Advanced Care Planning and Directives: An Ethical Dilemma

Argumentative essay
DIPLOMA OF NURSING
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Argumentative essay
Introduction
The last century has implemented major modifications in the system of
modern medicine in terms of understanding the disease and delivering better
health care. One such modification is the introduction of Advanced Care
Planning (ACP) to the modern medial system. The ACP holds the tendency to
improve patient care and extend the quality of life. Advanced Care Planning
(ACP) and Directives (ACD) is a patient right that allows them to make plans
about their future healthcare. This practice is widely accepted by many
countries including Australia (Thomas, Lobo & Detering, 2017).
This study involves a discussion supporting the use of ACP/ACD as a
good healthcare practice for better healthcare facilities for people of Victoria in
Australia. The study theme involves an argumentative discussion on
ACP/ACD practice, ethical principles and laws structuring this medical
practice followed by ethical issues related to use of ACP/ACD and their
possible solutions. As per the provided statement, the most commonly
generated ethical dilemma related to the use of ACP/ACD is a conflict
between patient autonomy and beneficence of medical ethics. This ethical
dilemma is discussed in this study to develop a better understanding of
advanced care practice.
Discussion
The Advanced care planning (ACP) and Directives (ACD) concept was
constructed to tackle the decision making choices at the end of life stage
respecting patient’s autonomy, cultural values and personal preferences. ACP
represents a balance between patient autonomy and the end-of-life decision-
making process. The ACPs and ACDs are developed as per the principles of
Code for Ethical Practice within jurisdictional boundaries (Moyle, Parker &
Bramble, 2014). The Advance care planning/directive is a voluntary process
where an individual is allowed to discuss and develop their future healthcare
needs, choices and decision regarding treatment in presence of their lawyer,
family and closed once (Thomas et al., 2017). According to Delaney (2018)
studies the presence of healthcare professionals in ACP/ACD process if the
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Argumentative essay
patient is suffering chronic illness, mental or physical health issue other else a
healthy person can develop their ACD in the absence of healthcare
professional. The advanced care planning involves the formation of future
care plans, advance directive and/or appointment of enduring power of
attorney in the presence of a lawyer, the family, closed once and healthcare
professional.
As per the provided statement, advance care planning is a process
developed to help people in budding better dealing related to health issues.
As a supporting study to this statement, White et al. (2014) indicated that
ACP/ACD serves a purpose to maximise or enhance the effect of patient
autonomy where the patient is free to manage every situation that can be
impossible to manage in future. But, on contrary, Lund, Richardson & May
(2015) stated that ACD/ACP is often vulnerable in future situations where
family members, surrogates and physician get involved or manipulated in
these serious matters to make difficult decisions. The family members and the
patient does not hold enough knowledge (health literacy) to decide in difficult
situations whereas professionals are not allowed to make such a decision for
their patient in the presence of advance care planning and directives. Further,
Lovell & Yates (2014) stated that difficult decision-making in advance care-
planning process can be solved with patient-physician interactions and
communications following professional guidelines. As per the code of ethics,
the professional can guide and perform clear communication with the patient
and/or their family members to develop a workable decision in such situations.
The most controversial ethical dilemma developed by the occurrence of
advanced care planning/directive is a clash between the healthcare ethical
principles of patient autonomy and beneficence (Sinclair, Williams, Knight &
Auret, 2014). As per the provided statement, the ACP served the purpose of
respecting patient choices and freedom where the patient can make their own
decision under ethical guidance. But, in some critical situations especially
end-of-life situations, professionals get trapped between their duties to
provide the best care (beneficence) or respecting ACP guidelines (Lund et al.,
2015). This occurs especially in emergencies where any kind of loophole in
advance care planning or directive leads to this ethical dilemma. For example-
surrogate decision-maker is missing or not reachable, unreasonable demands
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