Ethical Dilemmas In Hospices Care

As future DNP’s, we will be faced with patients who wish to end their life due to a terminal illness. We have to remember our ethical principles, and we have to be advocates for our patients. Our patients should not be judged for how they want their end of life care to be. Our patient’s safety should not be jeopardized. As future primary care providers, we might take care of patients who clearly states in their advance directives, that if they reach a terminal stage in their disease, they do not want to live anymore. We would have to communicate with our patients and let them know where PAS is legalized. I stand by my statement that PAS is ethical. Healthcare providers are not performing an action that is against the patient’s will.

The ethical principles for nurses to practice with beneficence and no maleficence. This legal battle between Terri Schiavo’s husband and her family was an ethical debate between continuing artificial life or remove her feeding tube by the request of her husband. Using the theories of utilitarianism and deontology can be applied or considered in making the most ethically correct resolution. The cases are very complex and raise many moral and ethical issues. The cases have brought awareness to society of “the importance of discussing end-of-life issues with family members and underscores how an advance directive, a living will and/or durable power of attorney for health care, are a healthcare proxy clarifies and provides evidence of the wishes of an individual regarding end-of-life decisions. Terri Schiavo should impress upon laypersons and professionals alike the uncertainty of the context in which issues of continuation and termination are argued ethically. Nobody knows what Mrs. Schiavo would have wanted. She left no advance directive and in its absence her husband says one thing and her parents

An ethical dilemma is a difficult situation that usually involves a conflict between moral obligations, in which to obey one would result in disobeying another (Murphy, 1997). Sedation is an ethical dilemma in palliative care because on one side it helps to relieve suffering for patients who are terminally ill and almost at the end of their lives. However, at the same time, sedation is making the patient deprived of certain bioethical principles such as autonomy, the main issue with palliative sedation is that it prohibits the patient from changing his or her decision, once sedation is commenced and informed consent also becomes complex (Cooney, 2005). The writer is in the favour of palliative sedation because it is an effective symptom controlled strategy for the patients who are nearly at the end of their lives. Moreover, it is believed that by providing sedation to a patient induce unconsciousness, which makes the patient completely unaware of the external world and tend to reduce the suffering by considering ethical and moral principles. However, some people think palliative sedation as euthanasia, which cause death because of making the patient deprive of nutrition and hydration while giving sedation. Ethical principles are going to be discussed in this essay such as autonomy, beneficence, non- maleficence and justice. Moreover, this essay also going to put light on current research

This film explains the legal role of advance directives in end of life issues. An advance directive is “a written document directing how medical decisions are to be made in the future when the patient lacks decisional capacity and is unable to decide and choose” (Hanlon, End of Life Issues, Slide 28, Bullet 1). All three of the cases demonstrate the importance in filling out some form of directive. When there is nothing to go off of, it makes decisions extremely tough for families and medical providers. Having legal documentation of patient wishes helps understand what treatments they would or would not consent to. In cases like

“An ethical dilemma exists when a choice has to be made in which the consequences may have a potential positive or negative outcome.”("Topic 4: Contemporary Ethical Dilemmas (How do managers evaluate beginning-of-life dilemmas?). ", n.d.) The given scenario presents a patient named Jamilah Shah, who is of Turkish descent, 90 years old and collapsed at the side of her bed in the extended care facility in which she resides. The patient suffers from Chronic Pulmonary disease and diabetes mellitus. The patient was rushed to the ER were the EKG and lab tests revealed she suffered a heart attack and she was started on anticoagulants. The patient has no advance directives and a communication barrier exists, the ER department contacts the emergency contact, one of the patient 's sons Bashir. The patient 's family arrives at the hospital and her son states that he makes the decisions and the wants a do not resuscitate order for his mother and no medical intervention other than comfort care. The social worker handling Jamilahs case is concerned by her family 's lack of support and that the family 's wishes are at odds with the patient 's request for help and her expressed desire to live. Furthermore if the patient does not receive a cardiac catheterization or is considered for a coronary bypass, she will surely die.

