Essay: Ethical Decision-Making In Healthcare: A Case Study.

The integrative essay represents an opportunity to synthesise some key concepts by applying them to their work context as healthcare practitioners. Ideally, this work should be the culmination of your studies throughout the unit but with a special focus on the last two weeks. It should enable you to critically integrate what you have absorbed in earlier weeks to some specific issues in your professional role.

In this course we have presented you with some ethical frameworks for understanding your professional role, some ‘principles in practice’. There has been a focus on the dignity of the human person and how 4 as your main perspective. From this perspective address the following:

1. Based on your chosen perspective (or professional role) describe a scenario (either a real one you have experienced, or a hypothetical case) that contains an ethical problem or dilemma.

2. Critically discuss two or three ways in which your ethical understanding can inform and (potentially) resolve the problem.

3. In answering this question say what principles and values relevant to your professional role were relevant and why they were relevant.

Mr. Robert, an 85-year old African American man with a history of falls and dementia is presented to the emergency department with a bad fall this time resulting to a kneecap fracture. He is accompanied by his two sons to the hospital that needed to foresee his treatment. Upon admission, Mr. Robert complained of so much pain around his knee joint and muscles of his right leg and was put on pain relieving medication, acetaminophen while he waited for the physician to monitor his knee. After a couple of hours, he was assessed and the physician pointed out that he needed a kneecap removal since it was damaged beyond repair.  During all this period Mr. Robert was already hysterical and demanded to know the findings from the physician. The physician went ahead and told him the news and he felt that surgery would send him to an early grave. He felt uncomfortable and confused with all the information regarding the surgical procedure and everything that needed to be done.

His sons were also called to the hospital and given the news. They were informed of the entire requirements for the procedure to be carried out. They enquired on the cost required for the whole procedure which the doctor gave them. The cost was high for them since they had no health insurance and did not qualify for Medicaid.  Looking at the condition Mr. Robert was in the physician explained to them that an urgent action was required which they agreed. The physician also enquired on the health history of the patient which they highlighted that he had a healthy life except for the case that he was becoming forgetful in many things and had few falls in the last three months. They also had questions for the physician regarding the possibility of walking normally again after the surgery which he assured them that the chance was higher. They were later presented with an Informed Consent Form and requested to consent for him since he wasn’t in a position to do it which they did. The surgery was scheduled for the next day at 0300hrs.

During that evening after being served a meal, Mr. Robert complained that he needed only liquids since his tongue pained and couldn’t chew. The nurse in the shift never paid much attention to know more about the tongue but gave in to his demands. He was also assisted in carrying out activities of daily living. The next day he underwent blood and urine analysis and x-ray on both knees prior the surgery. Later he was given general anesthesia by injection and inhalation and the surgery was successful. At the postoperative recovery area the patient was closely monitored and it was observed that he never ate well. On assessing his complaints about the tongue the doctor found a lump on the side. He was diagnosed with oral tongue cancer. He underwent another surgery to remove the tumor. After regular checkups the doctor noted that it was advancing towards the back of the tongue and chemotherapy, drugs and radiation were carried out. The cost was too much to bear already for the family. Mr. Robert felt that he was a burden already despite being in pain. The doctor continuously sedated him to relieve pain. Either he proposed to his sons and the physicians that he had lived his life and needed to rest since all he encountered at that moment was pain and suffering and burden to the family which to him wasn’t called for.  

Ethical Understanding in Healthcare

2. When it comes to ethical thinking and decision-making, moral issues greet health professionals each day bombarding them with questions on how to approach certain issues concerning their clients and the general healthcare system (Burkhardt & Nathaniel, 2013). Questions on the right of the patient, fairness to the diverse patients, morality in view of medical technology and justice are perplexing to the health professionals when it comes to ethical decision making (Burkhardt & Nathaniel, 2013). In dealing with ethical issues there is a need to first think through the issue, ask questions regarding the issue and finally draw on factors to consider (Chadwick & Gallagher, 2016). In resolving the problem, the first step is analyzing the moral issue (Burkhardt & Nathaniel, 2013). Getting the facts in this case is that Mr. Robert is in great pain and overwhelmed by the whole process of continuously seeking medical attention. He is also worried about the cost burden to his children. He further says that his age was reckoning enough to warrant him an end of life. The doctor is aware that the cancer treatment is fastening the death of his client despite the client requesting for a mercy –killing.

