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Kevin Jones is a farmer in his mid seventies. He is married to Dawn and has two children, Bronwyn and Daryl. Dawn has experienced a massive stroke three weeks ago and is now unconscious. Her condition continues to deteriorate and the nurse has initiated a family conference to discuss the next stage in her care plan. Kevin, Bronwyn and the nurse have a heated discussion about their ideas around Not for doing CPR. We have an obligation to respect the autonomy of dawn, Bronwyn and there father Kevin Jones which is to respect the decisions made by other people concerning their own lives. This is also called the principle of human dignity. It gives us a negative duty not to interfere with the decisions of competent adults, and a positive duty to empower others for whom we’re responsible. All we can do is listen to what each person have to say and what there worries and concerns are and help to explain when needed. Later in the essay we will be talking about the 4 principals of law and ethics and they are Autonomy – respect for the patient’s right to self-determination 1. Beneficence – the duty to ‘do good’ 2. Non-Maleficence – the duty to ‘not do bad’ 3. Justice – to treat all people equally and equitably The principle of autonomy is the individuals have to be permitted personal liberty to determine their own actions to. This means to respect an individual as self-controlled chooser. With in health care respecting people’s autonomy requires us to consult people and obtain their agreement before we do medical procedures on them as in the case with Dawn, hence the obligation to obtain informed consent from patients before we do any medical procedures to help them. Across the common law world there has long been recognised “a competent adult’s right of autonomy or self-determination: the right to control his or her own body.” in accordance with that right: A competent adult is generally entitled to reject a specific treatment or all treatment, or to select an alternate form of treatment, even if the decision may entail risks as serious as death and may appear mistaken in the eyes of the medical profession or of the community … it is the patient who has the final say on whether to undergo the treatment. This common law right has been recognised as an aspect of a number of fundamental human rights, including the right to privacy, security, and protection from cruel, inhuman or degrading treatment. Beneficence and Non-maleficence If the scenario is analysed, and the family’s decision consideration, a question arises about the intentions of the family. However, if the intensions are good then this act takes us towards the ethical principles of beneficence and non- malificence. The ethical principle of beneficence requires healthcare professionals to treat their patient in the same way as they would with others to maximise that patient and the principle of non-malificence assures the duty staff to avoid causing any harm to the patient. The principle of non-maleficence in doing no harm to Dawn. This means that it is the responsibility of the healthcare professionals to protect their patients. This goes along with the ethical theory of utilitarianism which believes in the actions that provide the greatest good for the greatest number of people. In healthcare ethics, utilitarianism supports the idea of maximum benefits and minimized costs and risks. The two principles of beneficence and non- maleficence often go simultaneously hand in hand. However, they may override each other at times. The principal of autonomy often comes into conflict with the principle of beneficence. In this situation, intentionally or unintentionally, healthcare professionals use paternalistic approach while caring for their patients as they consider that approach as useful for their patient. Though the intervention seems useful for the patient, yet it breaches the autonomy of the patient by disrespecting the right of her decision in the treatment. It is important to note that while situations like these require healthcare professionals to critically analyze the risks and benefits associated with the choices that they make, in the process of choosing the best option, the entire situation along with its consequences should be taken into account, well discussed and planned so that the decision made should promote maximum beneficence and minimum or no harm with respect to autonomy. Conclusion To sum up, There seems no perfect answer to an ethical dilemma. The paper has discussed the application of the ethical principles in the given situation. It is hard to justify the use of one principle over another. Yet the ethical decision making process provides a guide to take a step ahead and apply the best possible principle. However, it may not be the perfect choice but it may result in maximum beneficence and minimum harm which could be avoided. The framework that guides nursing practice for Nurses Association code of ethics and the patient bill of rights should also be taken into consideration while deciding for the best choice in situations which give rise to an ethical dilemma. Nevertheless, in any such situation, pros and cons and risks and benefits should be weighed against to get to the get best possible solution which would be in favor of the patient. The fourth ethical principle, justice, means giving each person or group what he/she or they are due. It can be “measured” in terms of fairness, equality, need or any other criterion that is material to the justice decision. In nursing, justice often focuses on