The goal of end-of-life care for dying patients is to prevent or relieve
suffering as much as possible while respecting the desires of the
patient.There are ethical challenges that providers face in end-of-life
care, and in these decisions, they must consider the rights, dignity, and
vigor of the patient and his/her family members.Some specific issues
that create ethical challenges include decisions regarding resuscitation,
mechanical ventilation, artificial nutrition and hydration, terminal sedation,
withholding/withdrawing treatment, euthanasia, and physician-assisted
suicide. (Akdeniz, et al, 2021) Technology advances have created more
challenges for providers when caring for patients who are at the end of
their life.
Healthcare providers working with patients and their families at a
patient’s end of life must understand and demonstrate the universal
principles ethics: autonomy, beneficence, nonmaleficence, fidelity, and
justice.Autonomy is a person’s right to decide about the care they want
to receive and needs to be respected by the medical providers. Advance
directives can help make this happen as they are oral and/or written
instructions made by a patient in the event he or she is unable to
communicate their wishes themselves.When a patient’s wishes are not
known, their provider must practice beneficence, which is when a
physician advocates for the treatment that should deliver the best care to
the patient.When caring for a patient, particularly at the end-of-life, some
pain may be felt because of a treatment provided.Nonmaleficence is the
moral justification of providing this pain-causing care if the benefit of the
care is greater than the harm caused. Fidelity requires providers to be
honest with their dying patients about their prognosis and facts about
their condition. This truth telling is the foundation of respecting a patient’s
autonomy- by providing the facts, a patient is better able to make a
decision.The principle of justice is to ensure that the distribution of
resources is fair, and that the delivery of care is impartial. Regarding end-
of-life decisions, this can be achieved through education by providers,
helping them to acquire knowledge of the latest treatment options to
ensure they are acting with justice. (Akdeniz, et al, 2021)
Advances in technology brings about a debate in end-of-life
care.Technology can keep a person alive after their body is unable to do
so on its own, raising the question of how much intervention through
technology should occur when caring for a person at the end of their
life.My husband was on and off a ventilator for months before he passed
away and looking back, I now see that the machine is the only reason he
lived as long as he did.While we were going through it, I knew that the
machines helped him live, but really believed his body was still doing
most of the work on its own. We did not have “the talk” about our wishes
before he got sick, as this all happened so quickly and we were young, so
I had to make decisions based on what I thought he would
want.Thankfully he could blink his eyes at me through much of his
hospitalization, minus a few times he was put into a medically induced
coma, so I felt comfortable making the decisions I made. It has been 12
years now since he died, and I still question the decisions I made,
particularly the day I told the doctors to turn off the machines. I believe
that some of his doctors struggled with the ethics of the decisions they
were making and the impact they had on the decisions I made as
well.These doctors had been caring for him for months and I know
understood more how much technology was keeping him alive. I can
imagine some of them were torn as he had good days and bad days and
swung so far from one extreme to the next.I imagine they struggled, as
many healthcare providers do with the ethical challenges their job
provides.
I do not regret any decision I made, but if I had to do it all over again, I
hope that I would be more aware of how much intervention was needed
and to be more aware of when the body was not able to fight a
reasonable amount on its own.End-of-life choices, in my opinion, should
be acknowledged and discussed for people of all ages.These
conversations will make decisions easier on both the family and the
healthcare team as they are many times “stuck” as families battle it
out.The ethical guidelines discussed can help direct them but trying to
work through a situation with a patient who is dying while their family is
fighting adds extra pressure. The hopes of what technology can do might
be farther reaching than reality, and when it comes to someone who is
dying, many people will hope technology is the answer.
Tiffany
Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life
care.SAGE Open Medicine.https://doi.org/10.1177/20503121211000918
