End Of Life Decisions

PHIFPX3200 Capella End of Life Issues in Relationship to Hospital Paper
End Of Life Decisions
End Of Life Decisions
Its important to meet the competencies!!
Overview
Write an article for a community newsletter for a local retirement village that explains
the laws, policies, and choices surrounding end-of-life health care decisions.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Explain the effect of health care policies, legislation, and legal issues on health care delivery and patient outcomes.
Identify the primary policies that define current health care practices in regard to end-of-life health care decisions.
Explain the legislation that generated end-of-life health care policies.
Competency 2: Explain the effect of regulatory environments and controls on health care delivery and patient outcomes.
Explain the effect of end-of-life regulations and controls on patient outcomes.
Competency 3: Apply professional nursing ethical standards and principles to the decision-making process.
Describe the role of the nurse in end-of-life decision making with patients and their families.
Describe the ethical considerations that have influenced policy decisions in regard to end-of-life decisions.
Competency 4: Communicate in a manner that is consistent with expectations of nursing professionals.
Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.
Correctly format citations and references using APA style.
Assessment Instructions
Your manager asked you to prepare an article for a community newsletter for a local retirement village. The editor wants you to talk about the laws, policies, and choices surrounding end-of-life health care decisions
Preparation
Search the Capella library and the Internet for scholarly and professional peer-reviewed articles on end-of-life care. You will need at least three articles to use as support for your work on this assessment.
Directions
Write an article of 750–1,000 words (3–4 pages) that discusses the laws, policies, and choices surrounding end-of-life health care decisions. Address the following in your article:
Describe the role of the nurse in end-of-life decision making with patients and their families.
Explain the legislation that generated end-of-life health care policies. Was the legislation an outcome of a specific medical case?
Identify the primary policies regarding current health care practices related to end-of-life health care decisions. How to these policies affect treatment decisions?
Explain the effect of end-of-life regulations and controls on patient outcomes. What effect does this have on the nurse-patient relationship?
Describe the ethical considerations that have influenced policy decisions in regard to end-of-life decisions.
Additional Requirements
Your article should meet the following requirements:
Written communication: Written communication should be free of errors that detract from the overall message.
References: Cite a minimum of three resources; a majority of these should be peer-reviewed sources. Your reference list should be appropriate to the body of literature available on this topic that has been published in the past 5 years.
APA format: Resources and citations should be formatted according to current APA style and formatting.
Length: 750–1,000 words or 3–4 typed, double-spaced pages, excluding title page and reference page. Use Microsoft Word to complete the assessment.
Font and font size: Times New Roman, 12-point.Correctly format citations and references using APA style.
Over the previous few decades, the circumstances of dying and death have changed.
People nowadays die more frequently from chronic progressive diseases, especially as they get older.
Most patients want to die gently rather than get harsh life-prolonging treatments, according to evidence.
1–6
As a result, end-of-life decisions (ELDs), which are an integrated facet of current palliative and end-of-life care, are becoming more common among healthcare professionals.
7–9
ELDs are medical decisions made near the end of life that could potentially shorten a person’s life.
ELD decision-making processes are interwoven in and stimulate clinical, ethical, sociocultural, religious, political, and economic considerations, according to 10,11.
End-of-life decisions are perceived by healthcare workers to be complex, challenging, and stressful, and ELDs are linked to burnout and moral suffering.
9,12–15
ELDs and their associated decision-making procedures are critical because they deal with the ethical and legal aspects of care.
End-of-life situations are frequently times of great vulnerability, and they can have a significant impact on patients’ ability to exercise autonomy.
When the latter is compromised, and patients are unwilling or unable to participate directly in decision-making, discussions with surrogate decision makers become necessary.
ELDs with 16–19 can also be used as a quality indication.
This occurs in terms of both outcomes (e.g., decision-making and care preferences) and procedures (e.g., communication) (e.g., discussions with patient about goals of care).
20–26
In 2014, the Council of Europe (CoE), through its Committee on Bioethics, launched the “Guide on the decision-making process regarding medical treatment in end-of-life situations” (hereinafter, the “Guide”). The aims of this Guide are: to propose reference points for the implementation of the decision-making process underlying medical treatment in end-of-life situations; to bring together both normative and ethical reference works and elements relating to good clinical practices; and to contribute to the overall discussion on the decision-making process in end-of-life situations, particularly the complex circumstances encountered in this context. The Guide is applicable throughout the continuum of healthcare provision, in any context or place of care. It targets a broad audience of stakeholders who are or may be involved in end-of-life situations (e.g., healthcare professionals, patients, families, and associations).
