DIPLOMA OF NURSING: Advanced Care Planning and Directives Essay

This argumentative essay explores the implementation and significance of Advanced Care Planning (ACP) and Advanced Care Directives (ACD) within the healthcare system, particularly in Victoria, Australia. The essay begins by introducing the concept of ACP/ACD and its role in palliative care, emphasizing its potential to improve patient care and respect patient autonomy. It then delves into the relevant legal frameworks governing ACP/ACD in Victoria, alongside a discussion of the ethical principles at play, including patient autonomy and beneficence. The core of the essay centers on an ethical dilemma arising from ACP/ACD, specifically the potential conflict between patient autonomy and the duty of beneficence. The discussion incorporates research from various clinical papers to support the arguments, addressing both the advantages and the challenges associated with ACP/ACD, such as potential loopholes in the system and issues related to health literacy. The essay concludes by advocating for the continued use of ACP/ACD, emphasizing the importance of addressing the identified ethical issues through improved communication, planning, and health literacy to ensure better healthcare facilities for people.

Argumentative essay
DIPLOMA OF NURSING
1

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
2

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
3

Argumentative essay
and pressure from family members, lack of information, emotional distress
from family etc. (Sinclair et al., 2014). In such situations, professionals get
confused between their duty of care and rules provided by advance care
planning that professionals are bound to follow as per legislative laws.
According to Luckett et al. (2015) study, the implantation of the ACP system is
sometimes imperfect that leads to such an ethical dilemma. Consistent and
constant communication between patients and physicians can help to resolve
this dilemma.
According to Carter, Detering, Silvester & Sutton (2016) studies, there
are various loopholes in the system of advance care planning that can lead to
challenging situations while practically implementing these ACP/ACD. One
such loophole are the wording used in ACD that sometimes don’t reflect the
proper viewpoint of the patient, an ACD is made in some rush or having only
‘tick box’ format or patient views get changed at the time of treatment with no
options to update ACD. However, this is a minor issue that can be resolved
with proper planning while forming ACD involving facilitated conversation by
professionals to help the patient understand their role in ACD formation. This
shall help to protect the patient autonomy as well as beneficence in advance
care planning formation.
Lovell & Yates (2014) studied certain misunderstanding and ill-
informed choices/decision in advance care planning that leads to ethical
dilemma affecting beneficence, further, as some point leading to malpractice
by professionals harming ethical principle of non-maleficence. These
misunderstanding and ill-informed decision occur due to misunderstanding the
purpose of ACD, lack of health literacy among patient and their family, people
perception while making ACD decisions that cannot be taken or refused in
future. This can lead to some situations where professionals find themselves
trapped in the ethical predicament. Therefore, proper processing of advance
care planning, good patient-professional communication, reviewing the ACD
and proper health literacy can together work to develop effective advance
care planning and overcome the ethical dilemmas leading to possible risks.
4

Argumentative essay
Conclusion
Irrespective of the discussed ethical issues and problems the
advantages of advance care planning and directive are remarkable enough to
allow betterment in healthcare treatment processes. The issues of patient risk,
lacking health literacy, improper planning and complications of advance care
planning/directive can be overruled with explained possible solutions in this
discussion to overcome the generating ethical dilemmas. But, it is clear and
true that ACPs/ACDs are meant to respect patient choices and deliver better
healthcare facilities within an ethical and legal framework.
5

Argumentative essay
References
Books
Moyle, W., Parker, D., & Bramble, M. (2014). Care of older adults: A
strengths-based approach. Cambridge UK: Cambridge University Press.
Thomas, K., Lobo, B., & Detering, K. (2017). Advance care planning in end of
life care. Oxford UK: Oxford University Press.
Journals
Carter, R. Z., Detering, K. M., Silvester, W., & Sutton, E. (2016). Advance
care planning in Australia: what does the law say?. Australian Health
Review, 40(4), 405-414.
Delaney, L. J. (2018). Patient-centred care as an approach to improving
health care in Australia. Collegian, 25(1), 119-123.
Lovell, A., & Yates, P. (2014). Advance care planning in palliative care: a
systematic literature review of the contextual factors influencing its uptake
2008–2012. Palliative Medicine, 28(8), 1026-1035.
Luckett, T., Bhattarai, P., Phillips, J., Agar, M., Currow, D., Krastev, Y., &
Davidson, P. M. (2015). Advance care planning in 21st century Australia: a
systematic review and appraisal of online advance care directive templates
against national framework criteria. Australian Health Review, 39(5), 552-
560.
Lund, S., Richardson, A., & May, C. (2015). Barriers to advance care planning
at the end of life: an explanatory systematic review of implementation
studies. Plos One, 10(2), e0116629.
Sinclair, C., Williams, G., Knight, A., & Auret, K. (2014). A public health
approach to promoting advance care planning to Aboriginal people in
regional communities. Australian Journal of Rural Health, 22(1), 23-28.
White, B., Tilse, C., Wilson, J., Rosenman, L., Strub, T., Feeney, R., &
Silvester, W. (2014). Prevalence and predictors of advance directives in A
Australia. Internal Medicine Journal, 44(10), 975-980.
6