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The End-of-Life Decision Making and Ethical Issues
Introduction
Medication used to manage critical care patients primarily focuses on extending life. Like in the case of Alan, the treatment was not of much importance, resulting in systemic failure. The decision to end a patients life is not easy and should not be made by the care provider. The patient and his family make such an actual conclusion. Even at such a point, comfort care should be continued to ensure the person dies naturally and painlessly. End of life by withdrawing treatments should be guided by ethical theories and principles while respecting the rights of every person.
Ethical Theories
The process of ending a patients life should be guided by ethical theories that ensure the process is morally upright. Such theories include Utilitarianism, which operates under the Consequentialist umbrella (Keatings & Adams, 2019). Utilitarianism requires that the decision made results in the greater good highest number of people rather than evil. The theory of Virtue ethics can also be used in the end-of-life scenario. Per the theory, action taken against someone should demonstrate the highest levels of morality. It embraces character traits of truthfulness, compassion, and courage. Further, it considers the motivation behind every decision, and it serves as a supplement to action-based ethics.
Ethical Principles
Every professional in the medical fraternity is required to uphold the set moral principle. In the case of Alan, such principles should have been used to guide the decision to end his life. As such, they include the principle of autonomy in which patients make decisions concerning their lives are respected. The principle of beneficence requires that one does and promotes good (Keatings & Adams, 2019). The Nonmaleficence principle requires that the persons giving care should refrain from causing harm unnecessarily. Any danger paused should be morally justifiable with proof that it was the best action.
Why Alans Family Needed to Advocate on His Behalf
Alan had a coronary artery disease in which the coronary arteries were narrowed to the extent of altering blood and oxygen supply to the heart. This, therefore, necessitated an urgent bypass surgery to save his life. At this point, Alan was conscious and stable to make an independent decision. However, the prognosis of the surgery was poor and he was in unconscious. For a patient in such a condition and following the continued deterioration, his next of kin takes over as the decision maker (Li & Chapman, 2020). Therefore, the family became his advocate in his medical decision since he could no longer speak for himself.
How the Situation Could Have Been Avoided
The decision to withhold medication requires adequate consideration and consultations. Making end-of-life decisions for patients without decision-making capacity needs an intensive integration and understanding of the ethical implications and conceptual knowledge. Alans situation could have been avoided by ensuring Alan had made prior directives. Alan should have had a living will in which he could have made decisions that could be respected throughout the treatment. Alternatively, Alan should have chosen her medical proxy while he was conscious. The person chosen could have the right and power of attorney to make decisions concerning his life and medical options (Li & Chapman, 2020). These processes could have resulted in better outcomes for everyone as they could have reflected what Alan wanted.
The Rights That Alan and His Family Have
Alan and his family, as his advocates, had medical rights, and every care provider had to respect them. As such, they included the right to continuity of care (Hoerger et al., 2018). This right was respected as Alan was on continued medication for all complications until the family decided to stop the treatment. The right to informed consent was also guaranteed as the nurse explained every action taken. For instance, she tells them of the decision to give calcium polystyrene enemas to solve the elevated potassium levels. They are also informed of kidney failure and given the autonomy to decide on dialysis. As the advocates of Alans care, the family has the right to refuse the offered treatment regimen. After being informed of Alans kidneys status, potassium levels, and available care alternatives, the family declined, and the caregivers respected their conclusion.
The Contradictions in the Story
End-of-life decisions can be contraindicated in some situations if the set criteria are not met. In the story of Alan, for instance, he had no living will or a medical proxy. Though the family members were his advocate, Alan was cognitively impaired because of his critical condition. The primary goal should have been achieving the best care outcomes and not ending his life (Webb, 2019). Alans family was distraught, and it was evident that they lacked frailty knowledge. They expressed challenging and understandable grief emotional reactions, and this could be a barrier to optimal care, and this was a contraindication to their medical decisions.
Conclusion
Generally, the end-of-life decision is complex and requires adequate ethical consideration. Some ethical theories that can be employed include the theory of Utilitarianism, which requires one to do what brings the greatest good rather than harm. The theory of virtue ethics also guided decisions based on compassion, truthfulness, and courage. Ethical principles such as autonomy and justice should also be observed. Alans situation resulted from the effects of his prognosis that left him cognitively impaired making the family his advocate. However, had Alan written a will or selected a proxy the problem could have been resolved. On some occasions, the end-of-life can be contraindicated in cases such as when the advocates of care lack adequate information.
References
Hoerger, M., Greer, J. A., Jackson, V. A., Park, E. R., Pirl, W. F., El-Jawahri, A., Gallagher, E. R., Hagan, T., Jacobsen, J., Perry, L. M., & Temel, J. S. (2018). Defining the elements of early palliative care that are associated with patient-reported outcomes and the delivery of end-of-life care. Journal of Clinical Oncology, 36(11), 1096. Web.
Keatings, M., & Adams, P. (2019). Ethical and legal issues in Canadian nursing E-book (4th ed.). Elsevier Health Sciences.
Li, M., & Chapman, G. B. (2020). Medical decision making. The Wiley Encyclopedia of Health Psychology, 347-353. Web.
Webb, M. S. (2019). The good death: The new American search to reshape the end of life (Publication No. 13807805) [Doctoral dissertation, The University of Chicago]. Proquest Dissertations.
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