Ethical Dilemma – Case Study
Executive Summary: Ethical Dilemma
As an application exercise, identify a specific ethical dilemma related to the health care needs of patients or populations in the community. This application exercise is a case study of a situation of which you are professionally involved or one in which you are an observer currently occurring. Assess, apply ethical analysis and clinical reasoning. Discuss interventions. If the issue has been resolved, discuss your thoughts regarding the outcome. If the issue is yet to be resolved discuss possible outcomes and your thoughts. Include the use of supportive technologies used to assess, intervene and evaluate (HIT, monitoring devices, etc).
Points = 100
Description of the Case and the Ethical Dilemma – 20 Points.
Ethical analysis – 20 Points
Supportive technologies – 10 Points
Interventions – 20 Points
Evaluation – 20 Points
APA Format and Organization, include Title Page and References (minimum – 4) – 10 Points
Content: Title Page, Reference List, Content – excluding Title Page and Reference List 500 – 1000 Words.
MY CHOICE-End-of-Life Decision-Making
Scenario:
My patient Mrs. Smith, is on the liver transplant list but has just been diagnosis with metastatic cancer. Out transplant team has advised her about treatment options that may prolong her life by six months to a year. However, to the dismay of her family, my patient has chosen comfort measures only. Mrs. Smith has prepared an Advanced Directive, including signing a DNR (Do Not Resuscitate).
Ethical Dilemma:
Decisions about end-of-life care is one of many examples of ethical dilemmas in nursing. Nurses can easily become overwhelmed when trying to comfort loved ones while honoring patient wishes.
How to Deal with this Ethical Dilemma:
Nurses are invaluable resources of help for patients and their loved ones during end-of-life transitions. Since Mrs. Smith is of sound mind and clearly understands her prognosis with and without treatment, she has the right to decide what treatment she does or does not want. Although the situation may be difficult, my primary responsibility is to my patient. Nurses must advocate for the autonomy and rights of patients. Because the patient in this scenario prepared an Advance Directive, the responsibility of following her wishes may be easier.
Ethical Dilemma
Student’s Name
Institutional Affiliations
Ethical Dilemma
The goal of the nurse in palliative care is to alleviate pain for patients and improve their quality of life. It is also important to note that nurses must respect their patient’s decisions during end-of-life care. Nurses may be faced with ethical dilemmas, especially when their patient’s decisions contradict their values and those of the nursing profession (Akdeniz et al., 2021). They can successfully get out of ethical dilemma situations by performing an ethical analysis and applying clinical reasoning to select moral interventions that will generate the best possible outcomes for patients (Schofield et al., 2021). This executive summary will explore a scenario of an ethical dilemma that was once faced in professional practice.
The Situation and Ethical Dilemma
My patient Mrs. Smith is on the liver transplant list but has just been diagnosed with metastatic cancer. Our transplant team has advised her about treatment options that may prolong her life by six months to a year. However, to the dismay of her family, my patient has chosen comfort measures only. Mrs. Smith has prepared an Advanced Directive, including signing a DNR (Do Not Resuscitate). Decisions about end-of-life care are among the many examples of ethical dilemmas in nursing. Nurses can easily become overwhelmed when trying to comfort loved ones while honoring patients’ wishes. The ethical dilemma in this scenario is whether the nurse should honor the patient’s wishes and place her on comfort measures only or offer treatment that will prolong her life by six months to a year.
Analysis
The American Nurses Association’s (ANA’s) Code of Ethics for nurses outlines nine provisions that govern nursing practice. Provision 1 directs nurses to respect and provide compassionate care to their patients based on their unique attributes (American Nurses Association, 2015). Patients receiving end-of-life care such as Mrs. Smith have unique features that the nurse must respect during the healthcare delivery process, provision 3 can cause an ethical dilemma as it emphasizes the importance of protecting the patient’s health rights and safety. In Mrs. Smith’s case, respecting the patient’s autonomy rights contradicts the nursing goal of respecting her health and promoting safety. The nurse’s wish is to provide care that will improve the patient’s quality of life and prevent early death. Offering a treatment option that will prolong the patient’s life by six months to a year will enable the nurse to fulfill this wish. Yet, Mrs. Smith has chosen the type of care that she wants, and the nurse will have to respect her decision. Although respecting the patient’s wishes might contradict the professional values of promoting the patient’s health and safety, it is the best action to take in the scenario because it demonstrates the nurse’s primary commitment to the patient as outlined in Provision 2 of the ANA Code of Ethics.
