Directive Implementation In Multidisciplinary Patient

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

1NURSING
The case study is about Peter Smith, an 82 year old man who has been diagnosed with
early onset dementia. Since the death of his wife Betty, he has moved to Sunny Hill Aged Care.
Recently, he has completed an Advanced Health Directive (AHD) 18 months ago and he has
stated in his AHD that he does want active treatment if brought to the hospital. The case present
several legal and ethical issues in decision making about Peter’s treatment because he has been
brought into emergency department with confusion, agitation and aggression. Mary is aware
about his father AHD, but he is very upset with his state of confusion and aggression. The
decision making for Peter will be difficult because of conflict between legal requirement of AHD
and violation of patient consent if Mary goes against her father’s AHD.
The key legal requirement in decision making for Peter is to comply by the procedure of
AHD and fulfil patients living will regarding future care to be provided to him. Advanced care
planning legislation exists for all states and territories of Australia. According to the legal
procedure for obtained AHD, it is necessary to discuss about AHD with physician and family
members. All involved members should have the copy of the directive too (Government of
Western Australia, 2019). Peter followed similar procedure as he discussed about this with
daughter and Mary, his lawyer doctor and nursing home had the copy of AHD. However, the
dilemma in the scenario is whether the AHD can be changed or ignored now following
deteriorating of patient condition. The legislations related to AHD in Australia include the
Medical Treatment Planning and Decisions Act 2016, which recognizes AHD as a legal
document (publicadvocate.vic.gov.au 2018). However, Mary cannot go against AHD despite
being the power of attorney because under the common law, the condition of advanced care
directive must be respected. Hence, Mary is at risk of legal actions if Peter’s AHD is not
respected.

2NURSING
However, the case scenario presents several ethical conflicts too. For example, the issue
is related to conflict between informed consent and ethical code of beneficence. For Mary,
withholding active treatment is important as per Peter’s AHD. This is relevant with the ethical
principle of informed consent and autonomy which supports respecting patient’s wishes and
preferences related to care plan and treatment and providing full autonomy to patient during
decision making. AHD is an important way to safeguard the autonomy of incompetent medical
patient (Judkins-Cohn et al. 2013). However, the moral authority of such patient autonomy is
questioned when a patient suffers from acute deterioration of health and family member’s fail to
endure sufferings for their loved ones. Similar ethical conflict is seen in the scenario too as Mary
saw her father is aggressive towards the staffs and he is trying to take off his clothes. Currently,
his condition is uncontrollable unless active treatment is initiated. If he is left like this, it may
harm him as well as other staffs in the ward. In addition, it will increase stress for family
members too. Evidence by Johnson et al. (2018) shows that although health care professionals
are in favour of respecting patient autonomy. However, respecting the same in real clinical
situations become very difficult.
The professional responsibility of a nurse in such situation according to the ethical code
of conduct is to consult patient’s family members regarding the best decision and inform them
about real situation related to pros and cons of going ahead with each treatment options (NMBA,
2018)). I would explain Mary that going ahead with AHD can be detrimental for Peter and it may
lead to disrespect of patient too as he will be left on his own. Explaining the risk and benefits of
treatment is important for me according to the ethical code of conduct for nurses in Australia
which states the need to recognize the rights of people to engage in shared decision making and
value the contribution of family members in case of patients whose decision making is restricted