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Keatings & Adams, 2020, pp.200

While advance directives aim to respect patient autonomy, a patient's interests may change due to illness or incapacity. This severs the link between respecting autonomy and ensuring patient welfare. Neither strictly following an advance directive (as a "Ulysses contract") nor solely considering a patient's current interests is satisfactory. To balance these concerns, advance care planning should involve regular review and updates to reflect any changes in a patient's wishes, with guidance from medical experts. This enhances patient trust in the process and medical institutions.

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202 views2 pages

Keatings & Adams, 2020, pp.200

While advance directives aim to respect patient autonomy, a patient's interests may change due to illness or incapacity. This severs the link between respecting autonomy and ensuring patient welfare. Neither strictly following an advance directive (as a "Ulysses contract") nor solely considering a patient's current interests is satisfactory. To balance these concerns, advance care planning should involve regular review and updates to reflect any changes in a patient's wishes, with guidance from medical experts. This enhances patient trust in the process and medical institutions.

Uploaded by

Binu Kumar
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Do you agree or disagree with London and Kestigian's argument that if, due to illness or

incapacity, patients' interests change, then the link between respect for autonomy and

fidelity to patent welfare is severed? Should we pay attention to the "then-self versus now-

self" distinction in making our assessments, or should we treat advance directives as a sort

of Ulysses contract (i.e., a freely made decision that is intended to be binding in the future)?

While preparing an advance directive, individuals cannot anticipate every possible

complexity of the proposed treatment. So, their preferences may change over time due to illness

or incapacity. In cases where the advance care plan conflicts with the current interest, it is not

easy to choose between the options. Executing any one of the choices will either disrespect the

patient's authentic wishes or unfavorably affect the fidelity policy. So, I agree with London and

Kestigian's argument that, due to illness or incapacity, patients' interests change, then the link

between respect for autonomy and fidelity to patent welfare is severed. 

In my perception, considering the patient's current interests rather than valuing

interests that the patient expressed when they are competent will result in breaking their trust

and autonomy to make decisions regarding their health care matters. However, treating

advance directive solely as a sort of Ulysses contract have deficiencies as it is not

exploring every possibility in advance or their future state of mind and circumstances (Keatings

& Adams, 2020, pp.200). So, integrating the advance directive in such a way to uphold honesty,

transparency, and patient's trust is a possible option to alleviate the potential problems.

Constructing a life value advance directive that lets the client express what they value most will

avoid potential complex issues in decision-making. Additionally, individuals who create the

advance directive should let appropriate people know the existence of the will and ensure that

the will is reviewed and updated regularly to reflect the client's current wishes. Consultation
with physicians, nurses, and lawyers will help them to anticipate the situations that may arise

and also helps them to make sound decisions (Keatings & Adams, 2020, pp. 200). 

In a nutshell, all the concerns should be addressed during the advance care planning

process, and patients should be made aware that their interests may change over time and that

their evaluation of future health states may be colored by present values that they may not retain

in that future state. This enhances patient's trust and the legitimacy of the institution (Kestigian &

London, 2016)

References

Keatings, M., & Adams, P. (2020). Ethical and Legal Issues in Canadian Nursing (4th ed.).

Elsevier.

Kestigian, A., & London, A. J. (2016). Adversaries at the Bedside: Advance Care Plans and

Future Welfare. Bioethics, 30(8), 557–567. https://doi.org/10.1111/bioe.12263

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