End of Life Patient Care - Essay Example

End of Life The issue of end-of-life care is a highly debatable and controversial issue because of the ethical andlegal implications that are associated with the concept. According to Grinyer (2011) the terminology, scope and definition for identifying end-of-life care is linked with the provision of care which is provided to an individual when he/she has reached the last phases of their life. Moreover, it is also important to suggest that palliative care and end-of-life care cannot be recognized as interchangeable terminologies as the former also encompasses the provision of care to prolong life. On the contrary, the scope of end-of-life care essentially aims to define guidelines for caring for patients whose death is expected or anticipated rather than working towards enhancing their life expectancy (Grinyer, 2011). The emergence of ethical dilemmas in end-of-life care are essentially rooted in handling sensitive issues and challenges which surface when executing significant decisions regarding an individual’s life. Thorns (2010) highlights that ethical considerations in the implementation of the process focus upon understanding the patient’s state so as to choose whether to continue with the treatment procedures or discontinue their provision. Moreover, under such circumstances where an individual likely does not possess the required psychological understanding to make correct decisions, concerned attendants and doctors are faced with either challenging the patients’ independence or agreeing with their choices thereby, granting them the right to possess complete control of their position and circumstances (Thorns, 2010). The emergence of ethical considerations in end-of-life care however, is not limited to the aforementioned assertions henceforth, this issue remains highly debated in scholarly circles; this paper applies three prominent ethical perspectives to critically evaluate and examine the concept from an ethical viewpoint. The utilitarian perspective explores theoretical issues from a multifaceted lens with reference to the concepts of end-of-life care and the role of doctors in the recognizing the independence and autonomy of patients with reference making their life decisions. As stated by Singer (2003) the nature of utilitarianism as a branch of consequentialism implies that the value of ethics in terms of each action or behavior is expected to be judged on an individual basis. In terms of examining the implications of adhering to utilitarianism the implications of the decision can be judged in a negative and positive outlook by suggesting that end-of-life medical supports the patient’s status as an autonomous being, therefore, any decision making conducting in such circumstances should be validated by upholding the value of consent and approval. Thus, arguments in support of end-of-life care can also be advanced by highlighting the efficient utilization of resources as a factor. The adoption of a utilitarian approach to examine the issue postulates that while, the mechanism has the ability to grant patients with an extended command over sensitive decision making, the role of their doctors must also be explored with relevance to the scenario. This view asserts that as the grant of power is provided to the doctors, they may be able to utilize their power to achieve personal interests. The need to evaluate situations on the basis of pleasure and pain provides a simplistic model for examining decisions nonetheless; this implies that utilitarianism would permit a patient to end their suffering if they believe that their chances of survival and reverting to a life of wellness are scarce (Savory and Marco, 2009). Despite of the fact that this theoretical model of assessing ethical situations is rooted in the advancement of patient rights over their body, wellbeing and life the weakness of this perspective lies in the ambiguity of outcomes. This view asserts that as the key to labeling a decision as successful and effective in terms of utilitarianism relies upon the eventual outcome of the selection and its given burden of pain and pleasure, it is not possible to identify the impact of the action because it remains largely undefined. As identified by Puntillo (2001) end-of-life issues range from concerns regarding the continuation or discontinuation of life support treatment, providing patients with drugs to significantly reduce pain levels and also assessing the sensitive decision regarding a possible demand for assisted suicide. Henceforth, if the facet of autonomy renders support to assisted suicide with the advocacy of a utilitarian ethical perspective it is likely that the patients and the system would begin to manipulate this aspect. The weakness of this debate lies in understanding the value and worth of a human life because the loss of an individual is incomparable and the moral implications of assisted suicide are controversial. The Kantian perspective on end-of-life care can be developed by establishing the focus of the discussion under the maxim of the philosopher’s ‘universality’ concept. According to Maj (2002) Kant’s theoretical understandings grant much weight to the value of human life and a patient’s being as the most important measure of value in a scenario where a life-threatening or terminal illness is deteriorating life expectancy significantly. Consequently, the philosopher’s comprehension of duty is also very critical in this scenario. Duty – as Kant would suggest refers to a doctor’s and family members’ sense of responsibility to preserve and uphold the value of a life under all circumstances. Nonetheless, the exploration of the ‘universality’ principle to examine the implications and considerations regarding end-of-life care would identify whether other measures which comprise of an end-of-life care system such as hospice care could be equated with Kant’s standing of preserving life. For example, in circumstances where a patient is provided with heavy drugs and medications to relieve