Due to the variability in cultural, societal, and legal status across European countries, the Guide is not legally binding, assuming solely an advisory role. Little is known about its effective implementation and whether or not end-of-life decision-making processes in European healthcare systems are consistent with its framework and recommendations.
Should We Withhold Life Support? The Mr. Martinez Case Study
January 2020
Allowing Limited Interventions
Many ethical questions surround the concept of end of life care. While most support the idea of passive euthanasia, meaning the refusal of life saving treatments to allow natural death, ethical debate surrounds the idea of active euthanasia, also known as physician assisted euthanasia. Most ethical theories and religious systems value human life and consider any form of suicide to be morally wrong. Many argue that terminally ill patients have a right to end their suffering and die with dignity, however others argue that medical professionals take an oath to “do no harm” and should abide by it. At what point do terminally ill patients have a right to end their suffering? The case study follows Mr. Martinez, a 75 year old patient with COPD admitted with an upper respiratory tract infection. When he was admitted, Mr. Martinez discussed with his wife and doctors that he would not want to be resuscitated. Although Mr. Martinez initially responded well to treatment, his oxygen was inadvertently turned up, causing respiratory distress.
Considerations When Limiting Life Support
It is important for healthcare providers to respect patients advanced directives when providing care. In the case of Mr. Martinez, many factors may have led to his decision for signing a Do Not Resuscitate order. Some common reasons that patients opt to sign a DNR are dissatisfaction with current quality of life, fear of the pain CPR can cause, fear of prolonged life support, and avoidance of being a burden on family members (Downar et al., 2011). Mr. Martinez’s healthcare team must respect that, although his current condition was caused by an accidental high dose of oxygen, it does not change his stance on life support. The only time a DNR order can be appropriately rescinded by the healthcare team is during the perioperative period or when directed by a designated healthcare agent (Whidbey Health, n.d.). About 69% of healthcare providers are more likely to override a DNR order if the cardiac arrest is iatrogenic. Common reasons for doing so are fear of malpractice lawsuit, feeling of guilt, and belief that patients did not have iatrogenic arrest in mind when they signed the DNR order (Tan, 2018). However, medical errors do not alter the obligation a physician has to respecting a DNR order. The healthcare team must also consider Mr. Martinez’s quality of life if they were to suspend his DNR and perform resuscitation. Due to his diagnosis of COPD and his current state of respiratory distress, it is likely that the healthcare team will struggle to wean him from mechanical ventilation. About 50% of COPD patients meet the criteria for being “difficult to wean”, meaning weaning can take greater than 7 days. The mortality rate increases by 27% for patients who require reintubation (Talwar and Dogra, 2016). It is very likely that despite the healthcare teams’ efforts, Mr. Martinez will still succumb to his illness. By intubating Mr. Martinez, the healthcare team is now burdening his wife with the decision to remove Mr. Martinez from life support.
Moral Issues Associated with Limiting Life Support
The right to refuse life prolonging treatments is covered under the concept of autonomy, which is the right to making informed and uncoerced decisions. For many healthcare professionals, the concept of withdrawing life prolonging treatments goes against the Hippocratic Oath of “do no harm”. Many feel that their responsibility as healthcare professionals is to treat patients, not allow them to die. As long as patients are determined to be competent, they have every right to forgo life sustaining treatment, allowing a natural death. Many equate this to dying with dignity. Most religious systems value all human life, therefore any action to end human life is considered wrong. Religions such as Catholicism, Buddhism, Islamism, and Judaism denounce physician assisted euthanasia, noting that human life is sacred and needs to be preserved. However, these religions still accept that a dying person has a right to refuse further treatment so that to not unnecessarily prolong their suffering (Pew Research Center, 2019). It is necessary for healthcare providers to identify that there is a difference in ending a life and ending a patient’s suffering.