equitable access to care and on equitable scarce resource allocation. So with the family they will need to all be treated the same and each have the right to say what they need to say. Nurse can offer the same support to dawn’s husband and kids. Ethical issues. When life support first came out, it was perceived as something good, special and a real life-saving procedure. These days, people are divided between different ethical issues, especially with the number of landmark cases that fueled debates to be carried on until today. Some of the concerns being raised include: – Quality vs. the quantity of life: It may be true that life support can prolong the life of Dawn, but are they really living without the discomfort or indignity? Are Kevin and his childrens really thinking about the welfare of their mum/wife or simply holding on to the hope of a full recovery? Giving doctors autonomy: If family members answer yes to a doctor’s question of “do you want us to do everything”, they are highly likely to be setting themselves up for unethical practices. Although doctors are bound by their ethical and legal obligations to provide treatments in the context that can best help the Dawn and their families, some make decisions without consulting surrogates, while others don’t even provide a clear and comprehensive explanation as to what is really involved in the process. Withholding and withdrawal of life support:When is enough really enough? The principle behind withholding and withdrawal of life support states that treatment may not be initiated if the patient or surrogate refuses. There have been cases, however, when physicians suggest for treatments to be withdrawn, but family have strongly disagreed. Due to the many advantages and disadvantages of life support, it is vital that the family or relative of a patient evaluate the situation carefully. They should consider the many factors at play, which include: The patients’ quality of life if they do recover from their coma. Will they be brain dead, in pain, etc? The chances of a patient surviving. The available treatment plans other than life support. The length of time and the costs associated with life-sustaining treatments.The wishes of the patient versus the wishes of the surrogates.The possibility of doctors finding a cure while a patient is on life support.The decision to withhold life-support treatments and when. List of the Pros of Life Support 1. Increase the chances of survival. When a patient is brain dead or no longer conscious, the decision to initiate life support falls on the hands of the surrogates (Kevin and his two childrens). Most of the time, the decision to put someone on life support revolves around the idea that a patient is given the chance to live longer or recover fully, which means that, denying them the treatment, would be equivalent to killing them. The extended time frame that the life-sustaining treatment provides allows the family to have hope, come to terms with the traumatic event, accept the situation, and have more time to grieve. This also gives doctors a chance to continue to evaluate the patient and provide newly discovered treatment if, there is any. There have been cases that a patient fully recovers, after being put on life support, but the percentage of this happening is not that high. Nonetheless, the time given for the family to hope and for the patient to survive is invaluable. .Allow families to come to terms with death. Most of the time, it is the hope that a patient will recover that motivates surrogates to initiate life-sustaining treatment. Over time, they will experience different stages of grief, until they can fully accept the fact that a loved one have little to no chance of surviving. They will reach a point when letting go and death becomes the only sensible option for them and for the patient. At this stage, deciding to unplug the machines would not be as difficult. Although they would still grieve over the loss, they would not have any regrets, considering the time they have allowed for a recovery to happen. They would not have to spend their time thinking about the ‘what ifs’ 1. Prolonged agony. It is a common argument that putting patients on life support only prolongs their agony. Life support, as defined in USLegal as a medical treatment that, “when applied to the patient, would only serve to prolong the dying process where the patient has a terminal illness or injury, or would serve only to maintain the patient in a condition of permanent unconsciousness”. However, it does not include administration of medication that will provide comfort to the patient or even alleviate pain. Based on the definition, it is clear that life support may only cause the patient unnecessary suffering. This explains why some people would have a DNR in place or tell love ones beforehand not to put them on life support. What is the point if a person is diagnosed with persistent vegetative state, anyway? Unfortunately there are plenty of misconceptions about life support, especially on brain death, according to Arthur Caplan, director of the Division of Medical Ethics at NYU Langone Medical Center. In the case of Jahi McMath who was brain dead following a surgery to remove her tonsils, he believed that doctors should have been more transparent with regards to the finality of brain death. This is to avoid a situation where the parents don’t really understand what is going on and would resist any removal of machines, or that they have the “impression that dead people can come back to life”.

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