The relevance and appropriateness of the article
The researcher who is a specialist registrar with the Department of Intensive Care at the Royal Cornell Hospital explores the issue of withdrawing and limiting the life support interventions, which are available to patients in the intensive care unit. Here, the author notes that such decisions are common in many intensive care units, and in several occasions patients are not included in decision-making (Tillyard, 2007). Conversely, agreements reached between physicians and the close relatives of patients are normally known as advance decisions (ADs). Therefore, most advance decisions are bound to reflect the willingness or last wish of the patient as presented by their relatives.
In addition, advance decisions can be legally-binding in that they are considered to represent the self-sufficiency of an incapacitated individual. However, some opponents of the move to legalize advance decisions in England and Wales are of the idea that legalizing advance decisions will be tantamount to euthanizing the patients illegally (Tillyard, 2007). Therefore, the article reviews available literature sources to assess the ethical issues involved in legalizing advance decisions a tos the last wishes of the incapacitated individuals especially the elderly persons who are under critical care.
Discussions
Relative to the impact of advance decisions on patients who are critically ill particularly the elderly patients; the author explores several salient points, which show the lack of ethical considerations when making advance decisions for critically ill patients. First, the author looks at the quality-of-life (QOL) considerations relative to advance decisions. Here, the researcher notes that the criterion used to determine the degree of survivability of critically ill patients is not precise and therefore, the QOL considerations should be based on the reasons provided by the patient for deciding to undertake certain medical interventions and not others (Tillyard, 2007).
In addition, some advance decisions are said to limit the ability of physicians to make sound decisions. Secondly, the author explores the cost implications in providing intensive care as a reason that for the relatives and physicians to make advance decisions for their critically ill patients. Here, the author shows that most patients who are given end-of-life interventions based on their ADs are initially provided full medical interventions. However, when the costs go higher, the ADs are used to limit or end the interventions (Tillyard, 2007).
Thirdly, the author looks at the number of the advance decision in the U.S. at a given period and notes that the number is relatively small; this will also be the case in England and Wales. Fourthly, the researcher is keen to note that legalizing advance decisions will also complicate the role of the Lasting Power Attorney (LPA) in helping incapacitated patients. Additionally, the author posits that it will be difficult for most patients and their relatives to interpret the legalized advance decisions relative to the prognosis and the preferred medical interventions. Lastly, the article shows thatonn several occasions, the advanced decisions can be used willingly to commit suicide for patients who think that their quality of life (QOL) after the medical interventions will see their physical or mental abilities reduced significantly (Tillyard, 2007).
Summary
Despite that the article is well structured and professionally presented; it lacks a relevant summary, which captures the article’s main points. However, the article is relevant to nursing practice because it offers a framework for nursing practitioners to reconsider their decision-making strategies, particularly in the intensive care unit. Conversely, if the issues presented in the article are used in nursing practice, they will enable nursing practitioners to realize positive patient outcomes because the article allows the nurses to make ethical considerations relative to the contents of advance decisions (ADs).
Lastly, the article is generally relevant to the topic of choice because it addresses pertinent issues in ethics, which should be given sound considerations when making decisions involving critically ill patients. Therefore, the article can be a resourceful tool in addressing various ethical issues in nursing, which influence patient outcomes and the quality of healthcare services.
Reference
Tillyard, A. R. (2007). Ethics review: ‘Living wills’ and intensive care-an overview of the American experience. Critical Care, 11, 219. Web.