Caregivers are always faced with ethical dilemmas when dealing with clients. Doctors and nurses and therefore guided by codes of ethics that help them in making ethical decisions. Health decisions pertaining to patients remain a key area of ethical concern. Policy development can go a long way in helping caregivers in the process of making decisions pertaining to the patients care. Various ethical theories have been developed to illustrate how ethical decisions are made. The aim of this essay is to evaluate different various practical ethical decisions that caregivers go through in the practice and how to offer ways of how they can be resolved.
Scenario 1
The nurse must not honor the request of the physician to talk to the family on transferring the patient to a major medical center for her to get advanced care with physical therapy and vigorous rehabilitation. The family desires are that their patient not be put under ventilator support since the patient would not have wanted that. As a nurse she should understand that the ethical guidelines require that she appreciate and understand the difference in the ethical values and views to those of the patient’s value system and culture and she should, therefore, advocate for what is the desires and decision of the patient’s members to let the patient remain in the facility as well as the desire to visit the patient fewer times in the coming days ( McCarthy, & Gastmans, 2015) .
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The autonomy principle has been violated in this scenario since the physician does not allow the patient or the family members of the patient to make their own decisions that affect the treatment and care they want to receive instead the physician makes the decision himself and goes to an extent of requesting the nurse to notify the family members ( McCarthy, & Gastmans, 2015) . The patient and the family members also are not provided information that is sufficient on the care and treatment administered which would guide in their decision making.
Respect for others as a principle has been violated by the physician by ignoring the voice of the family members where they insist that their patient would not want to be put under ventilator support. The physician does not give the patient or the family members the right to make decisions regarding what treatment and care are needed ( McCarthy, & Gastmans, 2015) .
The principle of veracity has also been violated by omitting the necessary information when the physician requests the nurse to tell the family members to transfer the patient. There is no clear information on the reasons as to why the patient should be transferred and the suggested therapy the physician advice which would help family members make the right decision.
The nurse can have moral distress from the recognition that the family members would refuse to transfer the patient to a better facility where the patient will receive better care and the fact that they plan to not visit their patient in the future days. The nurse can also begin to have moral distress from the scenario through the confusion on what action she should take. The nurse very well knows the ethical guidelines which require her to respect the desires of the patient or the patient’s family members and act according to those desires to give proper care to the patient. The nurse, however, receives a request from the physician to talk to the family members regarding the transfer of the patient which she does not even know if they will accept given that they had raised concern on the ventilator support. The nurse knows that she should allow the family members to make the decision but she has to pass the physicians information to the family members ( Pozgar, 2013).
The nurse should air her thinking to the physician regarding allowing the family members to make their own decision and for the physician to respect that so that she can maintain her integrity and act according to the guides of ethics ( Pozgar, 2013) .
Exercise 4-1
Summary
Jody Smith is completely paralyzed on her left side because of a cerebrovascular accident on the left side. Jody requires aggressive therapy for her to recover fully buts it is too painful. She does not desire to continue with aggressive therapy and asks the nurses the reasons why she cannot die in peace. Besides Jody’s pessimism, her doctor and her family are optimistic about her recovery.
The dilemma of the case
In this case, the dilemma is for the doctors to ignore Jody’s request for her to be left alone to die in peace or to respect her wish or whether to abandon Jody for her refusal to perform even the simplest of tasks. The nurses have a moral responsibility to take care of the sick but not to let the patients distress them with responsibilities that they can easily execute. Jody is an adult and has responsibility on whether to receive care or not ( McCarthy, & Gastmans, 2015) . The caregivers have the moral responsibility to provide care to the patients.
The available options, in this case, include respecting Jody’s wishes which include leaving her alone and not forcing her to engage in aggressive therapy, and not attending to her at all for her to die in peace ( Guido, 2014) . The option to ignore her request as doctors and continue offering care to her. For her children, they can ignore Jody’s request and find better care for her in another facility where she can be keenly managed.
In this resolving the dilemma I would therefore first consider the wishes of the patient. The assumption is that Jody does not want to receive the needed care despite the optimism of the doctors and her family. Her request is through words and actions is for her to be left alone to die slowly. She has already indicated that she does not want to part in any form of care especially the aggressive therapy and anticoagulant medication. Patients are allowed to make their own decision ( Guido, 2014) . However, the final decision lies with the doctor whether to honor or disregard the patients’ request.
