Abstract

Advanced Care Planning (ACP) in end-of-life decision making is a fairly new concept in Australia. The greater use of ACP may assist the community in recognising the limits of modern medicine and technology and acknowledge palliative care as a life enhancement philosophy of care. As health care professionals gain knowledge and skills in ACP they are confronted with issues and difficulties which may impact on moral and ethical values.

Disagreements and dilemmas have arisen regarding the interpretation and application of Advanced Care Directives (ACD). The intentions of the substitute decision makers, at the time when the patient has lost capacity can also be complicated. Problem solving, strategies implemented and the resolving of disputes are investigated and analysed.

Discourse Analysis of conversations and interviews with the major stakeholders (patients, families, doctors and nurses) within the case studies reveal power relations within social interaction and social structure. This influences end of life decision making. The case studies were set in residential aged care facilities, where ACP is now routinely offered (but not necessarily accepted).

ACP promotes autonomy and ensures that the person's values and preferences are respected and known for a future time, when capacity may be reduced. For various reasons, ACP has been slow in progress, as Australians have been hesitant in embracing this concept. By analysing these case studies, some of the dilemmas and barriers to ACP are identified through the views of the family, friends, carers, health care professionals and the person themselves.