Ethical Issues and Moral Dilemma

One of the ethical issues nurses face is addressing advanced care planning for end-of-life care in patients. The issue of end-of-life care creates an ethical issue in patient autonomy, especially when there is a conflict between the patient’s and the family’s demands. Patient autonomy relates to patient advocacy as it ensures that nursing practitioners respect the patients’ decisions by giving patients the right to make decisions over their medical care without the influence of the healthcare practitioner. During end-of-life care, patients have a right and autonomy to choose what they prefer, the treatment plan they should undergo, and other significant decisions that may affect their remaining period of life. However, these decisions may conflict with family decisions and preferences, especially given that most families will make decisions to ensure they can stay more time with patients. Nurses may therefore face a dilemma in deciding whether to follow the patient’s or family members’ decisions, especially when the family members’ decision seems to be in the patient’s best interests.

Patient autonomy during advance care planning is vital for patient satisfaction and a positive patient experience during their end-of-life care. It ensures patient stability and hope in their end-of-life situation, providing patients with physical and emotional strength and ensuring satisfaction in their desire to control their life and treatment (Engelhardt, 2022). However, nursing practitioners face an ethical dilemma when the patient’s decision does not seem to be in their best health interest and differs from the family members’ decision. Although nurses must respect the patient’s autonomy, they may find themselves in a dilemma deciding what seems morally right as the family seeks or respects the patient’s decisions.

For example, patients may choose to undergo euthanasia in the event their health deteriorates to a level where there is minimal chance of survival. However, close family members of the patient may reject the decision. They may not be ready to lose the patient and therefore frustrate a nursing practitioner’s duties in fulfilling the patient’s demands. Such a situation may put the medical practitioner in an ethical dilemma on whether to respect the patient’s decision or sympathize with the family by deciding not to put the patient under euthanasia. Such a dilemma can affect end-of-life care, prolonging the decision-making process and affecting the patient’s satisfaction and experience. In addition, the same dilemma may occur when a patient refuses to be put on a ventilator to aid their breathing during their end-of-life care. Again, such a decision may be met with opposition from the immediate family members putting a nursing practitioner in an ethical dilemma on whether to follow the patient’s preferences, which may mean their health deteriorating faster or the family’s decision to help the patient is comfortable breathing.

Ethical Principles Pertinent to Decision Making in Advance Care Planning

The ethical principles related to patient autonomy in advance care planning emphasize the importance of promoting supported decision-making, respecting the patient’s autonomy while also encouraging shared decision-making. This involves consulting with family members and healthcare practitioners to reduce ethical dilemmas, especially when the patient’s decision-making capacity is compromised. Additionally, promoting congruence between patients and substitute decision-makers is crucial to ensure that the patient’s preferences are followed during treatment, particularly towards the end of life. Nursing practitioners play a significant role in providing support and education to the substitute decision-makers to facilitate a seamless decision-making process.

Application in Organization and Institutional Policies

The healthcare organization I’m employed in promotes patient autonomy during advance care planning. The hospital has various policies to guide the staff and patients on patient autonomy during the advance care planning process, achieving various objectives such as patient-centered care, easy decision making, and patient satisfaction. One of the institution’s policies is adhering to the Patient Self-Determination Act of 1990, which states that healthcare organizations and practitioners are obliged to inquire from new patients whether they have an advance care plan to help promote their autonomy during their end-of-life treatment. According to the policy, if the patient is yet to execute an advance directive, the medical practitioner attending to the patient should offer the patient the chance to execute this directive, providing them the relevant information as long as the patient still has the mental capability to do so.

In addition, the hospital policy also requires medical practitioners to inform patients of their right to make their healthcare decision. In various cases, patients may not be aware of their right to autonomy during the advance care planning process. This lack of knowledge might result in confusion during the decision-making process causing conflicts and affecting the patient’s experience and satisfaction during their end of life. However, adhering to the Patient Self-Determination Act directive allows every health practitioner within the organization to inform the patient of their rights to autonomy before beginning the advance care planning process for efficient decision making and to promote patient advocacy. In addition, this act also requires the organization to provide patients with information on the institutional policies governing their autonomy rights during the advance care planning process to ensure they understand every process before making their decision. This information also helps prepare patients on what to expect during their end-of-life treatment process and understand their responsibilities and the responsibilities of their supportive decision-makers during the treatment process.

In addition, another policy the institution has in place is to ensure constant communication and sharing of information between the patient, their family, and the medical practitioners attending to the patient. Sharing information ensures that all the parties involved in the patient’s advance care planning process remain updated in case of any new developments regarding the patient’s health, ensuring an up-to-date treatment plan per the patient’s preferences (Hooper et al., 2020). In addition, constant communication also ensures that the supportive or substitute decision-makers remain prepared to take their roles and fulfill their responsibilities whenever called upon, reducing the chances of miscommunication which may affect the end-of-life care of the patient. Effective communication also ensures that patients remain informed of their treatment process, promoting patient satisfaction in knowing that the organization followed their preferred treatments. This policy also stipulates being honest with the patients about their current health status and the expected treatment results, helping them remain prepared and aiding their decision-making process on the next course of action and the preferred type of treatment.

References

Engelhardt, B. (2022). Palliative care: patient’s autonomy in the end-of-life situation. Memo-Magazine of European Medical Oncology, 15(1), 76-78.

Hamilton, I. J. (2017). Advance care planning in general practice: promoting patient autonomy and shared decision making. British Journal of General Practice, 67(656), 104-105.

Hooper, S., Sabatino, C. P., & Sudore, R. L. (2020). Improving medical-legal advance care planning. Journal of Pain and Symptom Management, 60(2), 487-494.

Lin, C. P., Cheng, S. Y., & Chen, P. J. (2018). Advance care planning for older people with cancer and its implications in Asia: highlighting the mental capacity and relational autonomy. Geriatrics, 3(3), 43.