Ethical Issues Associated with Limiting Life Support
When making the decision to withdraw life sustaining care, many ethical theories can be applied to the situation. Under the ideas of Utilitarianism, the decision to end life sustaining treatment must bring an outcome of the greatest good for the greatest amount of people. If a patient has been suffering with a terminal illness for an extended amount of time, their family may feel sad about their passing, but overall, they may feel at peace. Family members will feel okay with the passing because their loved one is no longer suffering. Under the ideas of Ross’s Ethics, the prima facie duties applying to the healthcare providers would be fidelity (the promise the physician made when signing the DNR order), beneficence (by ending suffering, the physician will be creating the greatest amount of good) and non-maleficence (the physician will be ending the patients suffering). The healthcare providers actual duty will be to respect the patient’s wish to limit life sustaining treatment. Under the ideas of Natural Law Theory, the idea of ending a human life is considered always morally wrong, however the Principle of Double Effect allows a bad effect as long as it is intended to have a good effect. By allowing the patient to die naturally, the physicians are ending the patient and their loved one’s suffering. Under the ideas of Kantian Ethics, humans should not be used and abused. The idea of autonomy is also strongly supported by Kantian Ethics. If the patient understands the prognosis and chooses not to undergo treatment, a doctor’s moral obligation is to respect this.
Conclusion
Many ethical questions surround the concept of end of life care. As healthcare providers it is important that we understand that we cannot save everyone from death. If the patient has made the decision to forgo further medical treatment, we must respect that decision. When a patient chooses to die with dignity, it becomes our responsibility to assist them in a peaceful death. In the case of Mr. Martinez, it is the healthcare providers responsibility to respect his wishes, no matter what the situation might be.
References
Downar, J., Luk, T., Sibbald, R. W., Santini, T., Mikhael, J., Berman, H., & Hawryluck, L. (2011). Why do patients agree to a “Do not resuscitate” or “Full code” order? Perspectives of medical inpatients. Journal of general internal medicine, 26(6), 582–587. doi:10.1007/s11606-010-1616-2
Pew Research Center. (2019, December 31). Religious Groups’ Views on End-of-Life Issues. Retrieved from https://www.pewforum.org/2013/11/21/religious-groups-views-on-end- of-life-issues/
Talwar, D., & Dogra, V. (2016). Weaning from mechanical ventilation in chronic obstructive pulmonary disease: Keys to success. Retrieved from http://www.jacpjournal.org/article.asp?issn=2320- 8775;year=2016;volume=4;issue=2;spage=43;epage=49;aulast=Talwar
Tan, S. Y. (2019, March 28). Consent and DNR orders. Retrieved from https://www.the- hospitalist.org/hospitalist/article/158675/business-medicine/consent-and-dnr-orders
Widbey Health. (n.d.). Do Not Resuscitate (DNR)/Do Not Attempt Resuscitation (DNAR) Policy. Retrieved from https://whidbeyhealth.org/about/important-policies/do-not- resuscitate-dnr-do-not-attempt-resuscitation-dnar-policy
PHIFPX3200 Capella End of Life Issues in Relationship to Hospital Paper
Tonya’s Case: Ethics and Professional Codes Scoring Guide CRITERIA NONPERFORMANC E BASIC PROFICIENT DISTINGUISHE D Demonstrate sound ethical thinking in applying ethical principles and moral theories to a specific case. Does not demonstrate sound ethical thinking about ethical theories and moral theories in applying them to a case. Demonstrate sound ethical thinking in applying ethical principles and moral theories to a specific case, but in an unclear, incomplete, or inaccurate manner. Demonstrate sound ethical thinking in applying ethical principles and moral theories to a specific case. Demonstrates sound ethical thinking in applying ethical principles and moral theories to a specific case, and does so with insight and original arguments Explain professional codes of ethics and apply them to a specific case. Does not explain professional codes of ethics and apply them to a specific case. Explains professional codes of ethics and applies them to a specific case, but in an unclear, incomplete, or inaccurate manner. Explains professional codes of ethics and applies them to a specific case. Explains professional codes of ethics and applies them to a specific case, and does so with insight and original arguments. Explain organizational documents like mission and value statements and use them to analyze a case study. Does not explain organizational documents like mission and value statements and use them to analyze a case study. Explains organizational documents like mission and value statements and uses them to analyze a case study, but in an unclear, incomplete, or Explains organizational documents like mission and value statements and uses them to analyze a case study. Explains organizational documents like mission and value statements and uses them to analyze a case study, and does so with insight CRITERIA NONPERFORMANC E BASIC PROFICIENT inaccurate manner. DISTINGUISHE D and original arguments. Explain the role of accrediting bodies and apply this understanding in analyzing a case study. Does not explain the role of accrediting bodies and applies this understanding in analyzing a case study. Explains the role of accrediting bodies and applies this understanding in analyzing a case study, but in an unclear, incomplete, or