This paper is written to discuss the ethical dilemma we come across when asking our self whether or not we should place a tube feeding in a patient with a history Alzheimer’s or Dementia. Will this prolong the patients’ life or just the inevitable death? Most often a decision needs to be made regarding the placement of a tube feeding. The question is not initiated by the patient themselves. This is the reason why educating our patients are so important. In this paper I will discuss how important the role of the healthcare professional plays in advocating for a patient. To help answer this ethical dilemma several issues will be explored. I will focus on the seven principles of ethics, education, utilitarianism, top-down …show more content…
Doctors often encourage the idea of a PEG or other available routes of feeding tubes. This is suggested when the patient has failed there swallow evaluation or has a history of aspiration pneumonia. According to Vital et.al. (2006) these reasons are not evidence based and may reveal discrepancies among healthcare professionals and their knowledge of advanced Dementia disease. Vital et. Al. (2006) also suggests that physicians may need improved education with regards to end stage dementia because they apparently lack understanding about the risks and benefits of artificial feeding. Taking this all into debate, development of knowledge is crucial aspect in maintaining and providing good care in an end of life process.
Principles of Ethics
If a patient has comorbidity such as Alzheimer’s disease, it is important that a healthcare proxy is designated. A healthcare proxy should be appointed when the patient is still has decision making capabilities. This is performed to help make medical decisions for the patient when they are unable to do so themselves.
Autonomy refers to an individual’s right to self- rule or governs one’s self (Beauchamp Childress, 2009). Autonomy is refer to the individual right to make his or her own decision regarding their health care needs. This is respected in the health care setting.
Without a living will or healthcare proxy
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Moreover, an emphasis is imposed on the rights of a single patient to commit an act or decision even though it is in contrast with the views of the others. In regards to the ethical dilemma, a nurse could not justify the morality of the two possible choices based on their results and consequences. The Deontological approach would encourage the health care staff as well as the patient to ask themselves the most righteous choice for their situation. With this in mind, a combination of ethical theories can also be employed to give light to the dilemma. In view of this, another ethical approach could be applied to solve the issue, and this is the Right-based approach. This theory also aim to promote the rights of every person, and that, they are indispensable just to make ends meet. However, not all ethical theories can be incorporated in every dilemma in a health care setting because their foundations would contradict one another. In order to provide an effective and efficient solution, nurses should be knowledgeable of the principles enveloping each of the ethical theories and should be wise to apply them in appropriate issues and
Cambridge (2016) defines autonomy as the ability to make a decision without any influence from any individual. Similarly, it is the freedom for someone to exercise their own will or action (Dictionary.com 2016).
Autonomy includes three primary conditions: (1) liberty (independence from controlling influences), (2) agency (capacity for intentional action), and (3) understanding (through informed consent) (Beauchamp & Childress, 2009, p. 100). According to Beauchamp & Childress (2009) to respect autonomous agents, one must acknowledge their right to hold views, to make choices, and to take actions based on their personal values and beliefs (p. 103). Respect for autonomy implies thaturges caregivers to respect theassist a patient in achieving? Heed? the autonomous choices of their patients. From there, patients can act intentionally and with full understanding when evaluating medical treatment modalities. Autonomy also includes a set of rules, one of which requires that providers honor patient decision-making rights by providing the truth, also known as veracity (Beauchamp & Childress, 2009, p. 103). In this case, several facets of the principle of respecting autonomy, specifically veracity, informed
According to ("Health care proxies - Medicare Interactive", 2016) a health care proxy is a health document that lets a patient chose an agent or proxy who makes decision on behalf of the patient.Situtation like these arise when a patient is not in a position to express his/her wishes. If the patient gains the ability to speak, he/she can change preferences. Health care proxy assumes the patient is incapacitated hence requires a proxy. However the patient has the right to periodically go through the health care proxy document in order to assess decisions made by the agent. Health care proxy allows a patient to name a second person who can act as your back up agent. In case one is not in a position to choose an agent, most states let close family
A Health Care Proxy (or durable health care power of attorney) is a legal document in which an individual names a person to make medical decisions for them in the event they become incapacitated.
The patient chosen in this study is one that has Alzheimer's. The patient is a 76-year-old man who has a history of heart disease and who is known as James Smith. Mr. Smith is a widow with three daughters, all of whom reside out of state. Mr. Smith is presently functioning well living on his own and has not yet had any incidences that resulted in potential harm to his well-being. Mr. Smith was referred by the VA hospital.
Furthermore, as explained earlier, autonomy refers to the right for individuals to make their own decisions, their ability to freedom and right for independence. Autonomy is situated around decision-making, about a person’s right to make a decision and ultimately may hold a debate if one does not hold enough information or cannot access the correct information, which is especially important in mental health field of nursing. Therefore this is why I am focusing this essay on autonomy, as it is an interesting and important principle that takes into account cultural and social aspects involved in the role of a nurse that is why I am focusing on this ethic.
