Advanced Directives
Advance directives include statements that simply inform a patient’s doctor and relatives exactly the sort of medical treatment they prefer or do not want should they become terminally ill and therefore unable to express themselves. Nurses throughout all specializations play a crucial role in fostering patient autonomy and also in the execution of advance directives, providing optimum care to patients, regardless of age and health status. They advocate for the promotion of advance directives by assisting patients in making well-informed decisions before a problem or deterioration of their health.
The Federal Patient Self-Determination Act of 1990 provides for the rights regulating health services, particularly the ability of healthcare consumers to choose how they want to be handled by healthcare professionals whenever they are incapable of expressing themselves (Munden, 2017). For example, in Texas, every resident over the age of 18 has the right to determine their personal healthcare choices, such as approving, terminating, or declining a treatment plan. Consumers express their written options and preferences in advance directive documents or through assigning a representative like a health care agent who would communicate on their behalf. The legislation mandates that hospitals and other healthcare providers keep documented policies and procedures regarding advance directives.
Providing informed consent regarding advanced directives is a challenging process. Some individuals and families may express dissatisfaction with healthcare professionals’ inability to provide comprehensive information regarding treatments or medical diagnoses. Often, patients seem comfortable requesting nurses to interpret a doctor’s prognosis, which creates an ethical dilemma regarding how much data such nurses can provide (Rainer et al., 2018). Sometimes, nurses may be unwilling to disclose the details for several reasons, including the sensitivity of the illness. Another ethical issue concerns the option between revealing the facts to patients versus lying to them, such as when families prefer that patients not be informed of their health condition or diagnosis. The patient has the right to hear the facts. However, nurses must choose between respecting the wishes of the families or informing their patients. The obligation to be faithful to patients and respect and observe the ethical norms of Nonmaleficence requires them to disclose the information.
References
Munden, L. M. (2017). The covert administration of medications: legal and ethical complexities for health care professionals. Journal of Law, Medicine & Ethics, 45(2), 182-192.
Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19-20), 3446-3461.
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Advanced Directives
What is a provider’s obligation to address advance directives? How does state and federal legislation affect this? What ethical or spiritual dilemmas might a provider encounter in these discussions with the patients and families? Support your answer with two or three peer-reviewed resources.
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