The Royal College of Nursing (2005) stresses that the primary duty of a nurse is to work to restore the optimum degree of autonomy for the patient, that is compatible with what has been lost as a result of disease, injury or mental illness. A duty of care exists to educating people enough so that they make autonomous decisions.
The RCN (2005) promotes advanced directives as a medium for patient advocacy, they state that many people who are not afraid of dying fear that they will be kept alive, in pain and in circumstances that they would not value. Where people to have their advanced wishes known, this could give them consolation in knowing that they can continue to have autonomy and be in control of their own lives, when they are no longer able to explicitly express or implement it.
A challenge that the medical profession are faced with is that they must maintain an understanding of their patient’s values and preferences. Hinchliff, Norman and Schober (2003) support respecting patient autonomy is a primary principle of western medical ethics, it is not the event of signing the actual form but the continuation of doctor and patient communication and relationships based on understanding and voluntary decision-making.
Just as patients have the right to give informed consent or to refuse medical treatment, they have the right to choose or refuse potentially life sustaining medical treatment, even if it goes against medical opinion. A patient’s hygiene needs must be met as the patient could contract opportunist infections, which would have the potential to contaminate others as well as worsening their own health. In this instance Dimond (2002) recognises that personal autonomy cannot override the potential for harm to others.
Olick (2001) considers there may be times when the autonomy of a patient could be questioned for example, if it is suspected that a decision has been made upon a belief that is false. A patient who is diagnosed with terminal disease may not fully understand what mental or physical condition they might be in at the end of their life, or they may have been miss informed by friends, family or the internet. When that time comes the patient may think their condition to be fair all considering.
When the time comes they may decide they have a good quality of life even though they are ill. The patient’s preferences or expectations of what they want from life could be different or have changed from when they were fit and well. Their views may have changed and they perhaps now decide they are more comfortable than what they had imagined they would be. There could also be advances in medicine that were not thought of when the directive was written.