Morality of Advanced Directives
Morality of Advanced DirectivesAbstract
This paper presents an in-depth discussion about the issues
involved in honoring a patient�s advance directive. Ethical
considerations surrounding the issue as they relate to the nursing
profession are addressed. The purpose of the paper is to express
an informed position on the issue of honoring a patient�s advance
directive and explore reasons why one may not be honored. The topic
was chosen on account of personal observation and awareness in an
acute care setting. The sources used to develop this paper are
published nursing journals, current books related to this issue, and
the Internet. The paper concludes with recommendations to assist the
professional nurse in dealing with issues related to honoring a
patient�s advance directive.
Will Your Advance Directive be Honored?
Advances in medical technology have done a great deal to
produce miraculous cures and recoveries. In some circumstances
however, these advances have created problems for the elderly. More
aggressive technology approaches are used to extend the life of the
elderly. On the whole the elderly, as well as others, welcome that
development -- even if they fear some of its consequences. With these
advances it has become possible to keep people in a vegetative state
for almost unlimited periods of time. Moreover, there are situations
in which neither the patient nor the family has the ability to bring
such unhappy circumstances to an end. For this reason, advance
directives are becoming increasingly prevalent. In a recent study,
King (1996) reported that approximately 90% of the American public
want advance directives. Both the young and the healthy express at
least as much interest in planning as those older than 65 and those in
fair to poor health (p. 77). According to Lynne (1986) nurses play a
significant role because they attend to the patient continuously and
have an especially strong claim to be allowed the opportunity to be
comfortable with the care plan (p. 216).
Advance directives, also known as living wills, are documents
that a person can complete to ensure that health care choices are
respected. An advance directive only comes into play if a person
cannot communicate wishes because the person is permanently
unconscious or mentally incapacitated. A 1991 law called The Patient
Self Determination Act (PSDA) requires hospitals and nursing homes to
tell patients about their right to refuse medical treatment. People
can put anything in their advance directives. Some people list every
medical intervention they do not want, while others want to make clear
their request for heroic measures at any cost. It is a way to spell
out personal wishes. It is crucial that the issue of advance
directives and the issue of euthanasia not be confused. These issues
couldn�t be more dissimilar. Euthanasia is largely illegal. Advance
directives are seen as a way to protect one�s legal rights for
refusal of treatment. But are advance directives effective in
achieving...
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