HLT54115 Diploma Of Nursing

As our population ages, we have more of society living longer with chronic disease & disability. Many of us have an idea of how we would like to be medically managed as we age & at the end of our life, but many of us do not have these conversations with those around us.

 

Victorian has recently formalised the Law relating to Advanced Care Planning & Advanced Care Directives in order to address some of these issues.  Respecting choices & ethical considerations are fundamental components of these discussion. 

Introduction

Aging is a normal process among human beings, no human being can escape aging. Aging comes with many psychological, physiological and emotional changes. These aspects necessitate that a proper plan is established so that the health of the individual is maintained during the aging process. Advanced care planning is a concept that illuminates planning for care in readiness for instances when a person cannot make health-related decisions in person -considering that aging comes with cognitive impairments and physical impairments that may hamper decision making and communication during old age (Bristowe, K., Horsley, H. L., Shepherd, K., Brown, H., Carey, I., Matthews, B., … & Murtagh, F. E, 2015).. Advanced care planning also represents deliberation and communication between the individual in question, her or his loved ones, substitute decision-makers and providers of health care services about the individual’s health.

Notwithstanding, advanced care planning creates an ethical dilemma. An ethical dilemma is created in cases where the patient’s autonomy has to be ignored to save the patient’s life or followed leading to the loss of life of the patient (Yu, J., Brown, D., Kodner, I. J., & Ray, S., 2015). Victoria has implemented and formalized laws regarding advanced care planning, raising the question “Is it the best thing to do?”

This paper will delve to prove why it may not be practical or right to formalize the laws that pertain to advanced care planning and follow the advanced care directives strictly due to the intense ethical dilemma developed, in addition to the associated risks to the patients in question. The paper will also show the preparation of an advanced care directive and the reason why I agree with the laws implemented by Victoria over the development of an advanced care directive. It will also highlight the research that has been performed regarding the significance of an advanced care directive. In addition, the definitions and clear meanings of advanced care planning and advanced care directives will be sufficiently dealt with in detail.

Body

The entirety of the process of development of an advanced care directive is governed by ethical principles and rules. These ethical principles include autonomy; beneficence; justice; veracity and fidelity (Byrd, G. D., & Winkelstein, P., 2014). Autonomy illuminates the right of the client to make his or her reasonable choices without interruption. Beneficence means that only good should be promoted to the client and harm should be avoided at all instances, this means no one should use an advanced care directive as a means to harm or threaten the client in any way whatsoever.

Justice should also prevail throughout the process of communication with the client and development of the advanced care directive (Braveman, P. A., Kumanyika, S., Fielding, J., LaVeist, T., Borrell, L. N., Manderscheid, R., & Troutman, A, 2011). The advanced care directive should be developed in a ground that supports fair treatment of the individual. Resources for the care of the elderly client should also be fairly distributed. There should be equal treatment of individuals regardless of their status or position in the healthcare facilities.  Veracity should also be followed to the latter. Veracity simply means that one should be truthful and not lie to another person in any instance. It is necessary that the client(s) are neither coerced to write a will or any other type of advanced care directive without receiving all the necessary information (Levi, B. H., Heverley, S. R., & Green, M. J. , 2011). Despite the development and presence of all the principles that govern advanced care planning, the existence of ethical dilemmas cannot be ignored. An ethical dilemma is bound to occur in cases where the ethical principles clash in one way or another. Ethical dilemmas lead to a situation where there is no right or wrong option. For instance, when a client has a DNR (Do Not Resuscitate) in the advanced care directives and yet they urgently need resuscitation to save their lives, an ethical dilemma is bound to develop (Karnik, S., & Kanekar, A., 2016).

Considering the recent surge in the size of the population, the ACP/ACD aid significantly in controlling the number of aged individuals who are admitted into nursing homes. The use of health care directives aids in improving the quality of lives of the older individuals. A large proportion of individuals in their end of life periods require many health decisions which are difficult to make without their consent or the presence of a significant other. However, a large number of these individuals lack the capacity and ability to make decisions on their own. Advanced care directives help simplifying the decision-making process and thus the health of the clients (Adams, J. A., Bailey, D. E., Anderson, R. A., & Docherty, S. L. , 2011). The process of development of an advanced care directive begins with appropriate communication with the client and significant others. Advanced care planning is necessary before the actual decisions are implemented in advanced care directive. The client has to be properly briefed on the importance of developing such a directive. The wishes of the client or individual in question are recorded in an advanced care directive- which is a document that can be used as a point of reference. Advanced care planning provides an avenue which helps doctors and loved ones to agree with the wishes of the individual in question. Victoria legislation supports that advanced care planning and advanced care directives are followed. It is a criminal offense to go against these directives in Victoria (Adams, J. A., Bailey, D. E., Anderson, R. A., & Docherty, S. L. , 2011).

I strongly support the rules that have been put in place by Victoria since their benefits outweigh their disadvantages. It will be easier to support patient care over their period in health facilities and also to improve the standard of living of the individual’s lefts behind. The fact that the dignity of the old aged individual is not stripped from them is also important –individuals are able to express their right of self-will even during their old age.

Conclusion

The ethical principles will be followed with more precision by employing advanced care planning and following the advanced care directives to the latter. The directives are significant as they improve the quality of life and ease the transitioning of the individual and family through the stages of death. It is highly relevant that they are followed to the latter.  

References

Adams, J. A., Bailey, D. E., Anderson, R. A., & Docherty, S. L. . (2011). Nursing roles and strategies in end-of-life decision making in acute care: a systematic review of the literature. . Nursing research and practice.

Braveman, P. A., Kumanyika, S., Fielding, J., LaVeist, T., Borrell, L. N., Manderscheid, R., & Troutman, A. (2011). Health disparities and health equity: the issue is justice. American journal of public health, 101(S1), S149-S155.

Bristowe, K., Horsley, H. L., Shepherd, K., Brown, H., Carey, I., Matthews, B., … & Murtagh, F. E. (2015). Thinking ahead–the need for early advance care planning for people on haemodialysis: a qualitative interview study. Palliative medicine, 29(5), 443-450.

Byrd, G. D., & Winkelstein, P. (2014). .A comparative analysis of moral principles and behavioral norms in eight ethical codes relevant to health sciences librarianship, medical informatics, and the health professions. Journal of the Medical Library Association: JMLA, 102(4), 247.

Karnik, S., & Kanekar, A. (2016, May). Ethical issues surrounding end-of-life care: a narrative review. In Healthcare(Vol. 4, No. 2, p. 24). Multidisciplinary Digital Publishing Institute.

Levi, B. H., Heverley, S. R., & Green, M. J. . (2011). Accuracy of a decision aid for advance care planning: simulated end-of-life decision making . The Journal of clinical ethics, 22(3), 223.

Yu, J., Brown, D., Kodner, I. J., & Ray, S. (2015). ). Looking beyond the crystal ball: An ethical dilemma in advance directive implementation in multidisciplinary patient care. Surgery, 158(5), 1389.