Ethics in end of life care Sarah Woodrum When dealing with the decisions of end of life care, as a nurse, one should consider many things. The major issue to contemplate is if prolonging the life of such patients is either more or less beneficial to the patient. Three things one should consider in the case of the patient whose wishes are unknown to the family are, are the measures that are taken more painful than the disease process itself, would the patient live longer than expected in pain caused by the disease or illness, and should the patients or families wishes be honored.
In the case of this patient, intubation is required to save her life. Intubation as well as other measures used to prolong life can be painful and add suffering rather than eliminate it from a patient’s life. According to Carolyn Hays, PhD, RN “If it is determined that an intervention would be of more harm than benefit to a patient, then it is ethically justifiable to withhold (forgo) or withdraw (discontinue) it”. An assumption that can be made is that the procedure will actually save the patient therefore proving beneficial because it prolongs the patient’s life.
Another consideration to be accounted for is if the procedure to prolong life was withheld, would the patient pass away quickly or would they live longer than expected. If the patient does not pass away quickly due to complications of the illness or disease process they could live longer in pain and suffering. An assumption that one could make would be that because of the measure to prolong life being withheld the patient will pass away due to complications quickly.
This assumption would make it more beneficial to withhold the intervention. One last consideration, and perhaps the most important one, is if the patient’s or families wishes should be honored. Hays states “However, ethical conflicts can arise when trying to treat the patient and the patient’s family members”. This assumes that when the family learns of the patient’s wishes they will disagree and argue to prolong the patient’s life in whatever ways possible. As nurses our goals and actions should be patient centered.
However, one must also determine what the definition of “what’s best” is for each individual patient. In the case of the patient in question, the patient’s wishes should be followed. This also makes the assumption that she is of sound mind to make this decision. When faced with end of life care nurses should always put the patient’s needs as well as their wishes and concerns in the forefront of all considerations and actions. Regardless of family issues and wishes the patient’s wellbeing always comes first.
When making this decision, consider all the facts and components individualized to each patient. Do the benefits outweigh the consequences? Is the patient of sound mind to make this kind of decision? Would prolonging life prolong pain and suffering? What would you want your nurse to do if you were the patient wanting to go home to god and your husband?
Bibliography Carolyn Hays PhD, R. (2004). Ethics in End-of-Life Care. Journal of Hospice and Palliative Nursing , 36-43.