Advance Directives: the New Zealand context

Abstract

Advance directives convey consumers' wishes about accepting or refusing future treatment if they become incompetent. They are designed to communicate a competent consumer's perspective regarding the preferred treatment, should the consumer later become incompetent. There are associated ethical issues for health practitioners and this article considers the features that are relevant to nurses. In New Zealand, consumers have a legal right to use an advance directive that is not limited to life-prolonging care and includes general health procedures. Concerns may arise regarding a consumer's competence and the document's validity. Nurses need to understand their legal and professional obligations to comply with an advance directive. What role does a nurse play and what questions arise for a nurse when advance directives are discussed with consumers? This article considers the cultural dimensions, legal boundaries, consumers' and providers' perspectives, and the medical and nursing positions in New Zealand.

Interdisciplinary researching: Exploring the opportunities and risks of working together

“…Indeed, “culture is not neutral, unitary, or transparent” (Kirkham et al ., 2002; p. 223). For example, New Zealand not only has a colonial heritage, but is a bicultural society that is shaped by two main cultural groups, Maori and Europeans (Wareham et al ., 2005). The political commitment to honour the Treaty of Waitangi, the founding document of New Zealand, has had a significant impact on New Zealand society.…”

“…Under biculturalism, all New Zealanders are expected to be culturally sensitive to Maori, the indigenous people, and work according to the principles of partnership, protection, and participation. As a result, “Maori ways of doing, thinking, viewing and acting [are] gradually integrated into the laws, policies and everyday life” (Wareham et al ., 2005; p. 350). Although health professionals working internationally are probably familiar with notions of cultural diversity, it is possible that, in New Zealand, the holistic Maori worldview that emphasizes relationships and cultural identity as fundamental for stability in a rapidly changing context (Durie, 2001) has had considerable effect on all New Zealanders, especially health professionals.…”

Advance care planning for Māori, Pacific and Asian people: the views of New Zealand healthcare professionals

“…The whole issue of ACP is more complicated in a culture where decision‐making by whānau (extended family) is important (Wareham et al . ). In addition, although distinct in language, culture and history, evidence indicates that Māori, Pacific and Asian groups are both more collectivist than individualist in their worldviews (McLaughlin & Braun ).…”

Service user and clinical perspectives of psychiatric advance directives in New Zealand

“…Advocates of advance directives believe they have the potential to facilitate autonomous decision making and increase sense of control by service users over their treatment (Appelbaum 2004;Scheyett et al 2007;Wareham et al 2005). A survey of stakeholder groups (service and non-service users) regarding different models of advance directives found respondents were largely positive about service users taking responsibility for their treatment through using advance directives, particularly as they perceived this as a positive step towards their treatment and recovery (Atkinson et al 2004).…”