Nurses and other hospital staff often find themselves in ethical dilemmas in their medical practice, especially those that are in association with end of life care. One of the current ethical issues encountered in end of life care is advance care planning. Advance care planning involves a patient's decisions for his or her future. Healthcare professionals or family members acting on behalf of people who are unable to make their decisions for themselves are guided by advanced plans which express the preferences on care and treatment. Advance care planning is an issue of significance in the aspect of ethics at the end of life care setting.
Advance care planning is crucial for any individual whether already in a state of illness or healthy. Today, any person is able to put down the health conditions and treatment that they would like to receive when they do get ill. These plans are most important for patients who are unable to speak or those who are not able to decide for themselves. Such are the patient in intensive care units, those with palliative or in end of life care. Healthcare professionals obliged to take charge of making decisions on the methods and conditions of treatment on behalf of the patient should always adhere to the interests of the patient (Curtis and Vincent, 2010).
Delegate your assignment to our experts and they will do the rest.
Advance care planning faces a lot of confounding issues or situations. Healthcare providers may feel that provision of treatment in end of life care may assist the patient. Legalized medical principles that support withdrawing or withholding of life-sustaining treatment in some countries may not be in the best interest of the patient of the healthcare providers. The patient or carer’s consent on the form of treatment is most important in advance care planning.
Healthcare professionals should acknowledge the fundamental key points about advance care planning. The patient should discuss his or her wishes with the healthcare professional. If a patient makes a decision to refuse any particular advance treatment, it should be respected no matter how critical the treatment is. A decision made by a patient to turn down a life-prolonging therapy must be in writing and also signed and witnessed.
As a healthcare professional, I agree that every individual has a right to choose what kind of treatment he or she would wish to have. The interest of every patient matters and the form of therapy should always be in their best interests. In end of life care situations, conditions that present dilemmas to health workers occasionally present themselves. Health workers may suggest a life-sustaining treatment for a patient in end of life care only to realize that the patient has a written document that prohibits such kind of treatment or therapy. The main worry of patients refusing advanced life-sustaining treatments is the fact that they may inadvertently prolong suffering and the delay the dying process, rather than bring healing and recovery.
Some of the life-sustaining treatments include cardiopulmonary resuscitation, artificial feeding and hydration, ventilation and intravenous medicine. Basic care is also provided to patients in end of life care which consist of nursing care and pain relief which is done using drugs. In some countries (specifically in Britain), the medical associations have a code of practice that states that a patient can say no to life-sustaining medical care, but patients are not eligible to say no to primary care.
Some principles have been developed to help patients, families and healthcare providers in making meaningful morally accepted decisions that relate to care at the end of life care situations. These principles include autonomy of the patient, beneficence, non-malfeasance and justice.
It is recommended that consent is sought for all the medical treatment in the hospital. People or patients choose to give or refuse consent in order to accept or refuse medical treatments. In end of life care, patients are unable to give or refuse consent for the necessary procedures. Family members or healthcare professionals acting on behalf of the patient is obliged to give consent in agreement with the patient's interests. If before the illness, the patient had written a well-signed document regarding advance treatment in end of life situation, then the interest of the patient must be respected and treatment offered as appropriate.
Refusal of a patient regarding life-sustaining medical treatment correlates to the goal of medicine especially in cases where death is inevitable. In fact, currently, in certain countries (in the U.K.), it is indeed recognized that if death would definitely occur, life-sustaining treatments may be withdrawn altogether or stopped. In these situations, the objective of medical practice is directed at the relief of pain and symptoms.
Ethical debates on withdrawing life-prolonging medical care are still being conducted on many fronts. In most cases, offering medical care according to accepted best clinical practice does not hasten death. Consequently, many medical associations argue out that withdrawing life-sustaining care may fasten death that is already known to occur soon. In some cases where a person is proved to lack capacity in decision making, doctors may offer treatment where they think is in that person’s best interests (Ellershaw, 2011).
Healthcare professionals should be sought by individuals or family of the patient. Healthcare professionals are critical in assisting people in giving valid and reasonable consents on treatment. Healthcare professionals provide detailed and appropriate information on the specific treatment including its significant to the patient.
References
Curtis, J. R., & Vincent, J. L. (2010). Ethics and end-of-life care for adults in the intensive care unit. The Lancet , 376 (9749), 1347-1353.
Ellershaw, J. (2011). Care of the dying: a pathway to excellence . Oxford University Press, USA.
