Overcoming Decision Making Conflicts in Palliative Care … Research Paper
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Ethical Analysis: Strategy for Palliative Care
The alternatives that are available today to take care of dying patients are numerous. These alternatives have increased as technology has evolved. Ethical dilemmas arise when one is faced with the decision of the best possible care for a patient who is dying. One of these decisions is on sustaining a patient's life through machines or terminating it through the switching off of the life supporting machines. These are decisions that create ethical dilemmas for all who are involved. Unlike in the past, when death could easily be defined as the cessation of life, today, things are different. This is because in today's world, there exist machines that can sustain the functions of various organs such as the lungs and this leads the definition of death to be more complex. Thus as Shaughnessy (2004) says, in the twentieth century a new patient has emerged whose heart and lungs are alive but the brain is essentially dead as it does not function. Technologies such as the cardiopulmonary resuscitation (CPR) have made this possible where a patient whose heart and lungs have ceased to work, but are restarted using machines. This care of dying patients as well as the ethical dilemmas imposed lead many healthcare workers to burnout because of the emotional exertion, the physical as well as psychological demands made on them. Periera, et.al, (2011) state that this suffering is as a result of facing death everyday by the palliative care workers. Some of the issues that confront these workers are the decision to comply with the advance requests of patients, the decision to assist in suicide or euthanasia, the decision to withhold or withdraw treatments that one knows are necessary to sustain life, the decision to withhold resuscitation techniques.
Intraprofessional Team to Formulate Strategies
Palliative care delivery is difficult and often requires a whole team; the team includes medical and nursing staff, physiotherapist, social worker, and spiritual caregiver. Communication and coordination of a team is very important and during meetings of the team, detailed information should be shared and every member should be on the same page. A stronger team requires common understanding and ideal of the contribution and the role of the team that each member makes to achieve successful results (Spruyt, 2011). Inadequate communication, interpersonal conflict, role overload, role ambiguity and conflict issues are some of the challenges within the team. This can be due to external or internal issues, corporate issues or stresses. As the team grows larger in lobby groups, alliances and subgroups, several agendas come up, which distract the team from its actual purpose (Crawford & Price, 2003).
Application of Ethical Standards
Through technological developments new ethical dilemmas have emerged. The patients, health workers, and families must now make decisions on whether to adopt procedures that will prolong the life of the patient, even though not curing them, or not. Some of these techniques to prolong life may also prolong the suffering of the patient and by extension the family and caregivers involved. There are principles that can guide those involved in making a decision that would be agreeable and morally right.
Hinshaw (2008) highlights four of these principles as the modern principles of autonomy and justice as well as the Hippocratic principles of non-malfeasance and beneficence. All who are involved in patient care must have adequate knowledge so that their care is preemptive and accommodates the inclinations of the patient. It can be a difficult thing to be truthful to patients in cases of terminal illness or advanced stages of cancer. Sometimes informed consent must be sought from the families of patients who are not in a conducive mental state for this. Thus a family caregiver will be in communication with the palliative care team so that during the patient's final stages, their dignity is preserved and confidentiality is maintained. In this case, the communication will serve two purposes as far as ethics is concerned. Mohanti (2009), states that one of these is to clarify what a good death would be and the other is try and resolve the needs of the patient and his/her family which are mostly in conflict.
Pain is a present factor in many terminal illnesses including cancer in its advanced stages. It causes the patient discomfort and agitation and is difficult to bear for their families. In palliative care, it is relieved through the scientific principles of the analgesic ladder. However much as it is an ethical duty to relieve pain, it has not been given priority in medical care. Mohanti (2009) explains the reasons for this as inadequacy of skills and knowledge to evaluate pain, poor medication, lack of morphine, and myths surrounding opioid addictions and sedation.
The World Health Organization has made efforts to improve these situations especially in palliative care. These efforts by WHO and other bodies has caused the relief of pain to be designated an ethical duty of medicine and made it the responsibility of society to avail morphine. Pain should actually be viewed as a public health crisis for ethical reasons and this will ensure that measures are put into place to give it priority. The palliative care principles and the preferences of the patients should try as much as possible to be balanced. Autonomy of the patient through the receiving of his or his family's consent should be encouraged. Through this numerous tests, prolonged hospitalization, and unnecessary procedures can be avoided. Many nations around the world have incorporated the DNR (do not resuscitate) policy into their palliative care (Mohanti, 2009).
Palliative care strategies
Baker, et.al, (2008) proposes various strategies when dealing with ethics in palliative care. One of these is the formation of ethics committees whose input is imperative when conflicts arise in resolving complex situations with regard to patients, the communication required with their families and healthcare providers and all the ethical issues arising from this.
Another strategy proposed by Baker, et.al, (2008) is that where pediatric oncology programs foster partnerships with health and hospice agencies so that the patient receives the palliative care that is better as a result of the partnership than it would have been without it.
Another strategy is by combating the fragmentation of care through coordinating the care process so that there is adequate communication and collaboration between health care providers as the disease progresses. This will ensure that the quality of life of the patient is improved while the healthcare is provided (Baker et.al, 2008).
Another strategy is to have a symptom control process (Baker et.al, 2008). This is the process by which attention is given, right from the point of diagnosis, to expected and unexpected symptoms with the aim of incorporating palliative care with oncology programs.
Lastly Baker et.al, (2008) state that special attention needs to be given to the patient's preferences as well as those of their families. The patient and their family's preferences and priorities are bound to change as the condition changes or the treatment is altered.
Team Member Conflict
Legal elements as well as human rights offer protection of rights that permit not only equal participation but also individual fairness in any functional society. This implies that individual life, health, freedom and property are protected by law. In this century, healthcare rights are well documented, including delivery of fundamental clinical services and an society that permits optimum and thriving health. Within this framework, a patient with terminal illness might seek to commit suicide assisted by a physician. This phenomenon is referred to as Euthanasia and this practice has been authorized by law in a few countries including Holland, Belgium, some states within the U.S. along with Australia). Nonetheless, euthanasia raises moral issues in palliative care. Since the staff is not trained for this act, stress and conflict tends to arise in such situations (Mohanti, 2009). The Physician in the team was against using euthanasia, while the rest of the team had no issue with it, in the palliative strategy because of several reasons he presented to the team; (1) he stated that euthanasia is wrong in its pure essence, violates professional integrity while also endangers the relationship between the patient and the physician; (2) this sends mixed messages to the public who are already misinformed about the issue; (3) it is a source of distress for both the family of the patient and the patient itself; (4) it is also a source of moral and emotional stress for the staff members; (5) and it places the entire team on the position of a gatekeeper between the family who disagrees with using euthanasia and the patient who wants to end his life through assisted suicide (Bigler, Jean-Michel, et al., 2006).
Incorporating the Decision Making Process and Achieving Consensus
As a basic human right, a person is entitled to healthcare. This as seen in the past century and even today encompasses an atmosphere that is conducive for good health as well as access to clinical services. Thus patients and their family members may express the wish… [END OF PREVIEW]
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