Nurses and other medical personnel normally confront ethical dilemmas when caring for terminally ill patients.
Correct understanding of the fundamental ethical principles aids the nurses to examine major dilemmas in the delivery of healthcare to the very sick patients or terminally ill patients. Due to a boost in medical knowledge and expertise, so are alternatives for healthcare. These alternatives present intricate moral dilemmas when decisions arise regarding the treatment of dying patients. Majority of the medical personnel are faced with the decisions related to the treatment of dying patients to ease a patient’s final misery. Conceivably, a decision will need to be made about whether to allow a patient to continue living or to end his or her life by terminating treatment when all’s said and done. Often, these decisions concerning the care of a dying loved one confront people from all walks of life (Butts and Rich, 2005)
Dying is no longer a simple affair between a patient and a doctor. This is in particular true in hospice care which advocates for a holistic and idealistic approach to end of life care and where there is a group effort among a patient, his family, doctors, nurses, social workers and other professionals and they come together as a care team. That is the precise reason why a majority of dying patients may choose hospice care. Martelli (2005) laments that the hospice team’s goal is to make the patient as contented as possible during his or her final days. Hospice lays a huge weight on pain managing, symptom management, ordinary death and value of life to ease the patient’s physical body. Improving the ending of life and campaigning for a good death has become the undertaking of many devoted medical persons and organization. According to (Callister, Luthy and Thompson, 2009), a good death is defined as one that has the following ordinary features:
tolerable pain and symptom administration
evading a protracted dying process
unambiguous communication about assessments by patient, family and physician
enough preparation for death, for both patient and loved ones
Feeling a sense of control
Finding a divine or poignant sense of completion
Affirming the patient as a unique and worthy person
increase in association with loved ones
Not being unaided.
Bach, Ploeg and Black (2009) state that all explanations of a good death value the law of autonomy which is a person’s capability to be in charge of circumstances and conditions. A fraction of the beliefs of hospice entails renovating and sustaining both the patient and his or her family’s power over the incident of death. The rest home team cares for the failing patient everywhere that patient is be at home, in a hospital, in a nursing home or in a hospice facility. Apart from medical care, the hospice group may provide poignant and spiritual support, social services, grief counseling for the patient as well as his family and nutrition counseling.
According to (Corless, Germino and Pittman, 2006) ethics are the values that ought to steer doctors, nurses as well as other health care personnel in their profession and resolution making. These principles are:
This principle entails nurses to act in such a way to reduce or do no harm. This is to say that whatever is done or said must not harm the patient either in the flesh or psychologically. The nurses are required to be completely truthful to the patients as lying to them can cause a great deal of harm. Additionally, for every intervention by the nurses or doctors, the possible benefits should be reflected alongside probable undesirable effects. Nurses are also required not to prescribe treatment until there is a strong probability that the patient can benefit from it and there will only be a small likelihood of objectionable unfavorable effects on the patient (Marrelli, 2005)
This principle requires the nurses to recognize the rights of the patient to self willpower, without discrimination. Nurses are obligated to administer treatments only with the patient’s informed approval as the patients have the rights to be fully conversant in order to come to their decisions. In addition to this, health care personnel have a responsibility to provide sincere and clear information when it is called for (Butts and Rich, 2005)
This principal requires the health care professionals to produce assistance, to do well and to at all time take action in the best welfare of the patient. It states that whatever is done or said must be for the well being of the patient (Bach, Ploeg and Black,2009) Nurses are obligated to be honest with the patients and this in most cases usually benefits the patient. Patients should not be subjected to unnecessary analysis and pointless therapies by the nurses. This principal must be not be mistaken by paternalism ( doctor knows best) rather, apart from applying not only to psychical good however it can be applied to mental, social and existential well being.
This principle refers to the unbiased allotment of health care resources according to need. However, it is not according to material goods, rank, doctrine or color. Regrettably, careful examination of health care globally demonstrates lack of this principle. In many places around the world, the majority of treatments are only available to the affluent or those with the authority and power, or those eloquent enough to ask for something better. In addition to this, in some countries medication such as morphine is available only when the patient can afford to purchase it and care has to be paid for and lack of financial resources may result to the patient dying in pain, in most cases alone often without dignity (Marrelli, 2005)
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However, it is good to note that an ethical dilemma in most cases arises when some values or principles like the ones I have discussed above, seem to conflict with each other, or do actually deal with each other, and nurses are tasked with the challenge of not knowing which one should have the first priority. Therefore, the nurses have to make the best attempts to plainly recognize these differing principles.
Ethical issues after death
After a patient passes on, the family may sometimes consider some issues like: organ donation, autopsy, the practicing of medical procedures on the body and others. In organ donation, the medical professional may confer with the deceased’s health care directive for their organ donation wishes. In case, there are no documents confirming to this, the medical practitioner may ask a family member for permission to use the organs for donation (Marrelli. 2005) On the other hand, autopsies may be used to establish the cause of the death of the deceased , or for examine and education or for forensic verification if the death was uncertain. Ethical issues regarding autopsy focus on respect for the dead body and preserving tissues from the body for study purposes (Corless, Germino and Pittman, 2006) Ethical issues regarding practicing medical procedures on the body of the deceased dwell on respecting the dignity of the deceased opposed to the learning value of practicing procedures for medical apprentices. Thus, training should be done with utmost dignity of the deceased’ body and with consent from family.
Role of leadership and management in clinical practice in addressing ethical issues
Butts and Rich (2005) lament that leadership in clinical practice is a process that ought to shape the goals of the medical care organizations, motivates the behavior of the nurses towards the accomplishment of these goals and help define the overall culture of the medical organizations. In clinical practice, it is a process of influencing the nurses to perform to their best. Thus, managers in medical institutions should have the capacity to motivate the medical personnel to do their best when dealing with the patients and especially when dealing with ethical issues. For example, if a nurse is not sure about an ethical issue, he or she should conform to her superior in this case who is a leader for the correct assessment. Therefore, the relevant leadership authorities in hospitals should make it their best effort to influence all team members in the medical circle to do their best.
Within hospice care, nurses are frequently faced with the challenges and actualities of ethical dilemmas. The nurses are often tasked with the question of the amount of information they should give the patient who is admitted to a hospice program. For example, when a patient asks a nurse to help him or her to die, what will be the limits of the ethic principle of autonomy? Thus, whatever the queries or ethical dilemmas the nurses face because caring for the very sick patients involves issues of vital concern, the nurses should not struggle with these queries alone (Marrelli, 2005)
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