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In certain cases, patients may provide written documents that outline various decisions or intended course of actions that he/she would prefer in relation to the treatment. Such documents are referred to as self-determination documents or advance directives. Krohm and Summers define an advance directive as a written document prepared by a patient that puts forward the type and amount of health care services he or she wishes to receive during the diagnosis and treatment processes. Three major types of advance directives that are available for patients include living wills, organ donation and durable power of the attorney.

A living will refers to a document written by an individual before he or she becomes incompetent or unable to make sound healthcare decisions. A living will usually contains the desires of a patient in relation to the types of medical treatment such as artificial nutritional support that one would like to obtain in case of severe illness. A living will is usually used by patients who suffer from terminal illnesses or who want to undergo surgeries.

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An organ donation document is an advance directive that permits persons aged above eighteen years to make a contribution of their body parts or organs for purposes of medical research or organ transplantation. An organ donation document or Uniform Anatomical Gift Act provides that no money should be exchanged for the donated organs or body parts.

On the other hand, a durable power of attorney is an advance directive that bestows power on a third party, usually referred to as the proxy or agent. The third party makes healthcare decisions on behalf of the patient after he/she becomes incompetent due to illness. Sass, Veatch and Kimura (2008) assert that a durable power of attorney becomes enforceable only after the patient becomes incompetent to make sound healthcare decisions.

Appropriateness of Advance Directives

The advance directives are appropriate to use when a patient is suffering from an incurable or untreatable illness and he/she is about to die, or when the patient intends to go for a surgery that might result in unconsciousness. The advance directive outlines the wishes of the patient, thus providing protection to both the patient and the physician.

An advance directive is put in place by providing an assurance to the patient that his wishes will be strictly followed and adhered to by the healthcare providers. The patient also obtains an assurance that the physician will act within the stipulated outlines sketched out in the advance directive by the patient.

Patient's Bill of Rights

A patientís bill of rights refers to a set of guidelines, procedures, principles and laws that govern the relationship between patients, physicians and other healthcare professionals. According to Smith, all healthcare professionals must follow and adhere to the provisions of the patientís bill of rights.

Responsibilities of Physicians and other Healthcare Providers in Reporting a Suspected Abuse

With respect to the patientís bill of rights and reporting of suspected abuse, physicians and healthcare providers are responsible for ensuring that they collect reliable information on the suspected abuse as required by the Child Abuse Prevention and Treatment Act of 1974. Physicians and other healthcare providers must also ensure that they conduct thorough investigations and adequately query the causes of the suspected abuse. Physicians and healthcare providers should also report on the cases of suspected abuse to the relevant authorities such as the police, crime investigation officers and Bureau of Child Welfare.

In cases of substance abuse, physicians and healthcare providers are also responsible for advising the patient on the appropriate courses of action. For example, the physician should advise the patient to seek counseling and rehabilitation services in social support centers. Physicians are also accountable for gathering plausible and convincing evidence about the suspected abuse.† Evidences may include photos of bruises, laboratory reports, presence of body fluids such as sperms in the urine of the victim, and presence of foreign objects such as hair, bullets and blood samples.

The physicians are also responsible for handling the patient in a professional and competent way. Moreover, physicians and healthcare providers should also ensure that they respect the rights of the patient. For example, the physicians should guarantee that they safeguard the confidential information about the patient within the limits of law. Physicians must also provide selfless and respectful care services for the patient. Last but not least, physicians and healthcare providers are also responsible for giving the patient all relevant information that relates to his/her health and safety.

Physicianís Right to Select the Patients to Treat

From my point of view, physicians should not have the right to select the patients they wish to treat because it is their responsibility to help save lives of all people. When physicians are allowed to choose the patient they treat, there appear higher risks of increased discrimination of patients. This would result into the provision of poor healthcare services, thus leading to increased death rates. In my judgment, physicians should consider patients to be their customers. Therefore, no rational trader would discriminate against any customer, neither should a physician† discriminate against patients.

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