When patients are termed as terminally ill with cancer, the impact of the information precipitates a feeling of vulnerability and isolation. The contemplation of impeding death wanes the concept of hope as the patients feel that a life extension is unattainable. With this in mind, nurses need to ethically care for the terminally ill cancer patients as in so doing; the patients will realize an improved quality of life in their end life (Nevidjon & Mayer, n.d). However, debates on healthcare reforms regarding the end of life care seem to get heated with societal views opposing the views of medical practitioners. In the context of cancer, the treatment implicates high costs on the family which eventually proves ineffective. The ethical issue that arises is, “life at what cost?” (Coyle et al., 2015). Although nurses have facts on costs and options in providing end of life treatment, barriers present on making informative conversation with the patient and his/her family. Nurses have to be bold and participate in the decision-making process as it has been proven to have positive outcomes.
Notably, nurses experience the most lengthy and close contact with terminally ill cancer patients. In the intensive care unit, various end of life states presents, and it is all upon nurses to provide care. Despite the different states, all terminally ill cancer patients require technical assistance for most bodily processes to take place. If the technical support is availed, the patients may live for a considerable amount of time, but the hope of recovery is nullified (Coyle et al., 2015). Given the differences of opinions regarding a patient’s end of life options, nurses face a strong challenge in maintaining professional ethics in the face of societal debates on end of life care. It remains the mandate of nurses to enlighten the community on the differences between, "a dignified death and prolonging life at all costs." Although the context and set of circumstances vary, the nurse cares for the same body. As a result, the Liverpool Care Pathway for the Dying Patient (LCP) was advanced to assist in establishing the complex interventions essential to deliver, “dignified and comfortable end-of-life care” (Melia, 2013). After its implementation, the LCP care pathway elicited a public debate with sections of the press fuelling the debate with claims that patients were, “being 'starved,' 'deprived of fluids' and left to die” (Melia, 2013). Other claims held that nurses used the LCP process to free up hospital beds with the NHS trusts receiving incentives to advocate for its use. Nevertheless, the aim of LCP was to avail a means of realizing a well- harmonized end of life care for terminally ill patients.
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Similar to LCP, most health care policies emphasize on individual choice as well as the rights of the individual (Nevidjon & Mayer, n.d). At some point, it becomes a challenge to harmonize the two with the desire for common good. As a result, significant interest has risen on physician-assisted suicide with different countries taking different approaches to the subject matter. Notably, the medical profession controls the jurisdiction of what can be termed as medical care, and physician-assisted suicide falls in this category. On its part, the nursing profession contributes significantly to the end of life care for terminally ill cancer patients. The use of euphemism in the profession makes some processes such as terminal sedation seem acceptable (Coyle et al., 2015). However, views from public debates put questions on the extent of application of terminal sedation, with most holding the view of applying it when death seems imminent. The conflict between public views and healthcare professionals’ views does not augur well with professional ethics. The ethics of best interest bears on the need for the patient to live his/her life without depending on the value of their life to other people. On the other hand, terminal sedation can be considered acceptable if the symptoms presenting at the end of life seem intolerable.
From a Hippocratic point of view, euthanasia and physician-assisted suicide do not fall under the acceptable medical practice. However, terminal sedation involves gradual life ending process that provides comfort and dignity to the patient thus having some Hippocratic basis in it (Nevidjon & Mayer, n.d). This argument, in turn, makes the nursing approach to ideas of physician-assisted suicide and terminal sedation to lean on the defensive side. Nevertheless, nurses and other healthcare professionals give priority to patient choice and individual autonomy thus delaying the initialization of terminal sedation though a legal practice. The legality of these practices further make the treatment options for terminally ill patients difficult.
In fact, a significant variability exists regarding the palliative options taken as last resort and depends more on the views of the healthcare professionals rather than the patient’s view (Coyle et al., 2015). The bottom line is that the medical professionals determine the most appropriate option for different terminally ill patients. Although the law needs to be considered, leaving it to determine medical issues results into a distorted view of the ideal healthcare practice. In fact, clinical practice has no clear cut ways of approaching every case but rely on the judgment and practical knowledge of medical practitioners. However, the influence of the society affects the conduct of medical professionals in caring for terminally ill patients with the liberal approach eliminating the freedom of healthcare givers in such contexts (Nevidjon & Mayer, n.d).
In conclusion, many options present regarding end of life care for terminally ill cancer patients. With the high cost and largely ineffective treatment, medical professionals have a duty to inform the patient’s family on the possible options. As a result, there will be a realization of a proper decision on the patient’s care at their end life that is ethically approved by the Hippocratic principles.
References
Coyle, N., Manna, R., Shen, M., Banerjee, S., Penn, S., Pehrson, C., Bylund, C. (2015). Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses. Clinical Journal of Oncology Nursing , 19(6), 697-702. doi:10.1188/15.cjon.697-702
Melia, K. M. (2013). When the body is past fixing: caring for bodies, caring for people. Journal of Clinical Nursing , 23(5-6), 616-622. doi:10.1111/jocn.12380
Nevidjon, B. M., & Mayer, D. K. (n.d.). Death Is Not an Option, How You Die Is - Reflections From a Career in Oncology Nursing. Nursing Economics .
