Ethical Issues & Advance Care Planning
According to Jimenez et al. (2018), there are multidimensional ethical concerns related to ACP and requires the balancing of values such as patient autonomy, beneficence, and non-maleficence. The protocol related to autonomy, which focuses on patients right to make decisions about their own lives, is at the core of ACP protocols. The documentation of the preferences for the treatment plan in advance can benefit the patient by providing control over their care plan even if they are in vegetative state. Supporting the ideal condition where patient has the final say for their treatment plan. However, Dabi and Rahman (2024), mention that challenging situation is when patient wishes contradicts the medical treatment recommended by of healthcare professional or chosen by family members. One of the most common examples is when a patient chooses no life-sustaining treatment during end-of-life care but family members insist on constant and robust interventions. This causes ethical dilemma as the principle of beneficence, that emphasis upon the upholding the well-being of the patient, conflicts with respecting the patient's autonomy, in circumstances when healthcare provider believes that continuing treatment can benefit the patient, despite the patient’s wishes. Furthermore, many of the ACP documents do not possess clarity and thus the patient might be unable to fully comprehend the effects of their choices when they plan advance directives (Panozzo et al., 2023).
This raises questions that if the patients are making decisions based on evidences and their choices is informed or whether they are influenced by the misinformation, societal pressure or the family members. Then there is the issue of timing as the patient might make certain decisions related to end-of-life care but as they approach the final stages of life, they might want to change the decisions but remain unable to do so as updating the ACP documents requires time and they might lose decision-making capacity. Thus, this raises the question and demands for the crucial need for open and transparent conversations regarding end-of-life preferences such that ACP adheres to the patient’s beliefs, wishes and values (Lewis et al., 2019).
The Role of Nurses & Advance Care Planning:
Nurses plays the key role during the advance care planning as they ensure that patients' wishes are respected throughout their end-of-life journey. According to the Nursing and Midwifery Board of Australia NMBA (2018), nurses are required to enforce patient autonomy, advocate for their preferences and wishes, and provide support to their families during difficult decision-making processes. Nurses holds the position to initiate conversations regarding advance care plan with patients and their families idly. They often document patients' wishes such that any misunderstandings or conflicts that may arise are catered timely. Nurses also have to make sure that the advance directives are followed strictly and continuously when a patient reaches the end of life. This requires the comprehension of the legal guidelines in their jurisdiction, interpreting ACP documents, and advocating for appropriate care aligning it with the patient's preferences. Nurses also have to deal with the ethical complications of ACP, for example when family members disagree with the patient’s documented preferences or when the patient's wishes are not clear (Moore et al., 2019).