To be able to deal with the above issues it is important to determine which actions will be morally best for the case. It will be best to consider utilitarian approach which suggests that ethical actions are those that provide the greatest balance of good over evil. The approach seeks first to identify which courses of action are available to the case. The available actions for the physician are on continuing to administer terminal sedatives to the patients to relieve pain together with chemotherapy to prevent the advance of cancer. The patient is also opting for euthanasia to stop the pain and suffering on him and relieves the cost burden to the family. To the sons they are left in dilemma on which side to choose, whether to support the doctor to continue with medication as they incur more cost or be in support of their father to end his life. The doctor is also faced by the challenge of whether to follow the patient’s autonomy and assist him to a quick death or ignore the patient’s demands. To resolve the actions we have to consider who will be affected by each action and what benefits or harm will be encountered in each action (Burkhardt & Nathaniel, 2013).  Mr. Robert is in pain and has a terminal illness and his option is euthanasia. According to utilitarianism on mercy killing is that the right thing to do is that which results to greatest amount of happiness to the greatest number of people involved (Stylianidou, 2013) (Chambers, 2011). Considering this the patient will be relieved from pain and suffering. His sons will also be relieved from cost expenses and will not continue seeing their father suffer. It is also said that any human being who is pitiful cannot allow another living thing to suffer for a no good end. The dilemma on the sons is whether to have pity on their father while he is suffering with no hope of survival or give him the dignity to die peacefully (Sharp, 2012). This is voluntary euthanasia since the patient has requested the end of their life early due to terminal illness that is causing an immense pain with no hope of survival.  Death cannot be avoided and suffering is in vain (Sharp, 2012). If they are in support of it the physician will assist in suicide by increasing the dosage to hasten death. Logically the patient needs to be relieved from suffering.

Addressing the Ethical Dilemma

But is it morally right or wrong? More important we say that it is not okay to kill another human except for the cases of retributivism (Sharp, 2012).  According to Kantian, mercy killing will break the seal of killing and result to all forms of killing that is acceptable. This will make people kill without value for life (Friend, 2011). Kantian is contradicting since they accept the retributivism form of killing while in denial of mercy killing (Paterson, 2017). This is because they are all fundamental killing (Paterson, 2017). Either life has exceptions or on this case we cannot consider mercy killing because of hardships of life like poverty. But we can focus on the unbearable pain and suffering that will result in no other way but death (Paterson, 2017). For the patient death is better since he will surely die, he is suffering, no person’s rights being violated and death will only benefit him in pain and will take nothing away from others (Chambers, 2011) (Vaughn, 2015). Either by embracing the phrase “the right to death with dignity” because of pain and suffering due to terminal illnesses will make more people disposed from our communities believed to be civilized. Especially older adults prone to these illnesses will be extinct. Hence it is the duty of the physician to provide care and protect life and not to harm patients. Allowing euthanasia will lead to critical decline in care quality of the patients with terminal illnesses. Palliative care can be provided to the patient for relief from suffering and pain, support the patient and the caregiver. The care is an active, compassionate and creative care towards the dying (Ten Have & Welie, 2014).

3. When it comes to health profession there are character traits that enable us to be who we are and act in ways that develop our greatest potential. These ethical virtues we strive on enable full development of our humanity (Mitchell & Golden, 2012). Reflecting on them helps in discovering what kind of people we shall be (Cannaerts, Gastmans & Casterlé, 2014). These virtues are courage, fairness, generosity, honesty, compassion, integrity, prudence, self-control and fidelity (Chadwick & Gallagher, 2016). These virtues form habit. They become part of us and once faced with ethical questions we are bound to naturally act in consistent with them. They are meant in identifying the most important ethical considerations and not provide automatic solution to problems (Chadwick & Gallagher, 2016).

Utilitarian and Kantian Approaches

Ethical principles are present in almost every aspect of daily life and healthcare practices (Chadwick & Gallagher, 2016). In this case there is the principle of truthfulness (Hsu, 2011). Truthfulness is about telling the truth to the client who has the right to know the truth. In the case study, Mr. Robert demanded to know the truth regarding the physician’s findings of his leg. The physician was open to him regarding the position of his knee and that the kneecap needed to be removed. He also briefed him on the necessary measures to be undertaken to ensure good care towards him and later consulted his sons since there was no confidentiality brought about by the client. It involves being honest with the patients about conditions, procedures, medications, and risks which are often unpleasant but necessary (Dossey & Keegan, 2012). Either at times it may not wholly apply since the moral duty of the physician is to do no harm. Either it should also be exercised with caution so that it is not abused (Hsu, 2011).