The article points out how the American Nurses Association (ANA), the Hospice and Palliative Nurse Association (HPNA), and Oncology Nursing Society (ONS) do not support the use of assisted dying. However, due to recent law changes, the organizations are reevaluating their position on dying with dignity. The article talks about the countries and states that have legalized assisted dying and who can qualify to obtain the prescription. It also points out that nurses who live in these countries and states are more likely to be uncomfortable to talk about this subject with their patients. Either way, patients need to be educated and advocated for while following the code of ethics when dealing with the subject of assisted dying. The article also points out how a nurse needs to be a tentative listener to further assess why the option of assisted dying is being considered. A brief case study demonstrates how a good nurse can reveal the true motives behind choosing the assisted dying as an option. Finally, the article talks about different communication techniques and approaches a nurse can use when discussing the subject of

According to Thelen (2005), one of the prevalent ethical issues physicians and nurses face in clinical practice has got to do with end-of-life decision making. Common dilemmas in this case as I have already pointed out in the introductory section include decisions revolving around the withdrawal of treatment in the end-of-life care. From an ethical and medical perspective, withdrawing treatment in end-of-life care can in some instances be considered both acceptable

I believe that as a nurse, you should be advocating the patients wishes and concerns no matter what they are. In the case of a terminally ill patient, I believe that the nurse should participate in euthanasia. The patient should be able to have a say in when to end their suffering if it is proven that they are not going to make it or get better. By having the patient as their number one priority, I think that nurses should advocate those wishes and be able to end their suffering because in 2.1 in The Guide to the Code of Ethics for Nurses, it states, “Because the nurse’s primary commitment is to the patient, it carries the greatest weight and priority and consequently it trumps all other loyalties” (ANA, 2015, p. 26).

Nurses are constantly challenged by changes which occur in their practice environment and are under the influence of internal or external factors. Due to the increased complexity of the health system, nowadays nurses are faced with ethical and legal decisions and often come across dilemmas regarding patient care. From this perspective a good question to be raised would be whether or not nurses have the necessary background, knowledge and skills to make appropriate legal and ethical decisions. Even though most nursing programs cover the ethical and moral issues in health care, it is questionable if new nurses have the depth of knowledge and understanding of these issues and apply them in their practice

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

Ethical dilemma may also arise in cases where a patient may feel their right to DNR should be carried out when giving direct order. The DNR process, however, is required to be documented by a physician. Andrew Putnam (2003) presents a case where an eighty-eight year old patient’s code status was DNR; “However, the patient has never signed formal advance directive statement or assigned durable power of attorney for her health care to anyone.” (Putnam, 2003, 2025) Ethics can be simply stated as doing the right thing (Roberts, 2002, 242); but in this case ethics is questioned because the physician was faced with the decision to carry out the wishes of the patient or to make a decision based on legality. In this case, it may have been morally right to carry out the wishes of the patient who wanted DNR orders carried out, but it may have been the right choice to do the legal thing and not carried out due to lack of signed documentation.

In end-of-life scenarios, where the patient may not be able to communicate their wishes, decisions must be made either by the healthcare professional(s) or family member(s). However, who gets to decide or where the line should be drawn are not always clear. Consequently, not all decisions may be ethically permissible. To illustrate, I will discuss a scenario in which physicians and family are not in agreement. Upon proving a brief summary and explaining the ethical dilemma, I will provide moral reasons for two ethically permissible choices from which, by referencing the principle of autonomy and Utilitarianism, will determine which course of action ought to be carried out.

The principle of autonomy states; “individuals have the right to make choices about their own lives” (Kozier et al, 2010.p.79). In health care, this means health care providers must honour the person’s right to choose methods or approaches to diagnosis or treatment (Kozier et al, 2010). Moreover, by not giving the client, the right to make her own decision this could cause anxiety and physiological effect to both parties. Which disregard the World Health Organization (WHO), definition of quality end of life care as the "active total care of patients whose disease is not responsive to curative treatment" (Sepúlveda, Marlin, Yoshida, & Ullrich, 2002). This definition includes meeting the psychological, social, and spiritual needs for both patients and families (Sepúlveda et al, 2002). In addition, the nurse did not put the beneficence principle in action, which “is the obligation to do good” (Kozier et al, 2010, p.80). Nurses have a duty to implement actions that benefit their client’s best interest (Kozier et al, 2010). It lays the groundwork for trust that society places in nursing professional, and provides nursing’s context and justification (Burkhardt & Nathaniel, 2002). This principle seems straight forward, but it is actually very complex. Should we determine what is good- by subjective, or by objective, means? So, when people disagree about what is good, whose opinion counts? In this case, the client, and not the family because she has the

Ethnical issue relation to “End-of-Life” comes into discussion “when decisions arise concerning the treatment of dying patients, these options present complex ethical dilemmas.” (Minnesota, 2005) We will discuss on Dilemmas such as Withdrawing and withholding treatment and physician-assisted suicide

End-of life treatment has been one of the most controversial issues and has gained significant attention over the past years. Legislation passed in 1990 (Patient Self-Determination Act) was implemented to protect the patient and the family’s self-determination and autonomy (McInnis-Dittrich, 2014). Advanced directives guide decision-making and the goal is