Ethics on Dementia Patient - Case Study Example

ETHICS ON DEMENTIA PATIENT by The of the The of the School The and where itis located The Date A. Introduction Decision making is an instrumental aspect in our daily life. Decisions are reached on the basis of our values and beliefs as well as the legislation requirements or the rules of the society. According to British Medical Association (2014, p. 2), ethics are philosophical in nature. They are also keen on rightness or wrongness of human actions as well as the goodness or badness of motives behind these actions and the end of such deeds. Most of these actions and conducts are based on shared beliefs, value, and culture within a society. Most importantly is that ethics are concerned with guided decision making rather than specific set of rules or principles. The guiding rules to ethical decision making are autonomy, justice, beneficence, veracity and nonmaleficence. Unfortunately, it is always hard to address all the principles ate the same time, particularly, in a clinical situation. Autonomy refers to giving individuals the rights to make their own decisions. In many cases, ethical dilemmas arise when the person served makes a decision that differs with that of the healthcare team. Such dilemmas emerge because they are good but also contradictory to ethical reasons that fully satisfy the courses of actions. For instance, a conflict in decision making may emerge where the patient is refusing treatment while nurses are prescribing it in order to increase chances of survival to the patient. However, the autonomy principle states that all health parties must respect any decision or wish from the patient. Beneficence and nonmaleficence are tired together since they address the need to do good but no harm to the inflicted person. In a treatment case, the nurses are supposed to choose an option that does well to the patient but not cause any harm. For instance, a treatment with high degrees of success could be lethal to a patient, and therefore conflict on decisions may emerge. Veracity is the principle of being truthful as well as providing the victim with sufficient information pertaining their health conditions. For instance, nurses have the obligations of informing the patients with dense understanding about procedures that carries significant risks in order to allow the patient to make informed decisions. Full disclosure to such information supports the person’s autonomy. If the person decides to take the medication, then there will not be any ethical results. Justice is the principle that requires the clinicians to act fairly and equally on risks and benefits. For instance, some clinicians question the application of justice in paying more dollars to health insurers who provide hefty benefits to victims than seeking medical assistance through an approach of a public payer. Based on the Hippocratic Oath, one principle is rarely adequate in solving ethical dilemmas and therefore it calls for application of all the principles in making coherent and fair decisions. B. Case Study Mr. C who is a 70 year old man has lived together with her wife of 72 years in their home. He is suffering from dementia and lung cancer. In this period of sufferings, his wife has cared for her every single day. Due to the chest infection, Mr. C requires oxygen in his home in order supplement the needed air for the continuous support of his life. His health is trending to worse conditions due to his poor feeding habits. In most cases, he refuses to eat and drink at home. The past hospital visits have caused Mr. C distress and as a result of failing to cope well with the changing environment, he is snubbing every idea of having him seek health assistance from the health centers. As much as the hospital treatment can provide reliable assistance to Mr. C, it does not guarantee permanent cure of his condition. Accordingly, doctors and nurses are much concerned about this case and are suggesting him to seek treatment. On top of that, Mr. C’s wife has advised him to visit hospital where he can afford maximum treatment. As for her, she cannot cope with her husband’s condition any longer because she is distressed on top of being tired out of taking care of her husband ever since he contracted the disease. In fact, she wants and needs some rest. Mr. C older son is religious and strongly holds to the belief that their father will be well through committed dosage of prayer, trust and faith. He does not see the necessity of taking their father to hospital for medical assistance. Biblical facts, truths, and the doctrines that are based on promises and faith will be helpful to make him recover from this condition. This is an ethical dilemma and thus decision making is required to sustain the health rights of Mr. C based on the five principles of ethical actions. (i) Ethical Dilemma In ethical dilemma, three possible courses of action are found to allow Mr. C receive medical assistance from home where he shall be comfortable with the environment, promoting his happiness, or going to hospital to seek medical help as suggested by the doctor. These courses translate to maximum support from health