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West Virginia’s Voluntary Nonopioid Advance Directive: Ethical and Practical Concerns

Rivera, Kevin (2019) West Virginia’s Voluntary Nonopioid Advance Directive: Ethical and Practical Concerns. Master's Thesis, University of Pittsburgh. (Unpublished)

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The West Virginia voluntary nonopioid advance directive (VNOAD) is a document indicating a person’s advance refusal of any discussion, offer, or administration of opioids by a healthcare provider. This thesis argues that, despite the worthy legislative intent behind its implementation in West Virginia—namely, to address the opioid epidemic by reducing the prescribing of opioids—the VNOAD not only fails to address the epidemic and its underlying etiology, but also presents multiple ethical and practical concerns. Because it neither requires discussion with a clinician, nor even the involvement and consent of the person to whom it applies, the VNOAD is contrary to the requirements and ethical values of informed consent. Because the VNOAD, once executed, prevents clinicians from discussing opioids with the patient, it undermines ideals of transparent clinician-patient communication and can prevent patients from receiving standard of care and from having their healthcare needs met. For clinicians, a patient’s executed VNOAD can give rise to distress and exposure to legal liability. This thesis discusses these ethical and practical concerns.
The introduction recounts the origin of the VNOAD in West Virginia and presents the structure of the thesis. The second section analyzes the VNOAD in comparison to traditional advance directives and physicians’ orders regarding life sustaining treatment, as well as the notion of a Ulysses contract. The third section presents the ethical and practical problems presented by the VNOAD as it has been designed and implemented in West Virginia, though the problems likely afflict most NOADs. These problems include undermining physician-patient communication and informed consent, not respecting patient autonomy, not serving the health interests of patients, and risking distress on the part of patients, their family members, and clinicians. The fourth section suggests what might be done to address some of these problems.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Rivera, KevinKAR229@pitt.eduKAR229
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairParker,
Committee MemberSatkoske,
Committee MemberKappel,
Date: 26 September 2019
Date Type: Publication
Defense Date: 15 July 2019
Approval Date: 26 September 2019
Submission Date: 31 July 2019
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 61
Institution: University of Pittsburgh
Schools and Programs: Dietrich School of Arts and Sciences > Bioethics
Degree: MA - Master of Arts
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Policy, Bioethics, Ethics, Commentary, West Virginia, Opioids, Opioid Epidemic, Voluntary Nonopioid Advance Directive
Date Deposited: 26 Sep 2019 12:43
Last Modified: 26 Sep 2019 12:43


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