Applying an Ethical Decision-Making Model Nursing Essay Example
End-of-Life Care Options and Patient Autonomy
Autonomy allows the patients to control their treatment based on their preferences, interests, believes, and attitudes. Most of the time, especially during the end of life care, the patient’s autonomy is not respected, creating ethical issues and conflicts between the care providers, the patients, and sometimes the family. Autonomy allows patients to receive the end of life care that is consistent with their preferences (Akdeniz et al., 2021). An autonomous individual has a set of values, deliberations, and goals that influence the decisions they communicate to their doctor. Patient autonomy is a significant ethical consideration for nurses that allows them to educate their patients to make informed decisions regarding their care. It allows them to engage patients in care planning, prescriptions, and treatment. Patient autonomy promotes patient-centered care because it places the patient at the core of care and nurses to guide appropriate care decisions.
Decision-making involves complex thought processes and is always challenging for patients and their families. Patients are expected to decide the course of action during their end-of-life care. Still, they need information and guidance from their healthcare providers to make informed and appropriate decisions with positive outcomes. There are alternative solutions to end of like care, and care providers should educate the patient on these alternatives, giving their advantages, side-effects, and effectiveness (Karnik & Kanekar, 2016). The Federal Patient Self-Determination Act (PSDA) of 1991 requires healthcare providers and patients to communicate and analyze the end-of-life treatment preferences the patient has brought forward. The care providers should ethically respect the patient’s right to communicate their preferred treatments and prognosis autonomously. However, they should also consider limitations to patient autonomy and prioritize their duty to select treatments with better outcomes and ensure no harm.
Patient autonomy in end-of-life care affects a patient population that is terminally ill and cannot recover from their conditions. This issue also affects incapacitated patients with several hours, days, or months to live, and they want the best possible experience at their end of life. Stakeholders involved include the patient, family members, healthcare providers, including nurses, physicians, therapists, and healthcare organizations that set policies to guide end-of-life care decisions and clinical action. Overcoming ethical issues associated with patient autonomy in end-of-life treatment requires clear communication between the healthcare providers, the patient, and the family. Physicians have a rightful duty to provide comprehensive information on the treatments or available options’ benefits, limitations, and drawbacks (Karnik & Kanekar, 2016). The Deontological theory requires physicians to do their duties to provide care that benefits the patients. The patients have the right to select a treatment or intervention option, but the physician should explain its effects and stress on its consequences. Based on this information, the initial problem was properly stated.
Patients have several alternatives they can choose from during their end-of-life care based on their health status. Life-sustaining treatment is always the first option for most patients and families to prolong the patient’s life as further as possible without reversing the underlying medical problem. There are multiple treatments based on the medical condition, including mechanical ventilation, antibiotics, renal dialysis, artificial nutrition and hydration, cardiopulmonary resuscitation, and chemotherapy (Akdeniz et al., 2021). Life-sustaining treatment is provided when the patient or the family requests it. Care providers should provide adequate information about every treatment option and its implications to help the patient and the family make informed decisions. Life-sustaining treatment supports a failing body, and it is suitable when the patient wants to stay around for longer or has a considerable number of days to live.
Patients have the right to decide to withdraw or forego life-sustaining treatment as an alternative during end-of-life care. Withdrawing or withholding life-sustaining treatment is ethically justifiable when the treatment does not benefit the patients or increases risks for more complications, side effects, or harm. This alternative is preferable when recovery is not an option, and the patient wants to be as comfortable as possible during their final moments. It is also appropriate when the treatment is futile. Another alternative is proper pain management in the case of a dying patient. Physicians are legally allowed to eliminate any physical pain in a patient in their final moments, with few hours or days to live (Shaw, 2019). Pain elimination promotes comfort, allowing the patient to enjoy their final times. Sometimes patients prefer to die quickly rather than continue suffering or experiencing pain, and there are no recovery hopes. In this case, euthanasia or physician-assisted suicide is an option but highly controversial. This alternative is morally right in particular cases, especially when appropriate pain control interventions are not working or available (Dugdale et al., 2019). The patient has the right to choose this alternative, and although the physicians must respect patient autonomy, most of them are always uncomfortable with this option. Physician-assisted suicide affects the weak and vulnerable family members, can corrupt clinical practice and family and intergenerational commitments.
Better Alternatives and Justification
In cases when the patient cannot recover and wants to have a comfortable ending out of the hospital, the better alternatives are proper pain management and withdrawing life-sustaining treatments. Pain management for imminently dying patients is the most appropriate to eliminate any physical pain that makes the patient uncomfortable (Shaw, 2019). Nurses should approach care using the total pain management concept that requires them to focus on all life aspects: emotional, physical, social, psychological, and spiritual. These are the primary palliative care principles that seek to improve the patient’s quality of life. Withdrawing life-sustaining treatment is critical when the treatment is futile or causes the patient more harm (Akdeniz et al., 2021). Withdrawal is appropriate if the physicians and family expect the patient to die from the underlying condition. Physicians should communicate with the patient and family to remove all treatments that no longer provide additional comfort to the patient. Patients in end-of-life care are vulnerable and require support from the healthcare providers and family to live comfortably in their final moments. Pain management and withdrawing no longer beneficial life-sustaining treatments are vital for this population to allow them to be with their families and live a comfortable life before they die.
Implementing the Alternatives
There are various methods of implementing pain management, including drug therapy, massaging, relaxation techniques, physical therapy, pet therapy, and gel packs. The implementation will need the help of a palliative care team that is specialized in managing any form of pain (Shaw, 2019). They have the knowledge and skills to establish a comfortable and relaxing atmosphere that further promotes easing pain. It is ethically appropriate for physicians to withdraw a treatment intervention that no longer helps achieve optimal patient outcomes. Physicians can choose to remove a ventilator, stop administering artificial nutrients and fluids, and follow the Do-Not-Resuscitate policy, stop hemodialysis, or antibiotic administration. These alternatives should be implemented with patients’ or surrogates’ informed consent. Any person who does not agree with these options needs to understand that patient autonomy is vital but has limitations based on the circumstances. Sometimes physicians tend to provide end-of-life care that is inconsistent with the patient’s preferences and ethically justified to do so if they provide concrete reasoning. These alternatives offer the most comfortable end-of-life care because they eliminate pain and all treatments that make the patient uncomfortable.
Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Pros and Cons of Physician Aid in Dying. The Yale journal of biology and medicine, 92(4), 747–750.
Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care. SAGE open medicine, 9, 20503121211000918. https://doi.org/10.1177/20503121211000918
Karnik, S., & Kanekar, A. (2016, June). Ethical issues surrounding end-of-life care: a narrative review. In Healthcare (Vol. 4, No. 2, p. 24). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare4020024
Shaw, G. (2019, August 19): Managing pain: beyond drugs. WebMD. https://www.webmd.com/palliative-care/managing-pain-beyond-drugs