inaccurate manner. Explains the role of accrediting bodies and applies this understanding in analyzing a case study Explains the role of accrediting bodies and applies this understanding in analyzing a case study, and does so with insight and original arguments. Provide validation and support within written communicatio ns by including relevant examples and supporting evidence using APA citations. Does not provide validation and support within written communicatio ns by including relevant examples and supporting evidence using APA citations. Provides minimal validation and support within written communicatio ns by including vaguely relevant examples and supporting evidence using APA citations. Provides validation and support within written communicatio ns by including relevant examples and supporting evidence using APA citations. Provides validation and support within written communication s by including relevant examples and supporting evidence using APA citations flawlessly. Produce writing with minimal errors in grammar, usage, Produces writing with many errors in grammar, usage, spelling, and mechanics. Produces writing with some errors in grammar, usage, spelling, and mechanics. Produces writing with minimal errors in grammar, usage, spelling, and mechanics. Produces writing that is consistently superior with no errors in grammar, usage, spelling, CRITERIA NONPERFORMANC E BASIC spelling, and mechanics. PROFICIENT DISTINGUISHE D and mechanics. Resources: Professional Ethical Codes and the Role of Ethics Committees. The Role of Ethics Committees Most hospitals today have an ethics committee, which is a group composed of various staff members and other individuals from the local community. The committee consults with staff and hospital administrators on cases that pose particularly challenging ethical dilemmas, but it has other functions as well. Think about the following questions: • • • • • What are the primary duties of a hospital ethics committee? When it comes to consultation, what sorts of cases does the committee advise on? Does the committee simply command what should be done in such cases? In terms of professional roles, who usually sits on them? Assess the value of ethics committees to your professional role. If you have direct experience with ethics committees, what have you observed? Legal and Ethical Considerations • • • o Chassin, M. R. (2013). Improving the quality of health care: Where law, accreditation, and professionalism collide. Health Matrix: Journal of Law-Medicine, 23(2), 395–407. Aulisio, M. P., Moore, J., Blanchard, M., Bailey, M., & Smith, D. (2009). Clinical ethics consultation and ethics integration in an urban public hospital. Cambridge Quarterly of Healthcare Ethics, 18(4), 371–383. The Joint Commission. (2016). Retrieved from https://www.jointcommission.org Review the general information on the scope and purpose of this accrediting organization. Case Study: Tonya Archer Introduction It is one thing to consider medical ethics in an abstract setting, but by their nature, medical ethics involve deeply personal and emotional situations. This activity asks you to consider a case in which the family’s wishes are in conflict with the medical advice they have been given. You will be asked to answer some questions at the end of this activity. Tonya is admitted to the hospital Tonya Archer is a fifteen year-old who has been admitted to Saint Anthony Medical Center for surgery to repair an ACL injury she suffered while playing softball. Tonya and her family have met with her surgeon and understand that while all surgery carries risks, this is a straightforward procedure that he has performed many times with no complications. Post-surgical complications The surgery goes as expected, but as Tonya is being transferred from the recovery room to her hospital room, she went into cardiac arrest. While Tonya received immediate medical attention, it took over seven minutes to restore cardiac function and the loss of blood circulation resulted in brain damage. During the attempt to resuscitate Tonya, she was intubated and placed on a ventilator. The medical staff has determined, though, that the loss of circulation caused brain death. Doctors recommend ending life support Tonya’s doctors explain to her family that the damage Tonya sustained is irreversible and that she suffered whole brain death, which means that there is no neurological function, even at the most basic functions such as respiration or cardiac function. They tell the family that the next step is to take Tonya off the ventilator. Tonya’s parents reaction is of steadfast refusal. They tell the doctor that they understand that Tonya has had a serious accident, but they point out that her body is warm, her heart is beating, and that she therefore is not dead. Hospital administrator and medical ethicist The doctors, hospital administrator, and the hospital’s medical ethicist tell the family that while the ventilator and other interventions can sustain the body’s functions, the damage done by the cardiac arrest will get worse and there is near certain expectation that Tonya will not recover any brain function. The family is told that there is no reasonable hope of benefit to Tonya by continuing ventilator and other treatment. Reflection: Answer this questions 1.What are the most relevant end-of-life issues in health care ethics as they relate to this case? 2.What should the hospital do? Should the hospital keep Tonya on life support as the parents desire, or should life support be removed because all medical evidence indicates whole brain death?