The principle of beneficence denotes on the provision of benefits and good to patients (Kangasniemi, Pakkanen & Korhonen, 2015). It requires the health care professionals to weigh risks and make decisions that are going to provide the maximum benefit to the patient (Hsu, 2011). In the case the physician observed that to enable the client lead a better life after the fall the kneecap needed to be removed and also ease pain. Either the possibility was he would require a stick for a stronger support. The patient was also diagnosed with cancer which required a series of chemotherapy to prevent its further advancing to the throat which would cause a sudden death.

Patients’ autonomy signifies that the health professionals have a duty to respect decision making of the capabilities of the patients (Bjarnason & LaSala, 2011). In regard to this the health professionals have to provide all the information regarding the available options to the patients to enable them choose the best for them (Holmes, 2016). Regarding the kneecap removal there was no other option available and besides the kneecap was badly damaged for other options. The physician declared the truth to the patient and his family and they had to ultimately bear the consequences. A patient has to be conscious in order to grasp the understanding of the information provided and make relevant decisions (Judkins-Cohn, et al, 2014). The principle also requires complete information provided without hiding anything to the patient to enable a holistic decision making (Sandman, et al, 2012) (Cannaerts, Gastmans & Casterlé, 2014). This will enable self-confident and freedom to take life into their own hands rather than the relatives. In this case the patient can opt not to undergo treatment and choose to die with dignity without pain and suffering (Judkins-Cohn, et al, 2014). Human beings have a right on deciding on what to do with their lives (Sandman, et al, 2012). In the case study the patient had opted for mercy killing to end suffering and pain in his life. The principle of beneficence supports the principle of autonomy with respect to the patient (Kangasniemi, Pakkanen & Korhonen, 2015). Truth telling to the patient and leaving them to make their own decisions is beneficial and makes them feel more confident with their life. If declaring the truth to the patient could harm the patient the health professional can distort the patient’s autonomy (Holmes, 2016). In the case, Mr. Robert was requesting for a mercy killing to ease suffering to him and he felt that he was bound to die after all which is why he was choosing a peaceful death rather than continue living in pain and anguish. In this case distorting the patient’s autonomy would only be right if the patient was given full information regarding the course of care that would be given to him in the meantime which is palliative care in order to reduce pain and suffering while giving him a comfortable life in the remaining days of his life (Kangasniemi, Pakkanen & Korhonen, 2015) (Holmes, 2016) (Materstvedt, 2013).

Conclusion

Conclusion

It is the work of the health care professionals to tell the truth to the patients. The patients have a right to acquire the correct information regarding their illnesses and the crucial processes required to undertake in order to gain full recovery. Patient’s autonomy may be respected but can be of benefit or detrimental to the patient. When it comes to mercy killing, right to life is a reality and succeeds the right to death with dignity. Hence palliative care provides the dignity of death.

References

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Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing. Nelson Ed

Cannaerts, N., Gastmans, C., & Casterlé, B. D. D. (2014). Contribution of ethics education to the ethical competence of nursing students: Educators’ and students’ perceptions. Nursing ethics, 21(8), 861-878.

Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Macmillan International Higher Education.ucation.

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Dossey, B. M., & Keegan, L. (2012). Holistic nursing. Jones & Bartlett Publishers.

Friend, M. L. (2011). Physician-Assisted Suicide: Death With Dignity?. Journal of Nursing Law, 14(3-4), 110-116.

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Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), 1744-1757.

Materstvedt, L. J. (2013). Palliative care ethics: the problems of combining palliation and assisted dying. Progress in Palliative Care, 21(3), 158-164.

Mitchell, P., & Golden, R. (2012). Core principles & values of effective team-based health care. National Academy of Sciences.

Paterson, C. (2017). Assisted suicide and euthanasia: a natural law ethics approach. Routledge.

Sandman, L., Granger, B. B., Ekman, I., & Munthe, C. (2012). Adherence, shared decision-making and patient autonomy. Medicine, Health Care and Philosophy, 15(2), 115-127.

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Stylianidou, S. (2013). Terminal cancer patients and euthanasia—the church’s position. Hellenic Journal of Surgery, 85(2), 105-108.

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Vaughn, L. (2015). Doing ethics: Moral reasoning and contemporary issues. WW Norton & Company.