Ethical Dilemma Associated with End of Life
Introduction
Human beings are mortal, and no one can run away from death, as it is inevitable. However, due to advancements in the healthcare sector, technology is changing the expectations of dying naturally. These technological advancements have the capacity of intervening at the time of dyeing and prolong the lives of individuals. Even though a medical cure has improved technologically, it possesses no promises for healing. Still, they can support life with or without relevant survival or without secondary assistance, such as the use of feeding tubes. Therefore, these improvements have provided patients and their loved ones with an essential duty of selecting their preferred treatment during end-of-life-care. As a result, physicians and other medical providers giving care for dying victims will face several moral issues and difficulties. In this case, health professionals providing care need to be well-educated of the possible difficulties and be well-informed of the plans aimed at evading conflict. Therefore, they need to be dynamic about formulating decisions and having excellent communication abilities keeping the victim in the middle of all decision formulations by respecting patient freedom. The health professions need to be well conversant with ethical problems such as medical futility, withdrawing, and withholding of interventions, and physicians- assisted suicide (Yun, 2018).
Medical futility
Medical futility is an involvement that may pose challenges in a medical set up while offering care at the end of life. It also refers to an involvement that will not allow the accomplishment of the deliberated aim of the response. Therefore, in this case, the involvement is regarded as purposeless if it does not comply with the victim’s desire or advanced direction if the patient has lost decision-formulation ability. In return, disagreements will emerge since the patient cannot make decisions, and the decisions about health lie on his/her hands. Also, conflict may be a result of the patient’s surrogate decision-maker misinterpretation of the prognosis, loss of trust, or difference in figures in the medical system. However, such disagreements may be solved by providing education, explaining the goals and the intentions of the patients, and promoting a group approach to decision formulation after including the ministry.
Withdrawing and withholding of interventions
Withdrawing and withholding are two different aspects used in the healthcare system and have different meanings. Withdrawal refers to removing a therapy that had already started in an attempt to support life, but it is no longer useful (Ho, 2016). At the same time, withholding applies to not making any further therapeutic interventions. Pulling back and holding back of life-supporting medication while managing victims at the end-of-life maybe both curatively and morally. In this case, interventions may be curatively futile if there are no moral, lawful, or medical essentials to manage care that is not beneficial. Besides, it is essential to pull out and hold back treatments that are not needed by the sick person or the patient’s surrogate decision-maker.
Usually, doctors have difficulties pulling out interventions that had previously started. However, if the intervention is not achieving the intended goals of the patients no longer want them, the best option would be to withdraw them. Therefore, form an ethical perspective, both aspects are morally equivalent. Although the interventions involve a team approach, the doctors are the only people required to note orders determining which interventions are to be withheld or pulled out. Therefore, physicians must know the ethics of pulling out and holding back interventions in looking after victims near the end of life. Sadly, most of the victims in the life-saving unit loose lives without notice of their desires concerning life-sustaining treatment.
Some of the interventions that could be withheld or withdrawn include surgery, dialysis, medications, diagnostic tests, antibiotics, elective intubation, and mechanical ventilation. For the interventions to be withheld or withdrawn, it will depend on whether the interventions can achieve the desired goal set by the doctor, the patient’s surrogate decision-maker, or the patient. It is essential to set time on a particular intervention so that if the time lapses and the goal was not achievable, withdrawal happens. For instance, the set time limit for the use of mechanical ventilation may be right if its goals are not attainable at the arranged time.
Physicians- assisted suicide.
Physicians-assisted suicide entails physicians giving means of ending a victim’s life, commonly by offering a deadly dose as requested by the patient. Most doctors concerned in end-life-care have, on several occasions, encountered a request for physician-assisted suicide. However, this practice is morally unacceptable globally, except in the state of Oregon in the United States. The majority of physicians and physician’s professional organizations such as American medical organizations and American Geriatrics society discovered this practice as a breach of the patient-physician association. Besides, many people trust that affirmation of physician-assisted suicide will nullify a communal responsibility to hospice care and pain killer drugs.
Several issues make victims request physician-assisted suicide. They include fear of being a liability on their family, intractable pain, sadness, and anxiety of loss of dignity. To avoid these issues, physicians must recognize the fundamental cause of the sick person’s distress. For instance, there should be assessment, management, and if need be, experts such as psychiatrists, psychologists, and ministers should be involved. Also, there should be a reassurance that signs such as pain are manageable. Spiritual symptoms of guilty and loss of motive of living should include a chaplain in the health care team who will address them
Ethical principles.
