Application and Controversies of Advance Care Directives in Cancer - Term Paper Example

Application and Controversies of Advance Care Directives in Cancer/End of Life Care Student’s Name Institution Application and Controversies of Advance Care Directives in Cancer Introduction An advance care directive is an important document, not only to terminally-ill patients, but also to their families, friends and caregivers. In most cases, it is difficult to identify what the wishes of a dying person are unless the issues were discussed and written down beforehand (Miller, 2009, p. 150). For that reason, an advance care directive supports patients’ autonomy, promotes conversation between them and their medical care providers, families and friends, and eases the burden they place on caregivers and families (Ditto & Hawkins, 2005, p. 63). Although an advance care directive seems to be an important document to terminally-ill patients, their caregivers, families and friends, its application is affected by a number of factors, especially the legal issues. The major laws that affect the application of the ACD include the Common Law, Medical Treatment Act 1988, and judge-made laws. For example, the Common Law gives the patients the liberty to accept or refuse treatment; consequently, ACD can only apply if a patient consents to its application (Cordner, Thomson, & Plueckhahn, 2010, p. 335). The purpose of this paper is to discuss the applications and controversies surrounding the use of ACD in end of life care. Firstly, the paper outlines the application of ACD in terminal diseases, such as cancer. Secondly, the paper explains the legislation underpinning advance care plans (ACPs). Thirdly, the paper outlines the organisations and factors that affect the application of ACPs in clinics. Lastly, the paper analyses the effects of the controversies that surround the application of ACPs on patients with terminal illnesses, their caregivers and families. Application of Advance Care Directive An advance care directive is a document that contains one’s instructions about his medical care should he become incapacitated and unable to make sound decisions in the future. The document only works according to the instructions contained in it. ACD is mostly used to do the following: appoint a health care provider or agent and prepare instructions regarding one’s health care. These are the major reasons that ACDs are mainly used for (Nay & Garratt, 2009). ACDs allow patients with terminal diseases, such as cancer, to prepare specific written instructions that may be used to make crucial decisions regarding their health care when they become incapable of making such choices. In this case, ACD is referred to as a “Living Will,” which illustrates the wishes of the patients regarding life-prolonging medical measures that can be used on these patients when they become permanently unconscious (Nay & Garratt, 2009). ACDs may also be used by patients, who are terminally ill, to instruct their health care providers to allow them to withdraw from treatment when they become permanently incapacitated or unconscious (Brown, Murtagh, & Murphy, 2012). ACDs can also be used by patients with cancer or any other terminal diseases to appoint a health care agent of their choice to oversee the decision-making process regarding their health should they become unable to make such choices. The agent, who is also referred to as “Durable Power of Attorney for Health Care”, has the legal mandate to decide on issues relating to the health care of his/her client when he/she loses the capacity to talk for himself/herself (White, 2006). An agent, in this case, can be a spouse, a member of the family, or a friend. An agent can make decisions concerning artificial hydration and nutrition and other medical strategies, such as dialysis, which can prolong the lives of their clients (Swota, 2009). ACDs are not complicated documents; they only require a person to outline what he would wish his family and care providers to do or not to do for him when he is unable to do that on his own. When preparing an ACD, it advisable that the person seeks the opinion of his family members and legal professionals to ensure that the document reflects his wishes. Most states in Australia make ACDs an easier job by availing fully designed forms, which only require patients to fill in a few details regarding their health care wishes (Johnstone, 2009). Legislation Underpinning ACPs The major legislations that affect advance care planning (ACPs) are mostly developed by the Australian Parliament and through court decisions. Courts in Australia spell out bodily integrity as the fundamental doctrine that should direct advance care planning. The courts, under the bodily integrity, assert that touching a person’s body without their consent is tantamount to a battering (Atkinson, 2007, p. 59). Apart from the rule of bodily integrity, the courts also reaffirm the common law, which protects the right of a competent adult to make decisions concerning their medical treatment. The common law, which is a legislation of the national assembly, provides patients who are terminally ill, with the right to or not to consent to medical treatment and care that would prolong their lives. As a result, the common law prohibits any person to force a patient to undergo any kind of medical treatment against his/her wishes (Atkins, Britton, & Lacey, 2011, p. 117). It is argued that the common law does not provide clear directions to guide the practices of health professionals with regard to ACPs. As a result, each Australian State Government has drafted their own statute laws to provide specific directions on when