Autonomy Autonomy is defined as self-determination or self-governance. Autonomy is composed of four key features: (1) intentionality, (2) understanding, (3) sufficiently free of external constraints, and (4) sufficiently free of internal constraints. Intentionality is defined as performing an action deliberately. Understanding is described as the ability to comprehend a situation, concept, or idea to a matter of degree. Free of external constraints is the freedom from physical barriers that would prevent an individual from acting out a conscious decision.
When working with hospice patients diagnosed with Dementia, the focus in medicine shifts from curative to that of providing comfort care and symptom control. The end stage Dementia patient typically presents unable to communicate meaningfully, incontinent, unable to ambulate or sit without assistance and exhibits swallowing concerns. The feeding and swallowing issues that arise with the progression of this disease can be challenging for family members, as many loved ones exhibit a need to feed. Providing the caregiver and family education related to not only the death and dying process but also the side effects related to interventions such as artificial nutrition is a vital part of the end of life process.
Patient autonomy is defined as, the patient t right to make their own decisions about the own treatment, without their health care providers or others to influence their decision in this regard. However, patient autonomy does allow the health care provider to educate the patient on their decision, but does not allow them to make the medial decision for them. (Medicine Net, 2012).
patient with advance stage of Alzheimer’s disease, permanent vegetative state, nurses and physician opinion on AHN, nurses and physician provide AHN according to their culture beliefs.
The use of tube feeding is done when a patient is no longer or unable to feed themselves orally. When tube feeding is required for just a short period of time an enteral tube feeding can be placed nasally. Incidences that require NG tube feeding would be prolonged bleeding, facial trauma, upper GI blockage and cancer. The NG tube catheter tip normally resides inside the stomach or in the small intestine past the pylorus. The number one complication involved with the use of NG tubal feeding is incorrect placement. A nurse can “inadvertently” place an NG catheter into the lungs, most notably when a patient has little to no gag reflex. As a result testing for gastric contents, pH or performing a chest x-ray are required once an NG tube has been inserted. Another major complication when using NG tubal feeding is aspiration within the lungs due to gastric “contents” enter the trachea and into the bronchial spaces of the lungs. Keeping the head of the bed elevated greater than 30 degrees will reduce aspiration at “minimum”. The use of a gastrostomy or jejunostomy tube can used for enteral feedings when an NG tube cannot be tolerated of interferes with therapy. The gastrostomy tube, PEG, tip is placed in the stomach and exits the body through the left upper quadrant of the abdomen where a bumper holds it into location. This can only be placed internally by a doctor during an endoscopy, radiology or surgery. A jejunostomy tube can be placed while in surgery, radiology
As Dementia patients are clinically faced with multiple risk factors they can also encounter the possibility of losing the ability to intake food. With such symptoms taking a toll on one’s body it is at times when family members can often become responsible for decision making situations. In James Jewells, case he was in charge of doing so as he had his mother Joan Jewell, who was 89 years old in a nursing home as she suffered from Dementia. While most of her time was spent in bed, she would sometimes recognize family members, could not speak that many words and had trouble swallowing. As her doctor noticed that she was rapidly losing weight he suggested on inserting a feeding tube that could
Primary care physicians (PCP) play a crucial role in dementia diagnosis. Older patients receive healthcare primarily from their general practitioners (GPs). [51, 52] Most patients and carers prefer their GPs to be the first source of professional help when dealing with dementia. [53-55] The Australian guidelines advocate early diagnosis by timely exploration of symptoms raised by patients and carers.  It would be reasonable for GPs to initiate the diagnostic process for suspected dementia cases before referring to specialists or memory clinics for confirmation of diagnosis. Following a formal diagnosis, GPs are expected to provide ongoing management and follow up, with adequate monitoring of efficacy and side effects of dementia modulating drugs; detection, prevention and treatment of dementia complications such as Behavioural and Psychological Symptoms of Dementia (BPSD), falls, malnutrition; and appropriate referrals to support services. [56-60] The disclosure of dementia diagnosis should be a shared responsibility between specialists and GPs, with GPs exploring patients ' perceptions about symptoms and initiating tentative discussions about possible diagnoses prior to referral to specialists and provide ongoing emotional and practical support post diagnosis.  Although discussion of advanced care planning, legal issues and driving may be raised by
Patients with advanced dementia commonly develop difficulty eating, often when they become bedridden and dependent in all activities of daily living (Finucane, 1999). #3 Due to this fact many dementia patients are placed on feeding tubes in their end-of-care stage. It has been suggested that there are times in which feeding tubes are administered for ease and convenience for health care professionals, rather than necessity. This idea stems from the fact that there is no proven research showing that tube feeding extents a patient’s life. A study was conducted to prove or disprove this statement. It was found that patients with feeding tubes still suffered from malnutrition and weight loss. Other aspects were also reviewed, including the prevention of pressure ulcers, infections, function and comfort. After all points were reviewed it was noted that tube feeding provided no substantial benefit to the patient. Tube feeding may not prolong life expectancy but simply be a reality when facing the final stages of dementia. This reality is a frightening factor for most facing this dementia, which leads to suggest that alternative options like euthanasia may seem justified.