Although every member of the hospital staff is important in their own way but it is the Nurses who play an integral role in caring for the patient and ensuring that all their legitimate wishes are abided with. Amongst the nurses it is the theatre nurse who ensures that all instructions are followed with respect to patients consent for surgery and if for any reason the opportunity for consent was not available then all alternatives need to be weighed and the best option selected. The nurse plays the role of a guardian cum chaperone even when it comes to the formal filing and explanation of advance statements.
A patient is legally entitled to decide which life-prolonging treatment he or she would want to receive. It is also the responsibility of the healthcare staff to be aware of patient's treatment preferences (Matesanz 2006). Admission evaluations should include questions about the advance statement so that the patient's wishes can be clarified. When the hospital staff (normally the surgical nurse) record advance statements, they should ensure that they are not vague as this will leave the statement open to subjective analysis by the family or hospital staff (McCahon 2001). For any form of consent to be legal it must be given freely and without pressure and after the individual has been informed of all the pros and cons. "For a person to have the capacity to consent, he or she must be able to understand and retain information related to the decision made and be able to weigh the benefits and drawbacks involved in such a decision" (RCN 2004).
"An advance statement is an expression of a person's wishes about medical care, to be used to guide doctors should circumstances arise when that person is unable to make or communicate decisions. It is also called a living will, advance directive or advance refusal." (Fiona Haas 2005). Typical advance directives include:
Name, address and birth date of birth of person making the living will
Any distinctive physical marks
Name and address of GP (stating if she/he has a copy)
Location of storage of living will
List of people with a copy, and their contact details
Date of writing and date of reviewing
Signatures by two witnesses
Statement of independence of witnesses and relationship to maker of living will.
The living will normally also includes details of the state that it should take effect in if the maker becomes incapable of making decisions and specify any treatments that will be refused. The living will should also state the circumstances in which it will apply and if wished it shall state that a decision to refuse treatment should apply even if the treatment is necessary to sustain life. If a person of sound mind makes a voluntary and informed decision not to undergo a particular treatment then this decision needs to be respected even if this decision will result in a gradual or immediate deterioration of health. The only exception to this is in the case of circumstance defined by the Mental Health Act 1983 (DH 2001a). According to Rashid, Kass-Bartelmes and Hughes treatments commonly listed in advance statements are mechanical ventilation, CPR, antibiotic therapy, surgery and artificial hydration and nutrition (Rashid 2000, Kass-Bartelmes and Hughes 2003).
According to British Law if an advance directive is made properly under the conditions that make it valid then it is treated equivalent to a refusal