and how a person can consent to or refuse treatment that would prolong his/her life in case one suffers a terminal disease (Forrester & Griffiths, 2010, p. 166). For instance, the State of Victoria has its own law, the Medical Treatment Act 1988, which contains the instructions that patients, their families and health care providers are required to follow in designing ACDs (Cordner, Thomson, & Plueckhahn, 2010, p. 335). Organisations and Factors Affecting ACP Application in Clinics There are a number of factors that affect the application of ACPs within clinical setups in the country. The first factor includes the culture and attitude of health care professionals who work in the clinics. Cultural practices of some communities in the country bar them from writing decisions concerning their health in advance. The communities, especially the Aboriginal ones, believe that the responsibility to decide how one’s health may be controlled when they are unable to make sound decisions should be left in the hands of their relatives (Joeng, Higgins, & McMillan, 2010). Apart from culture, the attitude of both health practitioners and the society significantly affects the applications of ACPs in most clinics. Most health professionals believe that they should be given the chance to determine the right treatment criteria for their patients, especially in case of terminally ill patients (Salmond & David, 2005). The professionals believe that they are in the best position to make decisions on behalf of their patients and as a result, such choices should not be left in the hands of the patients, who may not know what is really good for them. The professionals argue that it is unethical and inhuman to allow a patient to refuse treatment, which can prolong his life, because of the ACDs (Weller, 2012). The application of ACPs in clinics is also affected by the Organisation of Nurses and Nursing Ethics. The organisation requires nurses and other health care providers to do everything they can to ensure that patients, who are terminally ill, are put on health measures that can prolong their lives. This brings confusion to nurses, especially when patients refuse to consent to the life-prolonging health measures (Goroll & Mulley, 2009). The Nursing Ethics, like the organisation’s requirement, prohibits nurses from following a patient’s directive that they perceive to be inhuman. As a result, these ethics present a dilemma in cases in which patients, in the ACPs, express their intention not to continue with life-prolonging treatment in the future (Koutoukidis, Stainton, & Tabbner, 2013). Effects of ACP Controversies The controversies surrounding the implementation of ACPs within clinical setups have significant effects, including serious psychological impacts, not only on the terminally ill patients, but also their family members and health care providers. The patients become confused and agitated when they feel that their wishes may not be followed when they become permanently unconscious. Patients always want people to respect their health care wishes and to follow them as described in their ACPs (Summers & Krohm, 2001). Apart from the patients, the family members of the patients are also adversely affected by the controversies and legislations that underpin the application of ACPs. The fact that the law allows patients to refuse life-prolonging treatment as one of their wishes is not welcome by many people. Most people want to see their sick relatives live for a long time and as a result, are not at peace with the idea of allowing patients to refuse treatments that are meant to prolong their lives (Staunton & Chiarella, 2013). Health care providers are another group that is adversely affected by the controversies surrounding the application of ACPs within the clinical setups. Most health care professionals, in most cases, find themselves in a dilemma in situations where patients do not want to continue with the life-prolonging treatments (Thomas & Lobo, 2011). The professionals are required to make decisions that reflect the patients’ wishes, law provisions, and nursing ethics. It becomes difficult for these professionals to make appropriate decisions in cases where there is a significant conflict among the major interests (Rogers & Braunack-Mayer, 2009). Conclusion An advance care directive is an important document, not only to terminally-ill patients, but also to their families, friends and caregivers. As a result, an advance care directive supports patient autonomy, promotes conversation between the sick and their medical care providers, families and friends, and relieves the burden such cases bring to caregivers and families. The application of ACPs/ACDs within clinical settings is mostly affected by various legislations, nursing ethics and cultural factors. The legislations that affect ACD applications are the common law and judge-made laws, which grant a patient the right to consent to or refuse treatment that is targeted at prolonging their lives. The cultural factors and nursing ethics affect the way health care providers make decisions concerning their patients, especially the ones who are terminally ill. References Atkinson, J. M. (2007). Advance directives in mental health: theory, practice and ethics. London: Jessica Kingsley Publishers. Atkins, K., Britton, B., & Lacey, S. (2011). Ethics and law for Australia nurses. Cambridge, MA: Cambridge University Press. Brown, E. A., Murtagh, F., & Murphy, E. (2012). Kidney disease: From advanced disease to bereavement. Oxford: Oxford University Press. Cordner, S. M., Thomson, C. J. H., & Plueckhahn, V. D. (2010). 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