teams. Alternatively, he can opt to refuse any medical support from home or hospital and remain faithful and waiting through supplication and prayers as suggested by the older son. There are costs and benefits in each of the above actions. First, to remain at home, he will acquire attention from a home nurse, and be happy from avoiding stress and monotony of moving up and down in the corridors of hospital. However, this approach does not guarantee him full attention, which he would have acquired from the doctors and nurses in the working environment where they are able to examine his degrees of improvement by using reliable tools and equipment apart from administering the best medication possible. It will not be necessarily possible that the home attention by a nurse will be adequate to his condition since team operation with other health professionals will be lacking. Above all, the initial care giver, his wife, will be greatly stressed given that she has been supporting her husband since the occurrence of the disease. The fact that she was too old to carry out some of the activities is also an assurance that he opts to seek medical help in hospital (Campbell, 2005, p 288-290). (ii)Medical Indications Clinical analysis through verbalization of the medical facts on this case will be suitable to benefit the patient from all possible forms of treatments. When preparing the medical approach of this case, it will be helpful to articulate aspects of diagnosis, prescribing the condition of Mr. C, goals and chances of successes of the suggested approaches of life support, and all contingency plans in an event that the treatment of Mr. C condition is effective (Turner, 2004, p. 208). Even though Mr. C presents his case such that he may win sympathy from his wife and the health team, the principle of autonomy gives him right to make decisions pertaining to his health. At this stage, reasonable health professionals may disagree on the best approach to diagnose Mr. C with less certainty on the outcome of prognoses. The underlying beneficence principle outlines what physicians aspire to help Mr. C by applying their accumulated knowledge and skills from the health sector. Nomaleficence entails evaluating all potential benefits and risks of the proposed actions. Obviously, doctors and nurses will try to maximize benefits to Mr. C and mitigate harm. In case the risks and benefits of interventions proposed are close to equivocal, the health team and Mr. C’s family will struggle to proceed. This dilemma will be solved based on four topic approaches that include medical indications, patient preferences, quality of life, and contextual features (Campbell, 2005, p. 89). Mr. C has several medical complications that are approaching severe state. It is very clear that the supply of oxygen must continue or else he will die. Moreover, Mr. C is suffering from lung cancer, a condition that requires close medical attention and analysis on the performance of the patient. Previous antibiotics proved ineffective in curing the cancerous condition on top of long term dementia condition. Since Mr. C will no longer be medicated in hospital, sustainable oxygen supply, and dementia palliation would count effective. In case he foregoes reliable supply of oxygen and close medical attention, the prescribed health issues will end his life after a short period (General Medical Council, 2014, p. 7). Moreover, Mr. C’s remaining life expectancy is cumbersome to predict due to the occurrence of severe tumors and dementia. Most importantly, foregoing an indicated treatment as suggested by the health team at an expense of exercising Mr. C’s preference will be an ethical imperative case given since it is likely to hasten death. It is a duty of every health practitioner to analyze the condition of the patient, and calling for a family meeting to discuss on the implications of what the patient wants, and finally developing an ethical approach of resolving the case (National Youth Agency, 2014, p. 5). (iii) Patient’s Preferences Articulating Mr. C’s preferences is more than just listening to his wishes. It will be equally important to consider that Mr. C is suffering from dementia hence his wishes need to be re-accessed and re-evaluated over time. This is so because memory loss may inhibit him from recalling the acuteness and lethalness of his condition based on the previous history of his health status. Moreover, it will be beneficial to access Mr. C’s realization of the medical indications. Patient preference roots from ethical impression of respect for Mr. C’s autonomy. In respecting autonomy, both nurses and doctors would strive to understand the wishes of Mr. C as well as the beliefs of his older son (Daniels, 2008, p. 67). The current conflict tries to resolve whether to apply autonomy principles or beneficence and nonmaleficence principles. Medical directives indicated that the choice for medical attention in that oxygen supply will be unreliable and insufficient to entire health conditions. Recently, Mr. C has stated that he no longer wants to seek medical attention in hospital because the environment is distressing. The lung cancer and dementia are approaching chronic