Ethics

Write a 7 pages Research Paper following APA format including Title Page, Abstract, Conclusion, and References. You can select your favorite topic from anything related to this class: Ethics and the Elderly Population. The student must use other textbooks, research papers, and articles as references (minimum 4 references).
1 HIPPA and Pravice Law
2 Medical Record or informed consent
or
3 Death and Dying
You can choose any of these for the research paper

ANSWER

Ethical Issues of Death and Dying

Abstract

In this paper, we will explore the various ethical dilemmas faced by physicians and family members at the end of life care situations. The paper explores patient preferences such as assisted suicide and the ethical implications of assisted suicide. Other end of life preferences such as no resuscitation and no life support measures are explored, especially among the elderly and terminally ill people. The paper explores the implications of such requests to the physicians and the role of the family members in such requests. Hospital policies on ethical decision-making are integral in ensuring that the healthcare providers make the right decisions and follow the preferences of the patient (Karnik & Kanekar, 2016). They also help in making decisions where the patient preference is not clear.

Ethical Issues of Death and Dying

The medical field faces many ethical issues daily. One of the most common issues faced in the contemporary world is the issue of the end of life. There are many different routes a patient can take when it comes to the issues of death and dying. Once a patient is diagnosed with a terminal condition, they can choose palliative care or assisted suicide. Both methods are up for debate on the ethics of any of the two methods of care, and sometimes they conflict with each other (Karnik & Kanekar, 2016). Scientific advancements in medical science have the potential to shape the circumstances of death and can also prolong a person’s life. Human beings are mortals, and therefore death is an inevitable topic. It is the eventuality of all human life. The technological advancements in medicine are, however, reshaping and changing the norms of natural death. Technological advancements can prolong life with or without meaning. These include machines such as life support machines feeding tubes, and others.

The technological advancements give the families of the patients a chance to choose the preference of care during the end of life (Karnik & Kanekar, 2016). Due to the wide range of scientific and medical technology that can prolong life or end life, the ethical dilemmas are increased in the area surrounding death and dying in the medical field. The decision-making process in itself is a tedious process for the patients and their families. Patients also have a right to forward their end of life care treatment preferences. Ethically the preference of the person in their end of life care has to be respected. However, the preference of the patient has some limitations, which creates room for more ethical dilemmas. It is, therefore, the duty of the healthcare professional to carry out the preference of the patients, following through the limitation and without doing harm.

The issues of death and dying are sensitive, especially if the patient does not have much time left or is terminally ill. Sometimes it is confusing for healthcare workers on the amount of information they should reveal to a patient about their condition. It is also up to the doctors to work towards the good of such a patient, and that involves looking for the best possible ways to keep the patient comfortable until their lives come to an end. In situations where the patient is terminally ill, the patient might decide that they cannot endure the suffering and financial strain they are about to put on their families and choose that their physicians should assist in their suicide. However, the topic of assisted suicide is widely debated, and it is one of the significant areas of ethical dilemmas.

Euthanasia is the administration of lethal doses of medication to intentionally eliminate one’s life due to a terminal health condition. The ethical dilemma resulting from euthanasia is the physician is torn between carrying out the autonomous request of the patient and following through with the Non-maleficence act of doing no harm (Pfirrmann et al., 2016). Assisted suicide is a controversial topic and, in countries like New Zealand, illegal. A patient might be terminally ill and suffering and wants to get out of the misery. The doctor is supposed to carry out the eyes of the patient but is stopped by the limitations and their oath of doing no harm to any patient. There are situations where euthanasia is the best action for the patient, especially in a case where the patient is in a lot of pain, and the medical bills keep piling on, and the family is not in a situation to cater for them.  Euthanasia is illegal in most of the United States. Assisted suicide is legal in States such as Washington Dc, California, Colorado, Oregon, Vermont, Maine, New Jersey and Hawaii.

Assisted suicide is, however, not an easy issue and requires several guidelines to be followed. The maleficence act requires that doctors do no harm, but the beneficence act requires the physician to do good. Refusing to assist a patient in their autonomous end of life care request could be harming the patient than doing good (Terkamo-Moisio et al., 2017). The conflict arises from this because it is impossible for another human being to determine the rate of the suffering of another person. This, therefore, brings two sides to the ethical conflict. Those who see the ending of a patient’s life at their request to end the pain as harming and those who see refusing to follow through with the client request as doing the patient more harm. The ethical dilemma develops in this situation because doctors are supposed not to harm their patients, and they took an oath always to do well. In this situation, the patient loses either way.

Healthcare providers and physicians have to consider the patient’s perspective and preferences. They have to work for the good of the patient. The families of the patients should also put aside their selfish needs when faced with the situation where they have to make the end of life care decisions for the incapacitated patient. The working towards the greater good of the patient by the doctors and the patient’s family members falls under the virtue theory of ethics.  It is also the responsibility of the physician to provide information about the treatment of the patient to the family members, especially in cases of futile treatment. In cases of futile treatment, the physician’s responsibility is to allocate limited resources to manage the case and avoid inequity. For example, in a situation where the patient has been on life support for a long time, the physician can advise the family to choose and get the patient off life support to free up hospital resources and reduce the costs spent in the patient hospital from accumulating further.

