summary with 200 words each question making 1200 words total
Enny123
NorlanderChapter13EthicalIssues.pptxTo comfort always
A Nurse’s Guide to End of Life Care
Chapter 13: Ethical Issues
Patients and families are faced with difficult choices
Decisions become more difficult when the patient cannot speak for themselves and families are conflicted
Chapter 13: Ethical Issues
Healthcare ethics
Called bioethics or medical ethics
Study of moral obligations of healthcare providers and society in preventing and treating disease and injury and in caring for people with illness and injury
Chapter 13: Ethical Issues
The most common healthcare ethics framework is based on four principles
Beneficence
Non-maleficence
Autonomy
Justice
Chapter 13: Ethical Issues
Beneficence
Obligation to act for another’s benefit
Looking at the benefits and burdens of a particular action or treatment
Non-maleficence
Obligation to “do no harm”
Looking at the burden a treatment or course of action might cause
Is the treatment going to prolong the patient’s dying without increasing quality or comfort
Chapter 13: Ethical Issues
Autonomy
Person’s right to choose independently
The right to choose also means the right to refuse treatment
Justice
Fair and equitable treatment
Broader meaning in looking at the best use of limited resources
Chapter 13: Ethical Issues
You face ethical dilemmas when you encounter conflict or controversy over a treatment or course of action
Conflicts occur when a patient lacks the capacity to make decisions for themselves and does not have an advance directive or has not communicated their wishes to family members or care providers prior to losing capacity
Chapter 13: Ethical Issues
Decision-making capacity
The ability of a patient to understand a proposed course of treatment, including the benefits and burdens, and to communicate treatment preferences or wishes to others
Questions to ask
Can you tell me why your doctor is recommending this treatment?
Can you tell me what the recommended treatment is?
Can you tell me about the benefits and risks of this treatment?
Chapter 13: Ethical Issues
Many of the common dilemmas in end-of-life care for patients and families involve either starting or discontinuing a treatment
Resuscitation
Should CPR be attempted if a patient’s heart stops?
Artificial nutrition and hydration
Should IV hydration or tube feedings be initiated?
Chapter 13: Ethical Issues
Ventilator support
Should a patient be placed on a ventilator?
If on one, should it be discontinued?
Initiation of treatment such as surgery or chemotherapy that might be considered futile or of no benefit to the patient
Chapter 13: Ethical Issues
You also see dilemmas arise over use of medications (opioids or sedatives) to control pain and other symptoms
If you use an ethical framework to address these issues, you need to meet several conditions
Medications are not given to cause death
Must be to relieve pain – intention must be to do good
Good effect must outweigh the bad effect – relief of suffering is more important that a shortened life
Chapter 13: Ethical Issues
Physician-assisted suicide
Physician prescribes lethal dosages of medication that the patient can take
Available only to terminal ill patients who are considered competent to make this choice
Have been evaluated and determined not to have depression
Legal in four states
Oregon
Washington
Montana
Vermont
Chapter 13: Ethical Issues
Euthanasia
Killing of a patient with “merciful intent”
Not legal
Condemned by most ethicists
The Hospice and Palliative Nurse’s Association (HPNA) code of ethics opposes involvement in either physician-assisted suicide or active euthanasia
Chapter 13: Ethical Issues
As a skilled clinician, you have several roles
Have a thorough understanding of the patient’s illness including
Treatment options
Implications of treatment
Usual progression of the course of illness
Chapter 13: Ethical Issues
Questions you should ask when gathering relevant information
Does the patient have decision-making capacity? If not, who is the surrogate decision maker?
Has the patient expressed their wishes prior to losing capacity verbally or in a written advance care directive?
What choices need to be addressed?
Who are the relevant family members or stakeholders in this decision?
Chapter 13: Ethical Issues
Advocate: Making sure wishes are honored
Guiding per values
Guiding patients and families to make decisions that are consistent with their values and beliefs
You can provide the guidance a patient or family might need by reframing the discussion via the concepts of benefit versus burden, harm versus good, respect for autonomy, and consideration of justice
Chapter 13: Ethical Issues
What about a nurse’s personal ethics, beliefs and values?
If your values conflict with the patient’s wishes, step back and separate your own personal values from the situation
Because decisions at the end of life entail moral, ethical and even spiritual values, you might find your own values in conflict with the wishes of the patient, family or the other healthcare providers
You can be in the position of discontinuing treatments, administering medications, or initiating treatments you believe are wrong and harmful
Chapter 13: Ethical Issues
Try to understand the meaning of the illness to the patient and family
Get help from interdisciplinary team to work through issues
Consult your ethics committee
Usually interdisciplinary
Use an ethical framework to discuss and analyze the dilemma
Chapter 13: Ethical Issues
Within many non-European American cultures, the community and family members make decisions rather than the individuals
In some cultures, full disclosure to the patient is considered disrespectful
Chapter 13: Ethical Issues
Ethics in end-of-life care encompass the moral obligation to care for a patient in a way that prevents harm and benefits the patient
As an advocate, ensure that the patient’s wishes are heard, understood, and honored
As a guide, your communication skills are essential in walking patients and families through these difficult decisions