levels on top of the difficulties in breathing, hence exposing him to mere chances of living long (Fleck, 1994, p. 368). Despite medical attention being debilitating, there is every reason to believe that approach is highly necessary in order to control Mr. C conditions. Mr. C family is divided on what is suitable for Mr. C given that his condition call for immediate and reliable medical care under qualified health practitioner. Mr. C’s decision could lay on reducing medical cost for the good of the family, but his dementia disease may be limiting him from understanding the critical conditions that are facing him. While Mrs. C wants the husband to consult medical care in hospital, their son is adamant that religious beliefs, steadfastness, and doctrines are sufficient to help the father recover from his ailing conditions. This ambiguity calls for further discussions between Mr. C, the health team, and his family (Nursing and Midwifery Council, 2015, p. 1). (iv) Quality of Life Medicare treatment is concerned with restoring, maintaining, and improving on the quality of life. Clinical ethics should consider effects that prescribed treatment has on Mr. C’s quality of life. Nurses and doctors perception on the quality of life may differ significantly from Mr. C and the family perception. In such a situation, the health team will apply Mr. C’s wish in determining the quality of life that he needs. Furthermore, patient autonomy places Mr. C in best position to make a judgment that favors him most. Both beneficence and nonmaleficence facilitate in determining the suitability of accepting or declining proposed therapeutic options or dialysis. Mr. C had stated that he would rather remain at home than going back to hospital on top of refusing to eat and drink. These behaviors indicate that Mr. C’s own assessment on his quality of life is in doubt since he has not suggested how he would prefer spending the remaining days of his life. Though Mr. C has not made any statement regarding the end of his life, his comorbidities (Lung Cancer, dementia, and chest infections) based on the history of the diseases will be essential in determining medical decisions and the course of the best decision. Apparently, the above entities will help the family and the medical team to impacts on Mr. C quality of life. (v) Conceptual Features This step aims at determining whether the contextual features are applicable to the Mr. C case and its ethical analysis. This decision will be dependent on religion beliefs of the patient, family dynamics and many more. In addition, these entities surround evaluation of the impacts of any decision on caregivers as well as the continued ability to provide the required care and support to the patient. The concepts of justice and fairness will also be applied in determining the direction of this case (The Hippocratic Oath, 2014, p. 2). Legal ramifications must also be evaluated. Despite the oldest son’s suggestion of holding Mr. C at home and rely on his religious doctrines to heal his father, these beliefs are not echoed by the patient. Therefore, they will not be independent on improving the health conditions of Mr. C. Furthermore, the suggestions from the older son would only be used to cement the main treatment aspects but should not be relied solely for this purpose. Religion beliefs and doctrines will play a vital role on impacting faith and hope to Mr. C, hence improving his life expectancy. It is scientifically proven that patients who integrate medical support with religious beliefs and values have over 72% likelihoods of surviving from a deadly disease than those who focuses their ailing health solely on antibiotics (Daniels, 2008, p. 233). Religious beliefs would be the determinant factor in decision making if only the statements were produced by Mr. C. Treatment issues that may influence decision making should be analyzed. For instance, most healthcares are driven by notion of serving the patients as quickly as possible, and releasing them since the insurance providers calculates flat fees but service costs. Similarly, health management is incentivized to reduce the cost for chronic approaches such as dialysis, hence improving the operations of doctors and nurses. Mr. C’s son tries to evoke his religious views of sacredness in order to encourage him to fight on. Mrs. C is tired of providing care to her husband, which is reason why she is suggesting him to seek medical assistance. There is fear that foregoing oxygen supply is going to worsen the case even to the levels of Mr. C’s death. Close examination of the patients will be helpful in determining medication that will be effective in suppressing the lung cancer as well as dementia. C. Nurse’s Role Medical staffs have the duty to unite the patient’s family to acknowledge the decision made. In addition, nurses have the right to autonomy of judgment and decision making in a situation with conflicts. They are known to provide most influential support and care to the patients than other body in the health environment. Role taking is achieved through institutional context and within a multi-disciplinary work behavior between doctors, nurses, and other