Question

Paper is about an ethical dilemma between a son and daughter of a patient that disagree about end of life decisions.

1. Gather Data and Identify Conflicting Moral Claims • What makes the situation an ethical problem? Are there conflicting obligations, duties, rights, morals, values, or beliefs? • What are the issues? • What facts seem most important? • What emotions have an impact? • What are the gaps in information at the time?

Answer 1

Ethical Dilemma - situation pertaining to ethical problem

If a patient is dying, with little or no hope of recovery, almost any intervention beyond symptom management and comfort measures is seen as futile ( means something that is hopeless). In health care discussions, interventions unlikely to produce benefit for the patient. Predictions about health outcomes are not always accurate. Agreement on what is best is best is often elusive. When an aging patient is at end of life, issues may be complicated by his or her ability to take competent decisions

Conflicting obligations, duties, rights, morals and beliefs

Emotions, misunderstandings, inter-personal conflicts often complicate ethical dilemmas. Indeed, many ethical dilemmas are settled by addressing psychosocial issues rather than focussing on philosophical debates

Acknowledging and showing empathy for the emotions of patients and care-givers helps them feel that health care provider understands them and cares about them

Showing respect, concern and compassion bulids patient and family trust and makes them more likely to accept physician's orders

A chaplain, social worker or a nurse who have good rapport with the patient and family members can help physician to accomplish his goals

Issues

Health care providers need to understand the legal risk of course of action they have determined to be ethically appropriate

Ethics and law may differ. Many states do not explicitly authorise surrogate decision making by thefamily members who have not been designated as the proxies by the patient

Health care workers can minimize the legal risk by proper documentation in medical records ; the reasons justifying the plan for care

Issues occur when there is no "right" action or course of action is clear

Gaps in the information- Mind the gap

Understanding patient and family perspectives and preferences regarding end-of-life care issues is necessary to identify key opportunities for improving care. Advanced careplanning( co-ordiantion of care, care giver support, comprehensive symptom management) seamlessly bridge hospital and home

The greatest opportunities for improving End-of-life care are described as follows:

• Reduce physical burden on family
• Adequate plan of care following discharge
• Effective symptom relief
• Opportunities for honest communication by health care providers