Archive for November 2011
Most observers trace the modern euthanasia debate back to the court case of Karen Ann Quinlan, and her story is a poignant example of medical technology’s ability to prolong life. In 1975, after consuming alcohol and tranquilizers at a party, Quinlan collapsed into an irreversible coma. This coma left her unable to breathe without a respirator. She also needed a feeding tube to be able to eat. Her parents asked that she be removed from the respirator, but her doctors objected. The New Jersey Supreme court case that followed was the first to bring the issue of euthanasia into the public eye. In 1976 the court allowed Quinlan’s parents to have the respirator removed. Although Quinlan lived for another nine years with the help of the feeding tube, the case set a precedent for a patient’s right to refuse unwanted medical treatment.
In 1990, that right was further expanded in the case of Nancy Cruzan. Cruzan had gone into a irreversible coma in 1983 after a sever car crash, and her parents wanted the machine that was keeping her alive removed. However, in this case the machine consisted of intravenous feeding tubes that provided Cruzan with hydration and nutrition. Her parents viewed the removal of the machine as the termination of unwanted treatment. However, the state of Missouri argued that to remove the tubes would be intentionally killing Cruzan through starvation. In a controversial vote, the U.S. Supreme court ruled that the provision of artificially delivered food and water is a treatment which patients may legally refuse, even if doing so would result in death.
As noted, profits are not the sole reason that health care organizations exist. Sometimes profits are just a means to an end, and not an end in itself at all. Health care organizations should always make decisions that keep their underlying mission in mind. I hope to provide many techniques throughout my blogs to help you make the best decisions, other things being equal. While studying how to become an accountant in the health industry, it became apparent that even allied health individuals as well as organizations, need accounting as well.
How can you make the best decisions financially, other things being equal? If two projects yield the same health benefit, the one with the greater profits at a lower risk is the logical best choice. However, what if the health care benefits are not the same? In this case, managers need to factor that into the decision. Sometimes you may decide that you are willing to take a lesser profit or take a higher risk in hopes of achieving a better health outcome.
Healthcare organizations have no desire to go bankrupt, so it is no surprise that one of the crucial goals of financial management is ensuring financial viability. The goal is often measured in liquidity and solvency.
Liquidity – liquidity is the measure of the amount of resources an organization has that are cash or easily converted to cash in the near term to meet the obligations of the organization. Accountants use near term and short term and current interchangeably. Generally the near term means within 1 year or less. Thus, an organization is liquid if it has enough near term resources to meet its near-term obligations.
Solvency – solvency is the same concept but from a long term perspective where long term means more then one year. Will the organization have enough cash generation potential over the next 3,5, and 10 years to meet the major cash needs that will occur over those periods? An organization must plan for adequate solvency well in advance because the potentially large amounts of cash involved may take a longer period to generate.
For many years people were not allowed to make decisions about death with dignity. Today new laws allow individuals to have a say in how they want to live their last day. Each state has adopted natural death guidelines and declarations that give direction to people about how to legally tell others their desire concerning end of life issues. These documents ensure the individual the right to accept or refuse medical care. In the United States every person is encouraged to prepare this document called an advanced directive. Advanced directives help ensure the right to accept or refuse medical care. Each state has a slightly different laws that govern the interpretation of these documents. The advance directive is a written form providing a way for people to to express how they want medical decisions made if they are unable to make decisions for themselves. Three common forms of advance directives are a living will, a health care power of attorney, and a durable power of attorney for health care.
Living Will - The living will provides a way for a person to express her or his desire for or against extraordinary measures that could prolong life. A living will takes effect while a person is still alive. Legal assistance may be necessary to ensure that it is interpreted in the way it was intended.
Health Care Power of Attorney - A health care power of attorney allows an authorized person to make health care decisions for an individual if he or she is unable to do so. The HCPOA is more flexible than a living will and can cover any health care decisions. A HCPOA can apply in cases of temporary unconsciousness or in case of diseases like Alzheimer’s that affect decision making.
Durable Power of Attorney for Health Care – In many states, a durable power of attorney for health care is a signed, dated, and witnessed paper naming an authorized person to made medical decisions for the individual if he or she is unable to make them. This document also includes instructions about treatments to avoid.
It is important to remember that even with a written charge, a patient’s wishes stated directly to to the doctor generally carry more weight than a living will, health care power of attorney, or durable power of attorney, as long as the patient can decide and communicate his or her wishes.