Technologies
Supportive technologies such as electronic health records can help the nurse to record and safely store patient information for future reference. This will be useful in case Mrs. Smith gets to a situation where she lacks the cognitive ability to make her own decision (Kernebeck et al., 2022). As Tyacke et al. (2020) explain, patients who are receiving end-of-life care can choose to prepare an advanced directive to express their wishes and desires regarding the treatment options that can be provided when one gets to a scenario where he or she will be unable to make decisions. Electronic health records technology offers an opportunity for the documentation of and storage of an advanced directive for easy access in the future when needed.
Interventions
Nurses are invaluable resources of help for patients and their loved ones during end-of-life transitions. Since Mrs. Smith is of sound mind and clearly understands her prognosis with and without treatment, she has the right to decide what treatment she does or does not want. Although the situation may be difficult, my primary responsibility is to my patient (American Nurses Association, 2015). Nurses must advocate for the autonomy and rights of patients. Since the patient in this scenario prepared an Advance Directive, the responsibility of following her wishes may be easier. The nurse needs to involve interdisciplinary teams in decision-making to ensure that the patient receives care that will demonstrate respect for her rights (Pereira et al., 2018). For example, a lawyer and family members/significant others must be present during the signing of the advanced directive to avoid possible issues that might arise in the future suppose the patient’s health takes a negative trajectory.
Evaluation
Healthcare professionals are guided by ethical principles to make moral decisions during end-of-life care. Advocating for autonomy and respecting the patient’s rights in the current scenario generated positive outcomes in that it strengthened the therapeutic relationship between the healthcare providers and the patient as well as his family (Luna-Meza et al., 2021). One of the key roles of the nurse in end-of-life care is to identify and address ethical concerns that might arise during the healthcare delivery process. In this respect, they must view the patient as an autonomous individual whose decisions need to be respected.
Conclusion
Healthcare professionals must make ethical decisions when working with patients with terminal illnesses. Through ethical analysis, they can identify the ethical concerns that may arise, including those that might affect the therapeutic relationship. As observed in Mrs. Smith’s case, respecting the patient’s autonomy and rights strengthened the therapeutic relationship between the healthcare providers and the patient as well as his family.
References
Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care. SAGE Open Medicine, 9, 20503121211000918. https://doi.org/10.1177/20503121211000918
American Nurses Association. (2015). Code of ethics with interpretative statements. Silver Spring, MD. https://nursing.rutgers.edu/wp-content/uploads/2019/06/ANA-Code-of-Ethics-for-Nurses.pdf
Kernebeck, S., Busse, T. S., Jux, C., Dreier, L. A., Meyer, D., Zenz, D., Zernikow, B., & Ehlers, J. P. (2022). Evaluation of an electronic medical record module for nursing documentation in paediatric palliative care: involvement of nurses with a think-aloud approach. International Journal of Environmental Research and Public Health, 19(6), 3637. https://doi.org/10.3390/ijerph19063637
Luna-Meza, A., Godoy-Casasbuenas, N., Calvache, J. A., Díaz-Amado, E., Gempeler Rueda, F. E., Morales, O., Leal, F., Gómez-Restrepo, C., & de Vries, E. (2021). Decision making in the end-of-life care of patients who are terminally ill with cancer – a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers. BMC Palliative Care, 20(1), 76. https://doi.org/10.1186/s12904-021-00768-5
Pereira, S., Fradique, E., & Hernández-Marrero, P. (2018). End-of-Life decision making in palliative care and recommendations of the Council of Europe: Qualitative secondary analysis of interviews and observation field notes. Journal of Palliative Medicine, 21(5), 604–615. https://doi.org/10.1089/jpm.2017.0403
Schofield, G., Dittborn, M., Huxtable, R., Brangan, E., & Selman, L. E. (2021). Real-world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice. Palliative Medicine, 35(2), 315–334. https://doi.org/10.1177/0269216320974277
Tyacke, M. H., Guttormson, J. L., Garnier-Villarreal, M., Schroeter, K., & Peltier, W. (2020). Advance directives and intensity of care delivered to hospitalized older adults at the end-of-life. Heart & Lung: The Journal of Critical Care, 49(2), 123–131. https://doi.org/10.1016/j.hrtlng.2019.08.018