caretakers. In every medical practice, the nurse is required to behave rationally and professionally so that the patient gains maximally from any decision arrived. In the current case involving Mr. C, nurses will act like a manager, a coordinator whose aims to develop a balance between doctors, Mr. C’s family, and other parties’ best interest. If the decision will be made on autonomy of Mr. C, a nurse will be required to provide all the necessary support to enhance improving patient’s health. Dementia analysis and therapy will be provided by the nurse. Moreover, it will be the nurse’s duty to ensure that the patient is exercising health feeding in order to add strength to the body and at the same time improve the reliability and functionality of the administered antibiotics. In case the informed consent is not forthcoming in Mr. C’s situation, it will be the duty of a nurse to develop an alternative decision. The nurse will help the family to understand the need for a medical approach rather that spiritual sacrifices and home-oriented care. Furthermore, the nurse will enhance the understanding between family members and the patients based on any decision reached as well as ensure appreciation of positive and negative impacts on both short and long term implications. As much as the patient’s autonomy is regarded in this case, the nurse must exercise justice and fairness in order to meet the interest of the parties involved as well as increase the life expectancy of Mr. C. According to National Youth Agency, the nurse’s role will be to identify where there is shortage of information, and help Mr. C’s family to express the need and wishes to the medical staff. Moreover, the nurse is entitled to be the ‘patient’s advocate’ by evaluating Mr. C’s maturity and competence of recognizing the scope of hard decisions and at the same time defend his autonomy against the doctors, caretaker, and the entire family (Fleck, 1994, p. 302-303). The nurse will be entitled to show adequate care and dignity to Mr. C. In this situation, the nurse will be expected to modify her responses in order to input the ideas and views of all the participants (Gensler, 1998, p. 78). The situation described here is bound to be stressful to some parties, and therefore the nurse will have first choice opportunity to accept other decisions or else intervene with the aim of modifying the current wishes and suggestions. Nursing and Midwifery Council states that mediating and balancing between the views and wishes of different parties will require the nurse to have socialization aspects. The clash of interest between Mr. C’s son and Mrs. C will be coordinated by the nurse. A clash may occur between nurses and doctors towards the wishes of the family. In this case, the nurse has no right for paternalism. Utilitarianism nurse would be justified by concentrating on goodness, happiness, and the interest of the all the parties involved. D. Best Approach Although Mr. C wishes to remain at home and attain medical care from a specialist, it is more justified for him to seek medical care from a dedicated health centre. This is because the chest condition is likely to be adverse with age. Moreover, lack of attention from a dedicated health team would expose Mr. C to severe cancer conditions as well as extreme dementia levels. Utilitarianism would behave to make Mr. C feel happy but not improve his conditions. On the other hand, the utilitarian rule would try to apply all the accepted morals and values hence making Mr. C to improve his life expectancy. Religious beliefs and sacrifices would be applied to encourage Mr. C to soldier on until the last minute. It will be beneficial to develop the family discussions with the family members in order to promote rational decisions (Turner, 2004, p. 212). The responsibility of nurses and other caretakers will be required to express the importance of securing medical care than home attention to Mr. C. Bibliography British Medical Association (2014). Occupational Health. Retrieved from http://bma.org.uk/practical-support-at-work/ethics Campbell, G. J. (2005). Medical Ethics, Oxford University Press, Chapter 16, pp. 254-267 Daniels, N. (2008). Just Health: Meeting Health Needs Fairly, Cambridge University Press, chapter 4. Fleck, L. (1994). “Just Caring: Oregon, Health Care Rationing, and Informed Democratic Deliberation”, Journal of Medicine and Philosophy 18, pp. 367-88. General Medical Council (2014). Available at: http://www.gmc uk.org/publications/standards_guidance_for_doctors.asp Gensler, H. J. (1998). Ethics: A Contemporary Introduction, Routledge, pp. 11-20 (Chapter 2, Cultural Relativism). National Youth Agency (2014). Available at http://nya.org.uk/dynamic_files/workforce/Ethical%20Conduct%20in%20Youth%20Work%20(Reprint%202004).pdf Nursing and Midwifery Council. (2015). Available at: www.nursingworld.org/codeofethics Turner, L. (2004). Bioethics in Pluralistic Societies, Medicine, Health Care and Philosophy 7: 201–208. Available at: http://www.ahc.umn.edu/bioethics/prod/groups/ahc/@pub/@ahc/@bioethics/documents/asset/ahc_asset_178876.pdf The Hippocratic Oath. (2014). Available at: ttp://www.iep.utm.edu/hippocras Read More