pain, it is likely that the side effects of such drugs could work against any measure to prolong the patient’s life. Yet, in this scenario the administration of pain relief drugs is justified because the intention behind the administration of the drug is to not directly cause the individual’s death as a possible action of assisted suicide. Despite, of raising this statement it must be identified that the key weakness of Kantian ethics lies in the contradiction of principles when they are applied to this ethical dilemma with the addition of a subjective point of view to a certain extent. For example, while the principle of universality would disregard the notion of patient autonomy if assisted suicide is sought in this scenario it would not label the administration of pain relieving drugs as a means of aiding end of life. However, when applying Kant’s ‘means to an end’ principle in this case it can be concluded that the approach would imply that drugs are being used on the patient to accelerate the process of death to ease and ultimately end the affliction of the individual’s loved ones and possibly freeing hospital resources to treat patients which possess a greater chance of survival. Aristotle’s Nicomachean ethics provide a comprehensive guideline for addressing the issues and scenarios in lives of individuals including happiness, justice and the social relationships. However, the philosopher’s ethical contribution which shares a critical relevance with the issue of end-of-life care is rooted in the understanding and identification of virtues and traits which must be possessed by individuals which are a part of the hospital management system and most importantly the system of palliative care. According to Butts (2013) virtue ethics define truthfulness as the most significant characteristic of medical staff. The possession of this character trait is essentially defined as a neutral value between two abnormalities where an individual can either be imposture or self-depreciating (Butts, 2013). This notion would assert that as medical professionals, doctors and nurses are expected to provide a course of treatment to the patient that does not elevate their hopes of recovery and is marked by the provision of accurate information regarding their future physical and mental state and the progression of the illness. Henceforth, a medical professional is not expected to deliver information which in any manner or form may negatively influence the patient’s decision making regarding future course of treatment with regard to withdrawal or withholding. This perspective however, only outlines the medical professionals’ responsibility towards the patient under palliative care where they should ensure to never pass judgments or reflect opinions which may encourage the patient to consider options which they may not have considered otherwise. However, with reference to the aspect of assisted suicide in end-of-life care, Aristotle’s understandings and recommendations for promoting ethical standards are centered towards respecting and abiding by the laws of the state rather than exercising a degree of autonomy or individualism which portray the wishes of the patient. The evaluation and examination of the ethical perspectives on end of life medical issues and care which have been explored in this paper essentially present three critical and varying views on a sensitive and controversial issue. In utilitarianism the notion of individualism and autonomy has been greatly appreciated and regarded with significance however, this perspective fails to outline the implications of promoting vested interests of medical professionals which may encourage assisted suicide options to conserve resources. Moreover, utilitarianism possesses certain ambiguous outcomes with reference to the application of this issue because it does not define whether the achievement of pleasure is always guaranteed and certified given the fact that the issue of having a life at stake is imminent. Moreover, the perspective also does not value moral integrity and does not include the implications of supporting end of life decisions which support assisted suicide. Accordingly, Aristotle’s analysis of the issue is marked by highlighting the duty of medical professionals as remaining truthful and providing accurate information during all scenarios. This aspect of Aristotle’s ethical perspective is favorable however; it does not promote patient autonomy to a slightest degree by linking the decisions of life with the wider segment of society and requiring individuals to uphold state expectations before their own self. However, Kant’s perspective on this issue is balanced and justified in comparison with the preceding frameworks because it defines the limits of end of life care and provides practitioners with a guideline to care for terminally ill patients. For example, while Kant does not support assisted suicide he favors the administration of pain relieving drugs and medications even though it is possible that these medications might be escalating the process of death because of their side effects. While, it should be noted that the administration of pain relieving drugs and their subsequent side effects could be viewed as using the patient as a means to put an end to the misery of their loved ones, this argument can be challenged because they do not contribute directly to the demise of the individual. References Butts, J. B. (2013). Ethics in professional nursing practice. Nursing ethics: Across the curriculum and into practice, 81-93 Grinyer, A. (2011). Palliative and end of life care for children and young people: Home, hospice, hospital. John Wiley & Sons. Maj, J. (2002). Moral Law Based on Immanuel Kant’s Kantian Ethics and John Stuart Mill’s Arguments for Utilitarianism. Savory, E. & Marco, C. (2009). End-of-life issues in the acute and critically ill patients. Scandinavian Journal of Trauma, 17: 21 Thorns, A. (2010). Ethical and legal issues in end-of-life care. Clinical medicine,10(3), 282-285. Read More