Second I would consider the wishes of the family members. In cases where the patient is not capable of making decisions, the family has the role to make the decisions for the patient. The family members, in this case, want Judy to continue taking medication and aggressive therapy to help her recover. However, in this case, Judy is able to make her choices and she was a nurse during her days and she understands the decision she is making ( Guido, 2014).
I think that Judy is under pain especially when engaging in the aggressive therapy that is meant to address the CVA. Considering her age and her financial capacity to cater for the payment of the treatment. Jody’s behavior of not performing even the simplest tasks mean that she has given up on getting well (Philips, 2006). In this case, I think it is wise for the doctors and the family members to honor Judy’s wish and not to attend to her until she passes away.
Policy Needs in Shared Decision Making
There is a need for a policy that guides the caregivers in providing quality care and safe life of the patients. In our case Tyrell Dueck the patient makes the decision not to continue with cancer therapy and amputation of his leg which has cancer. As a result, cancer spreads to the lungs and there is little to be done. There is a need for a policy to guide doctors in helping patients make such lifesaving decisions. In cases where there is a chance to save the life of the patient do not want to continue with the treatment, a policy would help doctors in making the decision for the patient to a safe life. I would gather support from my fellow caregivers, nursing management to support my policy to improve the health of patients and safe life ( Agoritsas et al., 2015) . The ten questions identified by Malone has played a major role to assist in policy development.
The problem is patients refusing to undergo treatment when their life can be saved
The process is to undergo treatment when there is an opportunity to save the life of the patient.
In our case, one patient is affected but there are many who decide not to undergo cancer treatment.
Possible solutions are for the doctors to be part of the decision making especially when it is a matter of life and death and there is a chance to save the life ( Agoritsas et al., 2015) .
The ethical argument involved includes respecting the right of the patient to make a treatment decision, the decision of the family in making a treatment decision. The ethical responsibility of the doctor to save the life of the patient if they are in a position to.
The problem is effectively addressed when parties involved (patients or the public, caregivers and ethics committee) are engaged in policy development (Aulisio, & Arnold, 2008).
The healthcare providers including nurses, doctors and management teams are in a position to make the policy decision
The obstacles to the policy are the law that requires the rights of others to be respected ( Agoritsas et al., 2015)
Resources available are the professionals who can help in developing the policy
I can get involved by offering my views on the policy.
Proposed policy
Caregivers (doctors and nurses) to play a role in decision making in event that the patient is making the wrong decision in a situation of life and death.
From this case, the compelling rights being addressed are the rights if the patient and the family of the patient.
The rights of the patient, in this case, should take precedent. In case the patient is a child and is not able to make personal decisions, the right of the parents should take precedent.
A child who is about 14 years old has the right to make the decision of what happens to him. Ethically the child has the right to make such a decision because they are capable to make decisions that affect their lives.
As a nurse, I would have insisted Tyler get the leg amputated because it would have saved his life.
Conclusion
Patients are largely concerned with making decisions that pertain their health. If patients are not in a capacity to make such a decision the family members make the decision. Policy making is one of the ways of helping the caregivers to develop decision-making processes that can help in life-saving. Cooperation of the nurses and doctors help in minimizing distress that emanates with decision making. Moral distress affects the capacity of the caregiver to deliver their mandate. However, with concrete policies in place decision making becomes for the caregivers.
References
Agoritsas, T., Heen, A. F., Brandt, L., Alonso-Coello, P., Kristiansen, A., Akl, E. A., & Montori, V. M. (2015). Decision aids that really promote shared decision making: the pace quickens. Bmj , 350 , g7624.
Pozgar, G. D. (2013). Legal and ethical issues for health professionals (3rd ed.). Boston: Jones and Bartlett.
Aulisio, M.P., &Arnold, R.M. (2008). Role of the ethics committee. Helping to address value conflicts or uncertainties. Chest 134(2), 417-424.
Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ: Prentice Hall
McCarthy, J., & Gastmans, C. (2015). Moral distress: a review of the argument-based nursing ethics literature. Nursing Ethics , 22 (1), 131-152.
Philips, s. (2006). Ethical decision making when caring for the non-compliant patient. Journal of infusion nursing.
