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Ethical Decision Making Paper The following case involves a seventy one year old male patient who told his family if the time ever came when he could not sustain life on his own he didn’t want measures taken to do so. This patient found out in the late summer of 2008 he had stage four pancreatic cancer. The doctor gave him about four weeks to live. At this point he took things into his own hands and made his daughter durable power of attorney for his healthcare needs. Over the next few weeks he became very week and could no longer walk.
He stopped eating and drinking due to the mixture of him not feeling well and the medication he was taking. Eventually Hospice was called in to help assist with him and provide some comfort measures. Due to the increased incontinence he was having, hospice felt it was necessary to put a catheter in place. The family became concerned about him not eating and drinking and wanted an IV line started in the patient. Some of the family chose to place the line. The daughter who was the power of Attorney of healthcare over him decided a few days later to discontinue the IV line.
This caused a big argument among the family members. The hospice nurse was ordered to discontinue the line. She felt horrible going into the home and discontinuing the IV line but she had to follow the doctor’s orders. Approximately one week later the patient passed away. The ethical decision the nurse was put in was not what she would have done with her own family member, but this was her job and she needed to follow the orders from the physician. Multiple things need to be taken into consideration before a good a good ethical decision can be made.
A good ethical decision making process is what we will be looking at throughout this paper. When faced with the need to make an ethical judgment, we may choose the first idea that comes to mind or take advice from another individual. However, a professional who wishes to maximize the chances of making the best decision possible in any given circumstance, may enhance the possibility of providing good care to the dying person and/or loved ones, and protect them self from repercussions if someone is unhappy with the events that took place or the outcome that followed some sort of decision making model.
Further, the importance of consultation and documentation (as well as documentation of the consultation) throughout the decision (Hamric, Spross,: and Hanson, 12). Step One: Gather Relevant Information This patient was diagnosed with stage four pancreatic cancer and given a month to live. Options of treatment were discussed with the patient and his family. This patient decided he would have a stent put in to help ease the pain but that was as far as he wanted to go. The patient decided to make his daughter the durable power of attorney for his healthcare. He stated his wishes that he wanted no measures taken to sustain his life.
He believed he had lead a good long life and wanted to live his final days at home with his family not running back and forth to the hospital. The patient decided he thought the quality of his life would be better without treatment. He states “if god says it’s time to go why try and fight him A durable power of attorney for healthcare is when you place someone else in charge of your decisions for your healthcare needs. By placing his daughter in control of healthcare decisions even though he wanted no measures taken to sustain his life she had the final say in what the decision was.
Step 2: Type of Ethical Problem There are many types of ethical problems. Ethical problems become dilemmas when there are at least two good choices. The choice then becomes between good and good or good and bad. (Hamric, Spross,: and Hanson, 8). The nurse was placed in an ethical dilemma with this patient’s family. A ethical dilemma can occur among any type of problem that has more then one correct answer in any situation The dilemma came from part of the family wanting the IV line kept in while the other family member didn’t and the nurse but the nurse had to follow the orders from the doctor.
When presented with an ethical issue, there are a variety of ways of deliberating and resolving what to do. Regardless of the steps involved and the order in which they are considered, there must be a foundation to the problem. Making our own decision on what kind of treatment we receive at the end of our lives is a right we all have. Although some people think it is not morally right we all as individuals hold the right to our own healthcare as long as we are healthy and competent. Medical technology has shaped the circumstances of death, giving us options about when, where and how we die.
Intervening at the moment of death, technology can now sustain lives, but often there is little or no hope for recovery or for a meaningful existence(Kleespies 26). The traditional value to preserve life by all possible means is now being weighed against quality-of-life considerations(26). Step 3 Ethical Theories Many ethical theories have been studied. One of the first ethical theories would be beneficence. The principle of beneficence guides the ethical theory to do what is good. (Walker16). This priority to “do good” makes an ethical perspective and possible solution to an ethical dilemma cceptable. (2) Looking at this theory it is safe to say this patients family strives to achieve the greatest amount of good that will benefit their loved one. The family members who choose to have the Iv line inserted thought they were doing good for the patient. The daughter of the patient also thought she was doing well by following her father’s wishes. At this point with the patient is in the last few days of his life the best thing at this point would be to honor his last wish and do nothing to sustain his life any longer.
The second of the ethical theories we are looking at is Utilitarianism which is an act that Is right if it helps bring about the best balance of benefits over burdens (Purtilo 73). Utilitarianism is an effort to provide an answer to the practical question “What ought a man to do? ” Its answer is that he ought to act so as to produce the best consequences possible (Hamric, : Spross, and Hanson, 2000)… There are not many consequences of taking out the IV line because the end result is still terminal. Step 4: Exploring the Practical Alternatives:
Option 1- The patient stated to his daughter his wishes regarding the issue of his healthcare. The patient clearly stated when the time came for him to die if he could not sustain life on his own he wanted no steps taken to prolong his life. Therefore while he was still in sound mind he made his daughter Durable power of attorney over his healthcare needs. The patient should have signed a DNR to insure his wishes were followed through with. In that situation there would have been no doubt or second guessing by the family on what he wanted.
Option 2- The family had a conflict with each other regarding end of life care for their family member. The patient had only discussed with the daughter how he wanted cared for in the final days of his life. Therefore the other members of the family were not informed he wanted no measures taken to prolong his life. The family should have been thinking about the amount of suffering the patient was going through and put there differences aside and made things a little less stressful for the patient. Option 3 The family had a hard time dealing with the issue of loosing there family member.
They were not really given anytime to prepare themselves for the devastating news they were given so when things got bad they wanted someone to blame and ended up taking it out on each other. The family members who choose to place the IV were reaching for anything that might help save or prolong the patient’s life. In a situation like this talking things out instead of placing blame on one another would have been the best for this family. The most important step in the decision making process is to insure the patient Is getting the treatment they need along with anything the patient needs to make them comfortable.
Following the wishes of the patient is number one when ever possible. We all find ourselves in a situation from time to time that we feel uneasy about or uncomfortable with but we all need to remember the number one person in these situations is always the patient. In the best of circumstances dying can be a peaceful time during which important memories are shared. To enable the telling of these stories, all healthcare providers along with family members must manage the symptoms of the patient and do our best to keep our disputes and feelings under control.