Advanced Directives and Dementia - Essay Example

Most people prefer written-down advanced directives to oral ones since they are less likely to be challenged. Because of this nature, advanced directives have legal and ethical bases, as shall be seen.  

            According to Beyer and Hargrove (2007), there are legal bases upon which advanced directives may apply. These bases form the limitations and conditions that define the parameters upon which an advanced directive (AD) may be extended. For one, it is imperative to note that advanced directives cannot be used to carry out illegality. Thus, no medical officer may act on an AD if it contains an illegal wish such as assisted suicide. Another important legal injunction that may invalidate an AD is when the patient chooses another party to make decisions for him. This request can only hold if the chosen party has been granted the lasting power of attorney. Likewise, limitations may be placed on AD if the AD is merely a request declining treatment of a mental health condition. Part 4 of the Mental Act empowers physicians to treat mental conditions, the patient’s wishes notwithstanding.  This is because the Mental Act, of 2005 is supreme and other directives are ancillary to it.

            According to Jacobs and Martyn (1994), a doctor may also treat an AD as legally binding, only if: there are no changes that have been made; there are no ambiguities in the wording of the AD; and if there have not been advances in treatment which may have had consequences on the initial treatment. The first condition is to the effect that even changes to a religion that proscribes the refusal of treatment may be disregarded by the physician.   The second condition is to the effect that the ambiguity in the wording of the directive must at least not be relevant to the patient’s incumbent medical condition. The only exception to the third condition is when the patient specifies in his AD that such advances are to be declined.

            Allen (2003) divulges that the physician or the healthcare institution is also under a legal injunction to respect ADs that are only valid. ADs that are: not signed; supportive of vestiges of acts of duress (for instance, if the letter seems to have been signed under compulsion or stress); supportive of reasons for doubting authenticity; and supportive of reasons to doubt the patient’s state of mind, at the time of the signing of the AD, may not be regarded as valid.

            Alongside these provisions that provide the legal bases of the AD is that the signatory of the AD must be: mentally sane; of legal age; and one who acts out of his own volition.

            There are also ethical provisions that form the basis of AD. Fundamentally, AD and provisions thereof exist solely because it is believed that every individual has the right and freedom of being self-determinate. It is from this notion that matters such as euthanasia, wills and laws of infestation come into existence spring. If an individual has the right to end his life with dignity, then it is also logical that the same possesses the liberty to discriminate against some forms of treatment.  

            Particularly, DeGrazia (1999) contends that a living or a DA may apply if it does not make specifications on requested forms of medical treatment. In this case, the physician has the discretion to consider the ethics of treatment, such as the condition of the patient and the scarcity of medical resources, and their affordability.   

            Matters that also led to the consideration draft an AD are to be also regarded as an ethical premise. Some of these matters include awareness but inability to communicate, confusion and insufficient memory, extensive brain damage, a coma that leaves the brain markedly impaired, the incurring of terminal illness, and/ or constant and uncontrollable pain. Under any of these conditions, it is held that it is best to respect an individual’s wishes, to rid him of the misery such pain causes.

            Again, other factors that are fundamentally considered include the patient’s mental state (this is because a decision made in a state of noncompos mentis may not be rational), the exercising of free will at the time of the writing of the AD, and the attainment of legal age (anyone who has not attained this age is not only not considered a legal person, but is also deemed not to have the mental wherewithal to make sound, sober and solid decisions that are enforceable by law and medical practice