Question

1. Discuss the following ethical and legal issues related to a palliative care approach:
   ▪ Decisions regarding advance care directives
   ▪ Conflicts that may occur in relation to personal values and decisions made by or for the person

▪ Organ donation
▪ Request for autopsy

How could each of these ethical and legal issues affect your nursing practice?

Answer 1

1. Discuss the following ethical and legal issues related to a palliative care approach

ANSWER:

Ethical issues that arise towards the end of life may be complex. Some examples of ethical issues encountered in palliative care are:

Ø method and timing of conversations with family members around the imminent death of a loved one

Ø deciding when to withdraw futile treatment options and communicating this to the patient and their family

Ø advance care planning

Other issues include patients decision-making capacity and right to refuse treatment; withholding and withdrawing life-sustaining treatment, including nutrition and hydration; "no code" decisions; medical futility; and assisted suicide.

Ethical principals which we should keep in mind are

· beneficence

· respect

· self-determination

· truth telling

· confidentiality

· informed consent

· Justice and non-maleficence.

▪ Decisions regarding advance care directives

An advance care directive is an important part of your end-of-life care. An advance care directive formalises your advance care plan. The directive can contain all your needs, values and preferences for your future care and details of a substitute decision-maker.

An advance care directive is an important part of your end-of-life care. An advance care directive formalises your advance care plan. The directive can contain all your needs, values and preferences for your future care and details of a substitute decision-maker.

You can only make a valid advance care directive if you are over 18 and have decision making capacity. Decision making capacity refers to a person’s ability to make day to day decisions about things like:

• legal matters
• medical/health care matters
• financial matters
• personal matters

Health professionals and family members must follow a valid directive. They cannot override it.
▪ Conflicts that may occur in relation to personal values and decisions made by or for the person.

▪ Organ donation

There are some religions which do not allow organ donation because of their belief. We should respect their personal values or beliefs. Decision cannot be made by or force to make for others.

Major ethical concerns about organ donation by living related donors focus on the possibility of undue influence and emotional pressure and coercion. By contrast, the living unrelated donor lacks genetic ties to the recipient.

▪ Request for autopsy

Autopsy is restricted for some religion because of their religious beliefs and culture. We should respect their beliefs.

Any family member or close friend of the deceased may ask for an autopsy, but the autopsy must be properly authorized. Additionally, some autopsy examinations are required by law because they fall under the jurisdiction of a coroner, justice of the peace, or medical examiner.

How could each of these ethical and legal issues affect your nursing practice?

Nurses need to have a good knowledge about the legal and ethical issues so that she can avoid herself from all legal actions and follow the policy of the institution.

The five most frequently-occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making.

Nurses need to strictly adhere to the ethical principles while he make decisions regarding the patient. She should follow all the policy for the safety of herself, patient and institution and maintain standard.