Question

An Appalachian patient in your health care facility wishes to stop treatment for his stage 4 bone cancer. His family is adamant that he continue the treatments. There have been multiple incidents where the family has verbally abused the nursing staff for consenting to the patient's wishes. You decide to convene the ethics committee.

Using the ethical decision-making frameworks of your choice, how will you lead this committee?

Who would you include in the committee?

Answer 1

As the saying goes, ‘Health is Wealth’. We all want to survive as long as possible and as fit as possible. However, at times, certain diseases or physical problems may bane us down and force us to comply to its ultimate end. In this case here, the Patient from Appalachian suffers from Stage 4 bone cancer and he has now wished to stop his treatment. However, his family members are adamant in continuing the treatment, and as given, the family members have had many verbal altercations with the nursing staff for agreeing or complying to the decisions or wish of the patient. This is a case of medical dilemma or a decision where there is an ethical framework that would help us to make the decision and take appropriate measures accordingly. As can be seen, the nursing staff have decided to comply with the patient’s wish to not continue with the further treatment.

Since, we need to convince the ethical committee, we will need to invoke the major principles of medical ethics that guide us to take decisions at such levels of dilemma and confusion. The committee will involve the Senior Doctors of the medical institution, the personal doctor who was assigned to the take the care of the patient, the 3-4 nurses who were constantly assisting the doctor with the tasks. We first need to understand the principle four principles of medical ethics, around which such critical decisions are taken. One of such ethical guidelines is, the Nonmale fiancé principle, which postulates that, the nursing staff on most of the occasions come across a scenario, where they need to harm the patients to some degree in order to relieve the patients of a greater harm, being caused by the patient’s illness. This includes harm like, cutting a part of the patient’s physic, or dislocating some infected organs in order to save the other organs from getting infected too, etc. Here the nursing staff must choose the smaller harm to save the patient from the bigger harm. The Next framework, the principle of Beneficence, postulates that the nursing staff needs to act swiftly and sometimes even against the consent of the patient, so that the patient can be saved. An example of this can be the cases of suicidal tendencies. Third principle, ‘The Principle of Justice’ states that every patience has the equal right to be treated and the nursing staff has t ensure that every patient gets equal level of respect and treatment depending on the critically of this medical condition. However, the primary and the most important principle of medical ethics is the ‘Respect of Autonomy’. According to this principle, a patient is the sole ad final authority who can decide whether he wants be further treated or not. If a patient sees that the pain, trauma and harm that he has t undergo in the process of curing a particular disease or illness is much larger to him / her that bearing the final end of the illness, is much greater to him / her, then the patient may decide to not pursue the treatment. Moreover, a person is the sole person to decide the level of pain or harm he is undergoing through. Therefore, the respect of the wishes pf the patients is a must. Therefore, this was the principle that had guided us to take the decision to comply with the patient’s wishes.