Is The Best Patient Driven Autonomous Issue?

This ethical scenario presents an 86 year old female with numerous health issues and chronic illnesses. Mrs. Boswell’s advancing Alzheimer’s disease makes it extremely difficult to initiate dialysis, leading her physician to conclude a poor quality of life. The ethical dilemma portrayed in this case is between nonmaleficence and autonomy. Health care workers should focus on promoting the patient’s overall wellbeing and weigh the benefits and risks of the course of action, while also considering what the family declares they want done. Since the patient is deemed unable to make decisions, the goal is to collaborate with family, assess patient quality of life, address prognosis, and establish realistic care goals.

When a patient is unable to make decisions for himself or herself, their caregivers and those who know them are appointed to make the decisions based on what the patient would have wanted. This is called surrogate decision making. According to the article Terri Schiavo and End-of-Life Decisions “when surrogate decision makers and caregivers cannot agree upon what that choice would have been, they may turn to the courts to determine either what the now-incapacitated patient would have chosen or who is best suited to choose as the patient would have” (Mathes, 2005)

The Superior Court of Los Angeles County became a pivotal case in a patient’s right to refuse treatment. In the initial case Ms. Bouvia and her legal team sought a court order to have the NGT removed and to stop all medical treatments she did not consent to. She argued that this treatment would not be a cure for her condition and would not improve her quality of life. The hospital staff argued the interest of the state prevailed over a patient’s right to refuse treatment. They noted that the state and healthcare teams viable interests include: “(1) preserving life, (2) preventing suicide, (3) protecting innocent third parties, and (4) maintaining the ethical standards of the medical profession, including supporting the right of physicians to effectively render necessary and appropriate medical services” (Liang & Lin, 2005). Additionally they sighted Ms. Bouvia’s failed previous attempt to “starve herself to death” in 1983 with the assistance of her medical team. The court denied her request citing these key interests and the fact that medical professionals felt that Ms. Bouvia could live 15-20 additional years with supplemental nutrition justified the state’s interest in preserving her life. The court also stated that any other decision would be condoning a medical team to aid and abet suicide.

Although there are several debates against this view point, it is not up to anyone else to make decisions of the ill and infirm. As such it should be recognized that “patients have a right to make

The healthcare system is complex with nearly every decision made posing an ethical dilemma for patients, providers, and healthcare leaders. With an influx of new medical knowledge from evidence based practices and new technologies more decisions are being made available to patients and families. Terminally ill patients for instance are faced with numerous options when it comes to treatment including whether or not they end their life by terminating treatment altogether or seek controversial options such as Physician’s Assisted Suicide. The topic of Physician’s Assisted Suicide or (PAS) is very intricate with numerous pros and cons, moral ethics, and ways to address the issue within the healthcare practice.

It is more important to help a person suffering from mental illness to recover, before they are legally allowed to make such a terminal decision, and after a “thorough and comprehensive attempt to improve their life we have still not made living acceptable to them, we need to allow assistance to die” (Purdy, 2015). The exclusion of mental health as a condition, ties into the safeguard of type of condition. The 2007 British Attitude Survey shows that 84% of respondents agreed that a doctor should “definitely” or “probably” be legally allowed to end a patient’s life at their request” if they are suffering from unbearable pain and terminal illness (p39). However, if assisted dying were to be legalised extending this right to those suffering from painful chronic illnesses or severe disabilities should also be considered, if these individuals make the request, sufferer from terrible quality of life and show no sign of recovery. For example, it seems immoral to allow a cancer patient to request assisted dying, but not allow a paralysed individual, like Tony Nicklinson, to request the same consideration.

Depending on the context of how an individual resulted in a state where they were unable to transmit their feelings on if they want to decline or desire to prolong their existence and the connections others around them, should predict who has the power to make medical decisions on the one in question's behalf. In Schiavo's case, she had a medical emergency that resulted in her decline of being unable to communicate her end of life desires, considering her relationship with her loved ones, the closest individual with the highest understanding of her wants should have the authority over her

The ones who face a degenerative death does not have a lot of options to address the reality. The respect for autonomy is often over looked as an ethical principle. But as autonomy is the will of one’s actions, it would allow for people to relieve themselves from suffering. The second ethical principle is compassion. Having compassion for those who are terminally ill would advocate that suffering is unnecessary and can be prevented. If a person experiences unbearable physical symptoms and psychological distress, then physician assisted suicide would be the answer. Another path that is a growing

Significant advances in patient autonomy have been made in insisting the good and lawful right of rationally skilled patients to settle on choices about the course of their dying. This incorporates enhancing the techniques for the declaration of patients ' personality. It assists and makes it better for the family to comprehend when it is an ideal opportunity to settle on a choice. Sometimes the patient 's voice in medical basic leadership about forceful treatment in terminal sick conditions is not substantial because of their ailment. While doing my examination I read about Nancy Cruzan, and in this case where the US Supreme Court supported the state of Missouri 's privilege to require clear and inducing verification with respect to a patient 's desire to forego life-maintaining drugs. The consequence of that significant decision was a national outpouring of activity related to development mandates. It additionally incorporated the foundation of the administration Patient Self-Determination Act, which requires that specialist 's offices routinely teach patients about progress directives (Tilden, 1999).

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.

To begin with, the client whose name is Mr. Sam Pilsudski has an obstructed airway secondary to cancer of the larynx. He is a 67-year-old widower, and a father of one son and two daughters, who is unconscious and terminally ill, if not for a much-needed operation to remove both his cancer and larynx to save his life. However, one of Mr. Pilsudski’s daughters has adamantly refused to consent to the surgical procedure despite the physician explaining that although the operation would unfortunately render his patient disabled without a voice consequentially, but ultimately surviving the procedure to live and recover. Moreover, the physician attempted with rational and clear communication to express the gravity of the rather poor prognosis of his illness to his daughter that in the event of foregoing the surgery, his patient would surely die (Ralph Dolgoff, Donna Harrington, and Frank M. Loewenberg (2012), Ethical Decisions for Social Work Practice. 9th Ed; p. 279).

Helping professionals such as doctors, nurses, hospital managers, mental health professionals, relatives or ethicists may become involved in the process of assisting a terminally-ill patient with regards to end-of-life decisions. Helping professionals can best respond to client’s issues of end-of-life decisions through active listening and an empathic position (Duba & Magenta, 2008). Understanding the patient wholeheartedly should be practiced and considered as a significant aspect of the professional fiduciary relationship. He or she must be competent to assist dying patient from making the best end-of-life choices. Also, professional helpers must comply to the governing law and ethical guidelines to safeguard the patient from potential dangers

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

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.

Such a controversial topic as euthanasia and physician assisted suicide obviously brings about both proponents and opponents. When it comes to the case of a terminally ill person who is fully competent, how can one say no to his desire in having