M2006 Nursing

Question: Discuss about the Medical Treatment Planning and Decisions. Answer: Introduction: Ethical dilemma in a clinical setting is a moral dilemma wherein a person has to select between two situations neither of which might resolve the situation in a manner that is ethically acceptable. Advanced Care Planning (ACP) and Directive (ACD) has been an ethical issue widely discussed in the literature (Brinkman-Stoppelenburg, Rietjens and van der Heide 2014). The present essay discusses the significance to Advanced Care Planning and Directive. The paper speaks for the use of ACD in Australia. The professional obligation to respect the autonomy of a patient gives patients the right to refuse or accept treatment. Advance care planning through verbal and written health care directives is the process of documenting the values, beliefs and preferences of the patient about the treatment. End of life discussion held between a patient and a physician is to be documented in a record. Evidence of preferences of patients can be obtained in a legitimate manner when the conversation is between the two parties in the presence of a family member (McLennan et al. 2015). As highlighted by Swetz et al. (2014) ACP has the purpose of safeguarding the autonomy of the patient when he is not in a position to take decisions regarding own healthcare. However, families are found not to agree at times with the patient’s preferences, and this is more prominent when a critical decision is being taken. The prime reasons for such action are the alternative option of palliative care (Heyland et al. 2013). At times of disagreement between patient and family members, there are additional complications in the decision making process. Therefore ethical dilemma lies in the fact that though healthcare providers would be in the favour of respecting the autonomy of the patient, there would be uncertainty regarding the right actions to be taken (Abney et al. 2014). The Victoria government has passed the Medical Treatment Planning and Decisions Bill in 2016 that enshrines advance care directives in law. The Act sets distinct obligations for health practitioners providing care to patients who do not have the capacity to engage in the process of decision making. It ensures that medical decision making is consistent the perception of people regarding decisions about medical treatment and personal autonomy and is aligned with modern views (health.vic.gov.au 2016). The standpoint that is taken is that ACP and ACD would be helpful and must be encouraged for patients. Nevertheless, good communication is needed for suitable and harmless delivery of ACP. Since there is alway a scope for obtaining written directives from families and surrogates, compliance with the emotional wishes would not be a problem. ACP can improve communication, enhance relationships, and promote team functioning when a patient is being cared for. In conclusion, it is to be stated that ACP and ACD would provide benefits for the patient in the future. An instructional and value care directive would ensure that the values and views of the patient’s ae taken into consideration while delivering care to patients, especially for end-of-life care. A health care professional would be able to be a true decision maker in what the best treatment options for the patient are. Reference Abney, L., Burks, A., Pitman, W., Taylor, J., Obert, L. and Kern, N., 2014. Effective communication regarding advanced care planning and end-of-life care options. Women’s Health Care, 2. Brinkman-Stoppelenburg, A., Rietjens, J.A. and van der Heide, A., 2014. The effects of advance care planning on end-of-life care: a systematic review. Palliative medicine, 28(8), pp.1000-1025. Heyland, D.K., Barwich, D., Pichora, D., Dodek, P., Lamontagne, F., You, J.J., Tayler, C., Porterfield, P., Sinuff, T., Simon, J. and ACCEPT (Advance Care Planning Evaluation in Elderly Patients) Study Team, 2013. Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA internal medicine, 173(9), pp.778-787. McLennan, V.E., Boddy, J.H., Daly, M.G. and Chenoweth, L.M., 2015. Relinquishing or taking control? Community perspectives on barriers and opportunities in advance care planning. Australian Health Review, 39(5), pp.528-532. Swetz, K.M., Matlock, D.D., Ottenberg, A.L. and Mueller, P.S., 2014. Advance directives, advance care planning, and shared decision making: promoting synergy over exclusivity in contemporary context. Journal of pain and symptom management, 47(3), pp.e1-e3. Www2.health.vic.gov.au. (2016). Medical Treatment Planning and Decisions Act 2016. [online] Available at: https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/advance-care-planning/medical-treatment-planning-and-decisions-act [Accessed 23 Sep. 2017].

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