Any professional who feels they could shorten a patient`s life using opioids or tranquilizers should turn to specialized palliative care services. The General Medical Council released guidelines for end-of-life treatment and care in May 2010. The issues addressed in this article are addressed in the guidelines. Providing hydration and nutrition is an essential part of human flourishing. Families and professionals struggle with every thought from stopping clinically assisted hydration and nutrition to the last hours or days of life. When nutrition and hydration are clinically supported, they are classified as treatment rather than primary care. Therefore, if they no longer provide an overall benefit, they may be withdrawn.6,7 Ethical approach to these decisions. All physicians should be able to describe an ethical approach to decisions regarding refusal or discontinuation of treatment, taking into account the law, official guidelines, the evidence base, and available resources. You need to know the patient, their abilities, beliefs and preferences, as well as their clinical status and perspectives.
The physician must then clearly formulate the ethical question posed and ensure that his or her own point of view does not influence the way in which it is posed. In this way, the available options can be determined, including moral justifications and practical solutions (Table 2). To put this into practice, communication and coordination skills are required. This approach is now applied to joint end-of-life decisions. There is no doubt that you will face ethical dilemmas during your journey as a nurse. Death and how it eventually progresses can be questioned from an ethical point of view. Understanding how to deal with such situations when problems arise is an essential part of end-of-life care. As a nurse, there are several resources available in case you don`t know how to deal with a problem. Conducting an ethics consultation, counseling palliative care team members and other medical experts, and using educational materials can help you overcome an ethical dilemma.
Many institutions also have an ethics committee that can help you deal with such situations. Understanding the most common issues you`re likely to encounter can also be helpful during the decision-making process. A person`s right to self-determination is the starting point for many ethical dilemmas. Respect for autonomy has limitations highlighted by the Mental Capacity Act 2005 1 and the increased emphasis on patient choice. The physician must recognize these limitations and be aware of the other responsibility: to benefit the patient and not harm the patient and to use resources equitably. Decisions not to attempt CPR are limited to CPR and should not affect other aspects of decision-making. Each possible intervention can be considered separately in the context of pre-planning. By earning your PhD in Nursing Practice, you can understand how to better work with members of your end-of-life care plan with your patients and their loved ones. Attempts at cardiopulmonary resuscitation (CPR) to restart the heart are unlikely to succeed as patients approach the end of their lives or, if so, may result in a brief period of significant impairment of quality of life.12,13 Within the multidisciplinary team, it must be recognized that this is the following situation: and a decision must be carefully documented.14 Increasingly, cancer deaths occur after a long, progressive illness, requiring ongoing discussion of goals of care and a focus on shared decision-making. Regardless of the diversity of the community or the progressive health care environment, the needs, preferences and values of the patient and family will continue to be at the heart of palliative care. One course that deals with ethical decision-making in the online DNP program is NUR 730 Ethics in Advanced Practice Nursing.
Here, you`ll analyze ethical dilemmas that can arise early in your career in advanced professional and administrative roles. You will learn how to navigate the intersection of these issues with patient values as well as associated legal obligations. You will examine the history and literature of ethical dilemmas in relation to their treatment today. The NUR 730 experience gives you the opportunity to explore ways to participate in ethical decisions. The physician is responsible for developing and maintaining an effective approach to ethical decision-making and the skills necessary to implement the right moral action. At the heart of this process is experience and knowledge of certain conditions and their outcomes, as well as excellent communication and collaboration skills with colleagues. Finding the truth is fundamental to respect autonomy. Most patients want complete information, although this may diminish at the end of their lives.2,3 A physician should have the ability to recognize the patient`s preferences and communicate the information honestly but sensitively. A patient`s paternalistic refusal to make a life-threatening diagnosis has no place in current health care unless it is the patient`s informed preference or is unable to understand and use the information. Respect for the autonomy of a patient who wishes to continue or initiate treatment must be questioned if it results in overwhelming harm, unnecessary and unequal distribution of resources, or action that forces the physician to violate a professional code or the law.
The legal situation is clear: a patient cannot demand treatment that is not in his best interest and that doctors do not have to strive at all costs to preserve life. When in doubt, however, the presumption must be in favour of the preservation of life.6,7 Recognized as one of the most important factors in end-of-life care, decision-making becomes an ethical issue when more than one party is involved. When other important people try to act against the patient`s wishes, caregivers are faced with the problem of trusting the intention of other important people or respecting the patient`s wishes. Living wills, such as living wills, powers of attorney, life-sustaining medical orders, and DNR orders, should be considered in advance and presented during the decision-making process. Respecting autonomy is not synonymous with choice. Asking “Do you want to die at home?” offers choice. Explaining all the implications of such a decision to ensure that the patient is capable and has recognized all important consequences shows respect for autonomy.4 The physician has a responsibility to ensure that decisions are based on autonomous action that requires full information, freedom from coercion and necessary capacity, rather than simple decisions.