Clinical Dietitian Ethics

As evidenced by this individual stating “Don’t wait until I’m so sick that I can’t make any decisions about my own body” (J, Nguyen, personal communication, November 20th, 2014). He would want to be able to determine and make his own decisions in regards to his own health like medical interventions – organ transplant, operations, and medications. Therefore, members of healthcare should discuss with the patient about their wishes if events such as palliative care would occur as most people do not have an advanced directive planned. Additionally, it is a part of our role as a member of healthcare to always inform the patient what is happening, why they are taking this medication, and be as honest in regards to the client’s health. I can understand how not informing them information regarding their illness and neglecting their concerns can affect them physically and mentally. Furthermore, this individual does not want to receive futile treatment; especially, since he works in healthcare and understands the cost of medical treatments. The individual was logically and able to reason that if it is not beneficial, there is no need to perform it. Research indicated that “hospital and 6-month mortality rates were significantly higher for patients perceived as receiving futile and probably futile treatment compared with patients perceived as receiving no futile treatment”

To Feed or Not to Feed: An Ethical Case Study on End of Life Care

.“As medical technology continues to advance and health care choices become more complicated, the preservation of end-of-life autonomy is an increasingly important issue faced by various client populations.” (Galambos, 1998).

Caring for patients at the end of life is a challenging task that requires not only the consideration of the individual as a whole but also an understanding of the

Advance Directives by the patient designates no feeding tubes, artificial ventilation, or CPR. Concerns regarding alteration of mental status consequential to his illness provoke the physician to seek consultation from the designated Power of Attorney. Nursing responsibilities compel the nurse to consider if the proposed actions of Dr. G violate the patient’s rights of self determination and confidentiality and prompt the nurse to advocate for the patient’s desires regarding medical treatment. Health care providers have a responsibility to honor the patient’s autonomy and provide quality medical care (Badger, 2009 p122). Providing artificial nutrition and ventilation transgresses the patient’s directives and is unethical. The physician appears to be asserting a paternalistic approach in deciding what is best for this patient. Should the interventions be temporary and provide resolution of the condition, the physician can defend his actions as being healing and beneficial. However, there is a chance that the interventions may be permanent and futile; avoiding passive euthanasia and terminal dehydration, serving only to prolonging the illness. Violating the patient’s directives of care by performing invasive procedures can lead to legal incriminations of assault and battery.

A person who is dying of a terminal illness is faced with only one certainty; they will die from this disease. A doctor can say roughly the amount of time that a patient has, but they exact date and level of pain is hard to determine. Many may look to a physician for the answer on if they should/shouldn’t choose PAS, however, the only role a physician plays is giving the medical diagnosis and working with the patient to get what the patient feels is the best option. Therefore, the decision the patient makes doesn’t make the physician a moral guide, but rather a person doing their job. The last big decision people who are terminally ill have is when/how to die and it has to be their own and it has to be respected.

This is recognized to be an issue, and throughout the article the authors provided an understanding of how palliative care and end-of-life care are provided too late for a patient and should be provided at an earlier time in order to bring more comfort to the patients. The authors suggest that when and how end-of-life care is provided should be altered, with nursing ethics in mind, so that patients and nurses may feel better about the care they receive. This source will help my research by providing information on how changing the policies of end-of-life care and palliative care can result in the patient feeling a relief from their suffering and ultimately feeling more comfortable. This will also help my argument in how altering the current policies and focusing on providing better end-of-life care can lead to the diminishment of physician-assisted

This is a controversial discussion amongst end of life professionals. Many question the legal ramifications and place this choice in the same category as assisted suicide. Some believe the client is not choosing to die because to qualify for hospice a six month or less life expectancy has been established. They are choosing not to live under certain conditions or how to die. According to Schwarz (2014), "Increasing numbers of patients across the country are exploring and sometimes choosing VSED to escape intolerable suffering" (p. 130). In my career, I have witnessed patients in their last days involuntarily experience a decreased appetite and thirst as a natural process of dying. VSED is a voluntary choice to fast and allow nature to take its course. This is a new concept for me to digest and it intrigues me. Hospice is all about the patients' choice and quality of life and I believe this topic must be mentioned in my

Physician-assisted suicide enables terminally ill patients to die comfortably and peacefully in their own homes. Terminally ill patients suffer through constant pain in their final months, and there remains a “residual obligation to relieve suffering” when palliative and hospice care reach a stagnant point (Quill). Patients will reach a point where the value of life weighs against the consistent suffering they endure on daily basis. Those seeking physician assisted suicide maintain the ability to forcibly starve themselves by declining food and drink. It takes more energy for terminally ill patients to push themselves to

There are some ethical dilemmas evident in this scenario, starting with an End of life dilemma, refusal of care and informed consent.“End of

Humans have the obligation to provide and care for their loved ones, whether it is their child or parent. For this reason, having the ability to take away one’s own life because of health related issues should be carefully thought out by the family and affected person. As individuals grow older, the body naturally degenerates and its effects can be very painful for the person and their family members. There are many views regarding how a family and the affected person should go about the ultimate decision of taking one’s own life. John Hardwig believes that as we grow older there is a “duty to die” before one 's illnesses would cause death, in the absence of any terminal illness and sometimes when one would prefer to live. In his essay, “Is There a Duty to Die?” he explains why he thinks that there is a need to take away one’s life to benefit others. Felicia Ackerman disagrees completely in her essay, “For Now Have I My Death: The “Duty to Die” versus the Duty to Help the Ill Stay Alive.” She believes instead that there is a, “duty to aid” and the amount of aid ultimately depends on the family circumstance. Ackerman’s view is illustrated by Jerome Groopman, MD in The Anatomy of Hope where he talks about a man named George Griffin and his success in the fight of a very serious and rare stomach cancer through family support and hope. The decision to take away one’s own life may be very challenging and complex, but there is an absolute obligation for the family to be involved

Those who don't know better imagine that receiving no food or water until death would be a horrible way to die. It's not - especially if the dying person is already in a persistent vegetative state. Again, from the bioethicists'

With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient

This assignment has been structured to demonstrate the management of nutrition and hydration in end of life care. In this learning utilising the reflective frame work of Driscoll, 2007, I will critically explore and analyse the management of end of life care in relation to management of a patient’s nutrition and hydration, identifying potential elements and their impacts upon care delivery. As a health care practitioner, my role towards end of life care involves communicating with patients and their family members on a need to know the basis of the treatment plan. Also this would include adequate handover to professionals to maintain a seamless service; as outlined in the Individual Plan of Care (Support for the Dying Person in the Last Days and Hours of Life, NHS, Wigan & Leigh Hospice 2014) which, is currently in used in my area of practice. Each outcome would be supported with current literature including local and national government documents.

Today we are face with death in a different setting then our ancestors, instead of dying at a younger age and dying in our home with our families, people are now dying at a hospital or in a medical setting. We are living longer because of the advances in medicine, this is causing us to develop diseases that our ancestors never had to face. Our ancestors did not live long enough to develop some of the diseases we face today. As Jones (2011) provides, “we don’t just die of different diseases then our ancestors, we also die in different circumstances” (p. 302). The changes in circumstances have caused us to reevaluate what is believed to be ethical when faced with dying. There are many medical options a terminal ill or elderly patient that is dying can choose from, however there is great debate whether some of these options are ethical.