Dying is unique to each individual yet is a universally shared experience (Gluchman, 2019). Death significantly impacts the perceptions of identity and culture. The world is rapidly developing, and people are developing new ways in which they want to experience death. It is for this matter that end of life preferences are causing so many ethical dilemmas. Apart from assisted suicide, some patients may ask that they are not resuscitated or not put under the support system in the ICU. Although these are reasonable end of life preferences, the nurses and the doctors are faced with dilemmas when it comes to not doing all they can to preserve the life of their patients. Asking not to be resuscitated is asking a doctor not to do anything and watch as the patient dies, which is not what they are supposed to do. In situations such as these, the doctor can consult with the family on the best cause of action or make judgments on what is best for the patients. In other situations, however, the doctor might decide to honour the wish of the patient, especially if resuscitation harms the patient or puts them through unnecessary pain.

The ethics of death and dying also face the older population. The older population is more in touch with the reality of death than the younger population (Camp et al., 2018). Some older adults have confided in their doctors on their fear of death and how they are afraid of having a long sufferable death. Some are afraid that they will not receive the kind of death they want and that they will suffer towards the end.  The old persons described the different types of fears they had about their death process in research done by Tjernberg & Bokberg (2020). The older population involved in the research was also concerned about not receiving the care they needed towards the end.  Most of the subjects involved in the study hoped to remain healthy till the end. They also hoped that it would be quick and painless. It is, therefore, the ethical responsibility of the healthcare providers and the physicians to care for the elderly and make them comfortable during their end of life experience. In situations where the patient is old and ready to move on, the doctors should follow their end of life care preferences such as do not resuscitate because, in such a situation, resuscitation is doing harm to the patient and not respecting the patient’s care.

The older persons in the research by Tjernberg & Bokberg (2020) expressed the need to control their death circumstances, although most were aware that it is impossible to control death. Several shared thoughts about assisted death. Some were against the idea of assisted death but were also against the issue of life support. A percentage of the older adults expressed positive feelings towards assisted death and felt that the decisions made towards ones death should be individual and respected.  From the research carried out, the older adults expressed worry about death and dying. They were apprehensive about experiencing pain during their death experience. The ideal way of dying expressed in this research was quick and painless. It is, however, clear that older persons are not afraid of death but are worried about the conditions they will experience during death.

The research done in the study by Tjernberg & Bokberg (2020) concluded that older adults have a need to be involved in their end of life care preferences and need their family members to talk to them openly about death and dying. They also need to talk about what worries them about death and the measures that can be taken to improve their quality of life. The choices made during death and dying ethically might sometimes be different from other choices involved in health and social care. Therefore, it is crucial for physicians and family members to logically and coherently account for the decisions made for the patient at the end of life care. This especially concerning older adults who had already communicated the preferences. Suppose the person had asked not to be resuscitated and the family members decide to resuscitate. In that case, they have to provide a reasonable and logical reason because ethically speaking, in matters of death and dying, the patient’s preferences should be followed as long as they were made when the patient was of sound mind.

Ethical issues usually end up in the discussion of ethical decision-making. It all ends in the hands of the physicians and the family members and trying as much as possible to follow the needs preferences of the patient while still ensuring they fulfil their oath to protect and care for all their patients. This makes the situation hard, but it is not impossible. With the help of hospital management and created policies on ethical decision-making, healthcare providers and physicians can make the best decisions for their patients.

In conclusion, it is important to have a conversation about end of life care and the ethical dilemmas involved. In situations where the desires of the patient are not clear, community standards can be applied. Healthcare providers must have person to person conversations with their patients about their end of life care references to avoid problems. The patient’s family also plays a role in ensuring the patient gets the best care and the kind of care that works for their good.

References

Camp, M. E., Jeon-Slaughter, H., Johnson, A. E., & Sadler, J. Z. (2018). Medical student reflections on geriatrics: moral distress, empathy, ethics and end of life. Gerontology & geriatrics education, 39(2), 235-248.

Gluchman, V. (2019). PHILOSOPHY AND ETHICS OF DEATH AND DYING. In SCIENTIFIC PARTNERS OF NORDSCI CONFERENCE ON SOCIAL SCIENCES (p. 237).

Karnik, S., & Kanekar, A. (2016, June). Ethical issues surrounding end-of-life care: a narrative review. In Healthcare (Vol. 4, No. 2, p. 24). Multidisciplinary Digital Publishing Institute.

Pfirrmann, M., Baccarani, M., Saußele, S., Guilhot, J., Cervantes, F., Ossenkoppele, G., … & Simonsson, B. (2016). Prognosis of long-term survival considering disease-specific death in patients with chronic myeloid leukemia. Leukemia, 30(1), 48-56.

Terkamo-Moisio, A., Kvist, T., Kangasniemi, M., Laitila, T., Ryynänen, O. P., & Pietilä, A. M. (2017). Nurses’ attitudes towards euthanasia in conflict with professional ethical guidelines. Nursing Ethics, 24(1), 70-86.

Tjernberg, J., & Bökberg, C. (2020). Older persons’ thoughts about death and dying and their experiences of care in end-of-life: a qualitative study. BMC nursing, 19(1), 1-10.