Advance Decisions

On your first ward round you find that Mary’s condition has deteriorated overnight. She is tachycardic and tachypneic with a temperature of 38°C. You suspect she has developed bronchopneumonia. This is confirmed by a chest X-ray, and you decide that it would be best to start intravenous antibiotics and fluids. You discuss this with Mary’s family, but they are adamant that she would not wish to continue living in her current state as she would not consider her quality of life acceptable. Her daughter says that her mother had felt so strongly about this that she had made an advance decision. She gives you a two-sided piece of paper which states ‘If, as a result of my illness, I become unable to perform any basic tasks myself, then I would not wish to receive any form of life-sustaining treatment’. It is signed ‘Mary Jones’ and dated 5 years ago. You tell the family that antibiotic treatment is likely to cure Mary’s pneumonia but that she is likely to die without it. However, they say that you should respect their mother’s wishes and that all treatment should be withheld except for pain relief.

• What is an advance decision?
• Is this advance decision valid and applicable to the circumstances?
• If it is, do you have to follow it even if you do not think it is in the patient’s best interests?

Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)