earlier this week on her own terms.

What are you thoughts about this case? How can we learn from and use this information as health care leaders? What do you think about language choice? People will vote for the option to have "aid in dying" or "death with dignity", but don't like "euthanasia", "suicide" or "mercy killing". Does language matter? Why or why not? Even the one making the choice may not appreciate the different nuances of language. They may not want to be perceived as having committed suicide.

3. Hospice as an Ethical issue

Can you explain and support with a reference as to why hospice care is controversial and considered an ethical issue?

4. Patient Rights

a) Patient bill of rights
(1) Respect and dignity
(2) Confidentiality
(3) Refuse treatment
(4) Disclosure of financial and other incentives
(5) Information for decision making
(6) Communication

b) Informed consent
(1) Scope of consent
(2) Duty to disclose
(3) Special issues - Minors or emergencies

c) Emergency care (EMTALA)
(1) EMTALA duty to screen and stabilize
(2) Community call plans (CCP)
(3) Emergency room overcrowding
(4) Disaster and surge planning

We all know patients have rights (many are listed above), but what about the importance of their responsibilities to their health care team? Can you explain one or two? How do rights and responsibilities relate to principles of quality in health care?

5. What are the ways health care prevention, quality, and reporting have changed under health care reform/Affordable Care Act (ACA)?