Ethical issues are “moral challenges” facing the health care profession (Stanhope & Lancaster, 2012, p. 127). Ethical issues is a major concern in the healthcare field because healthcare providers observe ethical issues every day and have to make ethical decisions. Advance directives are written documents that addressed an individual’s medical care preferences. These documents usually take effect when patients no longer can make informed health care decisions for themselves. While these documents are helpful to loved ones and health care providers, there are a number of ethical considerations that can make the development and execution of advance directives difficult (Llama, 2014). This author is a geriatric nurse that …show more content…
Therefore, the patient was too incapacitated to make decisions. The patient’s only daughter was the durable power of attorney (DPOA). A durable power of attorney for health care is a document that names an individual health care proxy (MedlinePlus, 2014). The DPOA is person the patient trust to make health decisions if the patient is unable to do so (MedlinePlus, 2014). A signed DNR was on the patient’s medical records. Eight years ago, the patient had addressed in a living will that be no use of life-sustaining equipment such as dialysis machines, ventilators, and respirators, or no use of artificial hydration and nutrition such as feeding tubes.
The patient recently suffered from a serious pneumonia causing difficulty breathing and thick mucus in her throat. It had been told to the health care staff that the DPOA did not want the patient to be suction because it would cause discomfort to the patient. The patient had stopped taking oral nutrient. Although the patient had a living will, the daughter had suggested that her loved one be placed on a ventilator and placement for a percutaneous endoscopic gastrostomy (PEG) tube for a short term (approximately two weeks) to see if the patient’s condition would improve. This situation had an impact on the daughter because the daughter was not ready to accept the fact that the patient was dying. The daughter was not
After reading your post and many of the colleague in the class, most agree that is not professional to disregard the conversation that the family was having. Although the patient wishes were not to remain on life support and had a document to prove it he also fail to have a proxy to carry one his whishes. The Health Care Proxy is a simple document, legally valid in many states, which allows a person to name someone (an "agent") to make health care decisions their behalf if they are unable to make or communicate those decisions. (Society, 2015).
A physician must understand that when it comes to deciding to withhold or withdraw life sustaining treatment it is ultimately the patient’s decision unless the patient is not competent enough to make this choice. I believe that a person can lose their life at any point. Death is certain and no one can run from it. In my opinion, a patient’s autonomy is of utmost importance anytime during healthcare however the physician can name some recommendations of what would be the best option for the patient. When it comes to patients they deserve to be treated with respect and ultimately be treated as an end not as a means to an end.
The practically speaking, the case of Nancy Cruzan highlights the fact that an individual cannot rely only on telling his would be decision maker what type of care is desired should that individual become incompetent. Such evidence may not be viewed as sufficient to refuse medical treatment as happened with Nancy Cruzan. It thereby becomes important to record exactly what type of treatment should be accepted or refused if one’s decision making capacity is lost. The most common way to do this is in the form of an advance directive. Such a document would declare not only who the patient wants a surrogate decision maker, but also relates the degree of treatment desired by the patient. The presence of an advance directive makes caring for incompetent patients much easier because confusion over the patient’s wishes is avoided. Had Nancy Cruzan made an advance directive, withdrawing the artificial nutrition
1. The Mayor of a large city was given a free membership in an exclusive golf club by people who have received several city contracts. He also accepted gifts from organizations that have not done business with the City but might in the future. The gifts ranged from $200 tickets to professional sports events to designer watches and jewelry.
Judgment was passed on the 29th May 2003. The plaintiff, the Public Advocate of Victoria was a limited guardian of BWV, a woman aged 68 years old, who suffered from fatal and progressive dementia. The plaintiff was appointed the guardian of BWV to make medical decisions on her behalf, due to BWV’s unconsciousness with no brain activity or bodily functions for 3 years. BWV received fluid and nutrition required to keep her alive by percutaneous endoscopic gastrostomy (PEG). BWV’s brain stem functions normally but her cortex is damaged. She has no prospect of improvement, hence making PEG medical treatment pointless (as witnessed by 3 medical practitioners – Dr. Michael Ashby; Professor Malcolm Horne; Dr. Michael Woodward). Consulting medical professionals led to the conclusion that upon treatment cessation, BWV
Other barriers in implementation might include the legality of certain medical interventions, associated costs and limited resources for providing the best care possible (Mason, 2013, p.12). As nurses, a barrier in implementing advance directives might also arise when advocated end-of-life wishes are undervalued or poorly recognized by others who do not share the same comfort or high priority in the medical workplace. Finally, the patient, families, and healthcare professionals face barriers in misconceptions regarding advance directives, especially in regards to
The nurse in the case study is faced with an ethical and professional, dilemma. How can she be an advocate for her patient Mr. E? Dr G. is proceeding on a course of action or plan of care that is directly contrary to the patients advance directive and his verbalized objections to the course of treatment proposed by the physician and that is concerning for her. There are multiple issues to consider. For the nurse, she needs to think about her code of ethics, her scope of practice and the legal issues regarding advance directives and Durable Power Of Attorney (DPOA). She also needs to consider the patients right to privacy and confidentiality. As with most areas and issues in modern healthcare the statues can be
Every seriously ill patient and their family should have decided the following issues: proxy, resuscitation, hospitalization, and specific treatments. Every seriously ill person needs to have pointed out a person to speak on their behalf when they get too sick to do so. A “proxy” can be filled out at any hospital or nursing home granting “power of attorney” to a loved one to be able to make decisions. A person
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
In the medical field today, whenever a procedure is going to be done on a patient, informed consent must be given to the doctor from the patient prior the procedure taking place. Informed consent is the approval given by the patient to the doctor for treatment. In the case being discussed today, an 80 year old patient, with a history of congestive heart failure, is in the doctor's office complaining of chest pains. After an examination, the doctor believes the best course of treatment would be to have a surgical procedure, in an attempt to save the patients life. During the examination however, the patient expresses the wish to just be able to die. There is no Living will or Do Not Resuscitate (DNR) on file. The patient’s wife is
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.
An ethical dilemma is an incident that causes us to question how we should react based on our beliefs. A decision needs to be made between right and wrong. I have experienced many ethical dilemmas in my lifetime, so I know that there is no such thing as an ethical dilemma that only affects one person. I also know that some ethical dilemmas are easier to resolve than others are. The easy ones are the ones in which we can make decisions on the spot. For example, if a cashier gives me too much change, I can immediately make a decision to either return the money or keep it. Based on Kant’s, categorical imperative there are two criteria for determining moral right and wrong. First, there is universalizability, which states, “the person’s
Usually either patients or families have the legal rights to determine what medical course to take with the patient when it comes to the diagnosis of death, in this case the family's conflict needs be considered. The healthcare staff involved in the patient’s care must communicate with the family members during this difficult time. If the patient is determined to be dead, the family will need support from the health care staff that has been involved in the patients care, all available hospital resources, including medical, nursing, social work, ethics, and pastoral care will be a good resource for the family members. Lawyers will usually advise health care staff to work with the family in the most compassionate way possible, the lawyers should be there to help with any conflict between the family members, and this will also help the organization against any future malpractice suits against the health care staff and organization.
The case of Karen Ann Quinlan led to four basic approaches to this ethical problem; advance directives or other clear evidence of the patients wishes while competent, surrogate decision making (power of attorney), and action in the patients best interest. Each solution has deficiencies both in theory and practice, but there can be no debate that their application has changed the landscape of medical ethics.