Physicians need to understand ethical principles so that they can address the problems that face them and victims at the end of life. These includes include autonomy, beneficence, no maleficence, justice, and fidelity (Spoljar, 2020). Freedom calls for one to be the decision-maker. In this case, the physician preserves the victim’s right to self-rule even when the patient cannot make decisions on his/her own. These preservations are achievable through the use of advanced directives. Because of the challenges among involved parties, while making decisions related to end-of-life, doctors turn to their care providers to make decisions on behalf of the patient. However, letting the proxy patient’s decision-maker to make decisions while the patients could make it is a breach of the principle.
The beneficence principle allows the physician to champion what is right or helpful for the victim. In this case, the physician must always champion approaches that encourage proper care for the victim at the end of life. The doctor should ensure there is no violation of the patient’s autonomy in an aim to do what he/she sees is the sick person’s best interest. No maleficence calls for physicians not to cause harm with intentions. Participating in physician-assisted suicide is viewed by many physicians as a breach of these principles. This principle is strengthened by the pledge physicians take while graduating from their respective schools, which requires them not to give a deadly drug to any person even when required to so.
Justice principle calls for fairness while delivering health care. This principle requires doctors to have ethical obligations to champion for fair and suitable treatment while providing care to victims at the end of life. The last moral law is fidelity, which calls for physicians to be honest and loyal to the victim at the end of life. In this case, the physician should issue ongoing details about the patient’s conditions where he/she should provide truthful information on issues such as diagnosis.
Ethical theories and laws.
In every healthcare setting, health professionals should consider a patient’s point of view and desires. They have to act for the good of the patient. Therefore, they should work against the selfish theory (Chessa, 2019). Any patient’s proxy decision-maker, when given the mandate to make appropriate treatment choices, should put aside their egotism and judge the circumstances as they are and make a decision in the victim’s greatest interests. The act of the loved ones and physicians working towards the good for the patient refers to the virtue theory of ethics.
Standards of practice
Managing ethical dilemmas surrounding end-of-life care is demanding. Therefore, medical professionals need to solve these issues by implementing policies. First, they can direct the sick persons and their caregivers in making informed treatment wishes through the provision of secure information, correct prognosis, and available options concerning the case-specific treatment options (Chan, 2016). Second, they should set up an ethics committee to solve ethical or legal issues in case a disagreement arises. Third, healthcare executives should compile policies that will help them establish, alleviate, and debate the use of improved directives as an admission method. Hence, motivating patients to make a living will about their end-of-life care liking, which will guide their caregivers in making suitable decisions in the case of disabled patients. Lastly, the physicians should acknowledge the significance of spiritual matters at the end-of-life. They should know how to do a mental evaluation and use present resources for the sick person’s spiritual care.
Personal, professional response.
Based on the above information, I would recommend that healthcare providers put the goals of the patient in the middle of decision making. They should apprehend the initiative and talk about the patient’s goals for end-of-life as their wishes can change from patient to patient. For instance, several patient’s intentions may be treatment or some comfort of care; consequently, the availability of secure communication can help prevent ethical dilemmas surrounding the topic. For the preference goals to remain as they are, each health scenario needs renewable evaluation to avoid scenario-based preferences. In this case, clinicians need to develop communication, education, and discussion related to end-of-life care wishes and their effects among patients and their caregivers to ensure better decision making.
Conclusion.
In conclusion, involved stakeholders face many moral difficulties at the end-of-life. These moral dilemmas are avoidable if there is proper dialogue between the parties as well as advanced care planning. Supporting the principle of patient’s freedom is crucial to quality
end-of-life care. Additionally, pulling out and holding back interventions at the end of life are ethically allowed when they are compatible with the patient’s morals and objectives. Besides, doctor-assisted suicide issues will change the integrity of the sick person-physician association, which is to care and console and not to kill. Therefore, it is the responsibility of all parties to take charge and play their part by preventing problems arising as a result of ethical dilemmas from happening.
References
Chan, R. J. (2016). End‐of‐life care pathways for improving outcomes in caring for the dying. Cochrane Database of Systematic Reviews, (2).
Chessa, F. &. (2019). Ethical and Legal Considerations in End-of-Life Care. Primary Care. Clinics in Office Practice, 46(3), 387-398.
Ho, A. &. (2016). Making good death more accessible: end-of-life care in the intensive care unit. 1258-1260.
Spoljar, D. C. (2020). Ethical content of expert recommendations for end-of-life decision-making in intensive care units: A systematic review. Journal of Critical Care.
Yun, Y. H. (2018). Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia, and physician-assisted suicide): a multicentred cross-sectional survey of Korea. BMJ Open, 8(9), e020519.