Nursing Ethical Dilemma Scenario

Nursing Ethical Dilemma Scenario
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Nursing Ethical Dilemma Scenario
1.0 Introduction
End of life decision is a common dilemma in nursing practice. A patient may have a chronic illness that causes them severe pain and agony. In this scenario, family members and nurses are faced with a dilemma of ending the patient's life to save them from the suffering. In some cases, patients leave family members with specific end-of-life instructions. However, in many others, healthcare providers and families face a complex situation where the patient is not in a state to make any personal decision. This paper looks at a case study of a patient admitted in the intensive care unit at a large urban hospital.
2.0 Background
The patient was a Caucasian man aged 67 years old. He was a staunch Catholic priest in the local church. He did not have any physical disability. The man lived in a middle-class neighborhood with his wife of 30 years. They had three sons, and he shared a close bond with them. He took a life insurance policy ten years ago, with his sons and wife's main beneficiaries. He held a master's degree in Business Management and had operated a fast food restaurant for over 27 years. The man was healthy until 2016 when he started experiencing frequent strong headaches. They grew in intensity over the years. Soon, he started feeling other symptoms, such as seizures, memory losses, and blurred visions. When he visited the local large urban hospital neurology unit, he was diagnosed with a brain tumor. His income allowed him to access some of the best treatment options available. His tumor got worse in 2019, and he went for brain surgery. After the procedure, he was placed in life support in the ICU unit as his health deteriorated. So the family had to decide whether they should end his life, stop his suffering, or keep him alive and see him go through the endless pain.
3.0 Literature review
The Caucasian man’s ethical dilemma presents two conflicting positions. The first is whether to end the Caucasian man's life, and second is whether to prolong his treatment to keep him alive. This section looks at some of the ways his life can be supported. It then describes the controversies of ending the man’s life.
3.1 End of life decision-making models
3.1.1 Individual autonomy
This is based on the patient making decisions of an individual without external meddling. The choice should be based on medical proofs. Truth should be a guiding principle to permit the patient to make an autonomous decision. The process is straightforward when patients have shared their wishes to their next of kin. In this way, the family is obligated to abide by the patient’s whims. However, the effect of family and sociocultural practices may be stimulus to the decision making abilities of a patient. Family centric practices promote prolonged treatment interventions with the hope of recovery. So, nurses should discuss the patient's management with their primary caregivers, who may be the wife or children (Sy, Tan, & Krishna, 2015). This will help them understand the burden of care involved.
3.1.2 Relational autonomy
This model views the family and patient as a closely-knit unit. This means that the family will play an integral role in care determination and significantly influence the end-of-life decision-making process. The relational autonomy approach has been criticized because, in many instances, families do not put the patient's wellbeing first. They permit contending welfares within the family unit to cloud their judgment in the decision-making process. For example, the family will have to bear the significant healthcare costs involved in keeping the patient alive.
Further, primary caregivers need to shoulder the patient's economic, societal, physical, spiritual, and mental needs. This baggage of care leads to a conflict of interest. Alternatively, family members may seek non-conventional treatment options for the patient to preserve the patient's life. They can use a treatment intervention such as blood transfusion, which the patient would not have consented because of religious reasons (Sy, Tan, & Krishna, 2015). So, these situations question the capacity of family members to make decisions that put the patient's interest foremost.
3.1.3 Welfare-based model
This is a team-based approach that takes into thoughtfulness of various factors before decision-making. It integrates wishes of the patients, family interests, and nursing knowledge in regards to the end-of-life care process. This model removes exclusive rights from the family as other factors are considered in line with the patient's best interests. Using an interdisciplinary team ensures a shared decision and consensus. This collective approach creates accountability and boosts transparency in the decision-making process. (Sy, Tan, & Krishna, 2015). It looks at the overall benefit a decision will have on the patient, thus eliminating conflicts of interest.
3.2 Processes of end of life care
3.2.1 Patient-centered care
Nurses closely monitor the patient, showing empathy, and responding to their personal needs. This involves constant communication with the patient, family, substitute decision makes, and clinicians to provide a proper end of life care. This discussion ensures that patients are involved in their end of life care. It helps provide essential information to the patients and family (Australian Commission). Nurses and physicians employ their skills and knowledge to enlighten the end of the life decision-making process.
3.2.2 Teamwork and coordinating care
To meet the patient's end of life needs, all the care providers need to work together. This includes combining the different perspectives, values, and perspectives to give integrated care to the patient. For effective coordination, the treatment plans and goals of care should be clear to the inter-disciplinary team (Australian Commission). This ensures that everyone understands their role and responsibilities, which promotes a smooth exchange of information.
3.2.3 Using triggers
Nurses should have in place a system that identifies patients who are approaching an end of life situations. The patient may have days, weeks, or months left to live, and their health situation may be irreversible. In this way, nurses can understand their needs and align the treatment plans, goals of care with the patient's wishes (Australian Commission). These trigger tools are crucial in determining whether a patient will benefit from of end of life care.
3.3 Controversies at the end of life care
End of life decisions remain a contentious issue within the nursing practice. It is one of the most commo...