The article Ethical Dilemma presents the formidable role and functions of a nurse and other healthcare providers as it tries to preserve and uphold the dignity of life until its last breath. The authors Cynthia Kellam Stinson, MSN, RNC, CMS; Jennie Godkin, MSN, RN; and Rutchie Robinson,RN, MSN, all respected and reputable professionals in their field, have illustrated a real life situation coupled with an analysis that will hopefully give a well-grounded judgment and management to everybody working to perfect their roles in the care of patients most especially those stricken with debilitating diseases.
Ethical Dilemma showcased a case where an ill-stricken patient’s supposed request was granted, however, the decision to grant was eventually found lacking and wanting. The patient named Mr. Antonio had been a vibrant 60-year-old Associate Professor in the Music Department of a university before he developed a type of Parkinson’s disease. The disease advanced and had its toll on the well-being of the patient and brought tremendous concern on his family which eventually led to seeking the aid of a long-term care facility to ensure that the patient is perfectly cared for.
During his confinement in the long-term care facility, the patient went through personal bouts of self pity and despondency. All these feelings were manifested in his disposition and appetite. It was not clear if he clearly expressed that he no longer wants to eat and drink but it was stated in the article that for several times he would not swallow the food once it entered his mouth and will instead spit it out. The question if it was a qualified case of VSED or voluntarily stopping eating and drinking then surfaced.
The concern if the patient made an informed and competent decision came out; and if the family and the healthcare providers made a well discerned decision when the caring steps taken were based on the later behavior of the patient was also asked. To further define the case, the authors used relevant legal and social issues that arose from similar situations in the past. Another enlightening presentation of the article is the possible physiological issues of the Ethical Dilemma 2 patient’s situation.
The authors’ analysis of the case came into full circle when it reconciled the realizations and resolutions to the practice of nursing care and the indispensable role of a multidisciplinary group comprised of the family, the healthcare experts such as physicians, nurses, dietitians, psychiatrist, and should be joined too by lawyers, social workers, and a spiritual advisor to ensure a better health care for patients. This case surely taught important lessons to concerned healthcare practitioners although it took one life as an example.
The article says that the patient’s autonomy must be respected and healthcare providers must avoid inflicting more harm on the patient in the process of caring for him, however, additional harm befell the patient in the article when the healthcare providers failed to thoroughly and adequately discuss the benefits and risks of VSED and even the pros and cons of inserting a percutaneous endocopie gastrostomy (PEG) tube into the patient’s stomach and even allowing the patient to be fed with exclusive soda.
The American College of Physicians and the American Society of Internal Medicine’s Position Paper provided guidelines for VSED. It clearly stated that VSED was appropriate for a terminally ill patient provided the patient was competent to make decisions after a comprehensive psychological assessment of the patient to rule out depression, spiritual suffering, and assessment of motives. These conditions were not observed in the case of Mr. Antonio.
In the second to the last paragraph of the article, it was mentioned that in the last 21 days of the patient, there were instances that he stared at the nurses with pleading eyes. Could this mean a contradiction of how matters in his situation were interpreted? It is possible that there was a point that the patient wanted to stop eating and drinking because of depression, but a good facilitation to make him further understand his situation and realize what can still be done, the patient might just decide to fight his battle.
It is a fact that Parkinson’s disease, and any of its’ type, is a progressive, debilitating illness and all measures of treatment and Ethical Dilemma 3 dealings should have evolved on this reality with complete consideration of how the patient will respond to the situation. Nurses aren’t just around to merely nurse and purely attend to ailing patients, their skills and most importantly their presence can help patients bear the pain of their illnesses.
It is right to call them advocates and it may be an overwhelming job but there’s so much fulfillment involved when they listen to the patients’ plight, help patients find the truth and share that faith and courage to face their situations. Nursing as a profession entails many things thus the mention of countless points to consider in carrying out the job. Mastery of each point most especially the ethical theories will make a better nurse and will increase the chances of saving more lives.
Insights learned, realizations, and resolutions should be lived. The article made a very good point when it enumerated a list of possible improvements such as enhance quality care in the ICU through educational preparation of staff, patient, and family; emotional preparation of practitioners, family, and patient; flexible staffing; provision of privacy for patient and family; maximum communication between family and staff; spiritual support to the family; ongoing evaluation of patient; and stress debriefing program for the staff.
All of these measures should be implemented for a better health care system. It should not wait for another patient to experience the same situation. Health care providers should be proactive and must always be prepared should another patient will need their expertise and attention.
Courtney from Study Moose
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