Morality Of Advanced Directives Essay Research Paper

Morality Of Advanced Directives Essay, Research Paper

Abstract

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 the aim intended.

There is evidence to indicate that advance directives alone

fall far short of their objective. In a recent study conducted at

Harvard Medical School, Fishback (1996) reported 66% of all physicians

interviewed felt there was nothing wrong with overriding a patient.s

advance directive, even if the directive unambiguously stated the

conditions for the withdraw and withholding of medical treatment.

Fishback also reported 40% of the physicians questioned chose a level

of care different from that requested in advance by patients who

subsequently became incompetent. The physicians interviewed indicated

that they would only follow a patient.s advance directive if it was

consistent with their own clinical judgment. The physicians indicated

that they wanted to reserve the right to make clinical judgments about

treatment regardless of a patient.s request. In another study, Docker

(1995) reported on a study where 900 patients were studied over a

period of ten years. In very few cases did advance directives have

any influence over decisions to withdraw or withhold life prolonging

treatment. The passage of the PSDA half way through the study changed

their effectiveness by barely one percent. A study conducted in the

state of Utah, among 1398 participants, found little evidence that

advance directives affect life sustaining treatments (Jacobson,

Kasworm, Baltin, Francis, Green, 1996). Jaffe and Ehrlich (1997)

report .unfortunately, the advance directive movement has not had

great success . . . breakdowns occur with alarming frequency in the

chain of responsibility to observe them. (p. 145). When patients were

transferred from ambulatory to acute care settings, only 26 percent of

the patients wh

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