Question

End-of-Life Care and Decision Making

Kelsey is a nursing student in her first clinical rotation. One of her classes focuses on bedside manner. The purpose of the course is to give students time to speak with patients and understand their perspectives - their knowledge, hopes, and fears. Kelsey and a few of her classmates are assigned to a hospice, where each spends time talking in a non-medical capacity with a patient. In the previous semester, the students heard lectures on how to take histories from different types of patients (e.g., children, the elderly) and on special topics (e.g., cultural sensitivity and end-of-life care). Kelsey had had one lecture about talking with the elderly and one lecture about end-of-life issues and options before her first visit to the hospice.

On one trip, Kelsey was assigned to spend time with Mrs. Walsh, an amiable 70-year-old woman who had entered hospice care 2 days earlier. Mrs. Walsh’s chart said that she and her family members had elected to discontinue chemotherapy, which was making her feel terrible and not having any effect on her cancer, which had metastasized to her spine and lungs. Mrs. Walsh had a do-not-resuscitate (DNR) order in place. The visit was going well: Mrs. Walsh was talking happily about her husband, her children, and her grandchildren. Then Mrs. Walsh related her struggles with cancer and the decision to enter hospice care. Next Mrs. Walsh began to talk about facing mortality and said she was frightened about how she would die. She was not sure what the end would be like for her and questioned whether hospice was the right choice, though she was not really sure what would have been a better choice.

Throughout this time, Kelsey remained quiet. She wanted to empathize with Mrs. Walsh, to encourage her to continue thinking about these tough topics, and to ask questions that would help Mrs. Walsh flesh out her own ideas. She wanted to talk about the other options (not having a DNR order, receiving aggressive treatment, dying in an ICU on a ventilator) in ways that might remind Mrs. Walsh why she and her family had chosen hospice care in the first place. But Kelsey didn’t know whether she was allowed to enter into this type of conversation with a patient - she’d barely begun her nursing training, after all.

Adapted from: Tan, A. (2013). Medical students and dying patients. AMA Journal of Ethics, 15(12), 1027-1033.

Questions

1. What ethical theories and principles are involved in this situation?

Answer 1

Kelsey is a nursing student, when she patient refusing treatment these ethical principles can guide them to make right solution to the problems they face..ethical principles helps nurses to provide exceptional care throgth out their carrier..

Ethical dilemma for patient care should always be benefited by focus on maximum preference, minimizing harm when patient suffering with illness..In most of the cases surrogates( their relation) will make consent and withdraw consent for any intervention for many reasons.

There is ethical principles should be followed patient is in hospice care..

Patient Autonomy should be respected, patient privacy and maintain confidentiality and providing opportunities for patients to make their own decisions regarding their care..

Honor and respect patient decision and also patient has right to receive or refuse the treatment and information from doctor and nurse..

Act for best interest to the patient, be as a advocate, and avoid causing suffering physically and mentally with the patient .

Ethical principles should be followed while handling mrs.walsh, Kelsey should be focused on Autonomy, Beneficence, nonmaleficence, and justice..

There is lot of ethical dilemmas in end of life care..

Physician responsible to make communication with family what patient prefer and what is best for the Patient..death is common for the physician but physician - assisted suicide is illegal..ethical principles that legitimate an act of good causing serious harm...