The Royal College of Nursing

Beauchamp and Childress (2001) state the principle of beneficence involves the concern for the patient’s best out come and highlights the moral importance of doing good. The question of best interest is not simply just a physiological one. When a patient is unable to make an autonomous choice health care professionals have a duty of beneficence, to act for the best interest of the patient. However, Fry and Johnston (2002) identify this is normally measured in relation to a personal view of what would be best for the patient.

What the doctors consider best for the patient may be in retrospect what the patient would deem best if they were able to autonomously make the decision for themselves. Doctors may feel that they should do whatever is in their power to preserve a patients life. But considerations should be broader than that of just medical risks or benefits, it should include religious and cultural needs and beliefs of the patient. If these were considered it would imply the duty of best interest lie in, what would be appropriate in the context of that particular patient’s life.

By acting in beneficence way the nurse helps to increase the power of the patients and to further their own importance, by giving them a voice. However, it is important that the nurse has a history of the patient’s values and wishes. Davis, Aroskar, Liaschenko and Drought (1997) look at the principle of non-maleficence being the avoidance of harm. In assessing whether to give invasive treatment or not, consideration should be given regarding the harm that the treatment may cause to the patient and compare this against any benefits.

McCormack (1998) state that the duty of preventing harm should take priority over providing the patient with benefits. Fry and Johnston (2002) recognise that this could extend to respecting the patients advanced values and wished at the end of their life. Therefore the nurse should way up the side effects of treatments such as antibiotics or extensive mouth care when being fed other than orally. Culture and Diversity The influence of culture on Advanced Directive can be difficult to understand and when nursing patients of different ethnic groups.

The family should be involved in helping the health providers to understand the diverse need of the individual patient. Henley and Schott (1999) recognise the concept of autonomy and informed consent may vary among different cultures. Helman (2000) consider that many Asian cultures believe that family members should be spared from having to make their own end of life decisions and it is perceived as unnecessarily cruel for a doctor to inform the patient directly of a terminal illness. Holland and Hogg (2001) even recognise that some Asian adults are often expected to care for their ageing parents.

This may leave the family with a sense of obligation, to influence a decision for advanced treatments to sustain life. This may lead to elderly Asian patients continuing with treatments they would otherwise have choose to terminate, but for the emotional comfort of their family. Were an advanced directive is to be discussed with cultures other than that of the medical professionals an interpreter should be used to aid with understanding of all concerned. This would be of more benefit if the interpreter had a medical background and understood the consequences of refusing treatment, so there are no misinterpretations.

Holland and Hogg (2002) appreciate most Asian cultures permit the use of life support and disconnecting equipment could be seen as causing death. However some believe that treatments should not be given just to prolong a person who is going to die anyway. Holland and Hogg (2002) go on to explain in some religions the use of life sustaining equipment and medication is unacceptable if the doctor see it as useless, in this situation switching off life support is seen as merciful.

Nurses should consider justice and diversity in relation to providing care for different cultures and take into account the NMC (2004) Code of Conduct which states that care is to be provided irrespective of race, culture, age, gender, social class or political belief. The NMC (2004) Code of Conduct advocate nurses are responsible for their standard of practice and the care they provide. This involves making sure different cultures understand and are educated about their rights to have or not to have medical treatment. Conclusion and Reflection

After considering advanced directives the writer reflected that it is not only vital that they have some legal backing for both patient and doctor. They are part of any ethical decision making process. Knowing this should promote shared management with medical staff and the family enabling all patients to feel that they are part of any decision making process, when in a time of immense change in their lives. This has lead the writer to believe that rather than making advanced directives with emphasis being on just patient rights, consideration should be made so that the patient has the right people around them when making the directive.

An Advanced Directive can give the patient a voice in the process of deciding about future medical treatment; it can aid medical professionals when deciding on the best interests of their patients, by providing them with a reflection on the patient’s individual values of what life means to them. Due to a wide variety of cultural values medical professionals should be aware of listening to family members as well as spirituals associates connected to them.

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