Ethical Dilemmas in End-of-life Decision Making

Tony, who is 67 years old and competent, has been diagnosed with advanced pancreatic cancer. He admits to the hospital staff that he does not want any treatment and informs them that he already signed an advanced medical directive (AMD). This means that he does not want any resuscitation or any treatment that would prolong his life as his Christianity religion requires that he should die with dignity. However, his wife and daughter are opposed to his decision and have asked the doctor to offer treatment that would prolong his life. The doctor is therefore torn between withholding life-prolonging treatment and administering it as per the family’s request. The ethical issues in this case pertain to autonomy, non-maleficence, and utility. In this essay, the decision-making process will be applied to resolve the dilemma and discuss the implications of the issue for nursing practice.

Ethical Decision-Making

As noted by Rubulotta and Rubulotta (2013), the issue of resuscitation has always yielded ethical dilemmas in healthcare because of the need to respect the patient’s autonomy, while still upholding the principle of non-maleficence. Respect for patient’s autonomy requires that patients’ decision regarding their desired healthcare intervention is respected (Avasthi, Ghosh, Sarkar, & Grover, 2013). This implies that the doctor should respect Tony’s decision not to be resuscitated irrespective of what his wife and daughter wants. Since Tony is competent, the decision he makes should be what guides the doctor’s actions. If the doctor administers life-prolonging treatment as requested by Tony’s wife and daughter, he will be violating Tony’s autonomy. However, the positive benefits of resuscitation such as restoration of life are an aspect that most doctors consider (Marco, n.d.). ( In-text citation must have dates. Cannot “n.d.”) Such benefits create a conflict between autonomy and non-maleficence, which dictates that no harm should be done to patients. However, literature shows that resuscitation drains finances and resources of family members, and makes the patient live a suboptimal life (Ahmed, Mudasser, Khan, & Abdoun, 2016). Therefore, the doctor should respect Tony’s decision not to administer treatment that prolongs his life.

Ethical conflict also occurs between autonomy and utilitarianism. The principle of utility asserts that the best action should be the one that maximizes the greatest possible benefits for the greatest number of individuals (Mandal, Ponnambath, & Parija, 2016). Following the utility principle, the doctor should heed the request of Tony’s wife and daughter because this way; the net benefits will be maximized. This is in the sense that resuscitating Tony will yield happiness for his wife, daughter, and other family member whose desire is to see Tony last longer. On the other hand, not resuscitating Tony will benefit him only, while causing harm to his family members, and the doctor whose relationship with Tony’s family members, who are potential client will be ruined. As noted by Adams, Bailey, Anderson, and Docherty (2011), during end-of-life-decisions, it is important that the doctor develops and maintain trusting relationships with the client’s family members. In this light, not resuscitating Tony would ruin the doctor’s relationship with his family. Therefore, to maximize the benefits, the doctor should preserve Tony’s life.

In choosing the best doctor’s action, it will be important to refer to the patient’s rights which were stipulated during the Universal Declaration of Human Rights. According to WHO (2018), the informative model of patients’ rights assert that patients are the best judges of their own interests and should therefore make their own decisions. To ensure that they make the best decision, the doctor should provide them with sufficient information. With respect to this right, the doctor should respect Tony’s decision not to be resuscitated or have treatment to prolong his life. The fact that Tony already signed an advanced medical directive implies that he is in her right mental state and has every right to make decisions pertaining to his health. Therefore, the doctor should ensure that he does not violate his rights by doing as requested by the wife and the daughter.

Doctors have an obligation to provide patient-centered care to patients. This means that their services should be in line with and should respect the preferences, values, and interests of the patient (Ogden, Barr, & Greenfield, 2017). If the doctor chooses to listen to Tony’s wife and daughter, he will have violated his obligation to provide patient-centered care. In light of this obligation, the doctor has a responsibility to respect Tony’s decision, and only offer him services that keep him pain-free and comfortable. The doctor should also respect the Christianity values of Tony and let him die in the way that he considers dignified.

Following this discussion, the benefits of not resuscitating Tony outweighs those of resuscitating him as proposed by his wife and daughter. Therefore, based on the IDEA ethical decision-making process, the best doctor’s action would be to abide by Tony’s request and let him go home. By letting Tony go home; the doctor will be respecting the ethical decision of patient’s autonomy. (“go home refers to death not home” sentence need to be amended)Additionally, the doctor will have upheld the obligation to offer patient-centered care. This is in the sense that he will have respected Tony’s preferences to only receive pain-free care, and also his Christianity values to die a dignified death.

Communication with family members about the decision should be made in a way that improves their satisfaction. Hence, good communication plays a vital role in preventing psychological distress within the family members according to Caswell, Pollock, Harwood, and Porock (2015). Therefore, the doctor should inform them about the decision not to resuscitate him by citing the reasons why the decision was made. They should be made to understand why Tony’s decision outweighs their decision. The implementation should be documented, with regular monitoring to ensure that Tony remains comfortable and pain-free.

Conclusion

Decisions on resuscitation and life-prolonged treatment pose various ethical issues for healthcare professionals. To ensure that they deal with these ethical dilemmas effectively, nurses should understand nursing ethical principles and code of conduct. Such an understanding will ensure that nursing actions and decisions are in line with professional conduct and will prevent instances where nurses are held liable for being negligent in their profession. Tony’s case affirms why nurses should be conversant with ethical principles. The analysis of the case impacts nursing practice by challenging nurses to ensure that all nursing actions are in line with legal and ethical principles, so as to prevent legal charges by patients. The case has helped me realize that in some situations, nurses lack awareness on the best action especially on issues of ethical dilemma. Therefore, it is important that healthcare professionals work collaboratively to make the best decision.

References

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