Medical practitioners are faced with the challenge of making decisions on whether to withhold or withdraw a patient’s life sustaining therapy in the intensive care unit. Intensive care units are departments which provide high quality and advanced forms of therapies to very ill patients in the intensive care unit at an increased cost. These patients’ expectations are high with regard to modern medicine, and as a result, have led to the rise of complex ethical issues in the ICU.
Clinicians managing patients in the intensive care unit face many ethical problems during the patient’s routine care. This is seen in cases of withholding life sustaining therapy, withdrawing life sustaining therapy, informed consent and making decisions that affect the patients. Introduction Ethical related issues in the intensive care unit are a dilemma facing medical practitioners and nurses. This has affected the quality of care given to the patients in the ICU.
Nurses responsible for caring for critically ill patients are faced with many ethical problems in the ICU due to the lack of enough full time critical care personnel and lack of enough funds to facilitate and run the intensive care units. A guideline on ethical issues in the intensive care unit demands that nurses offering critical care to patients apply the care with humanity by showing respect for the emotions and choices of the patients and their families.
Nurses in this field are required to provide all necessary information to the patients and the family, counsel them and assist in interpreting the results so they can make well informed decisions. Nurses must consult with all physicians involved in the patients’ management. ethical problems facing nurses in he intensive care unit range from aggressive forms of treatment, following the wishes of the patients families to using extreme forms of reducing pain and assisted suicide and euthanasia..
Care of patients in the intensive care units involves aggressive forms of treatments with high risks associated with them and high-tech modern medicine which has higher risks than improving the patients’ prognosis. Critically ill patients and terminally ill patients who should be left to die in the comfort of their homes like in the earlier days are now made to undergo last minute aggressive treatments which may end up being no significant. In such cases when the treatment fails and the patient dies, the patients’ family blames the nurses and doctors for being insensitive to their wishes.
Nurses are faced with the burden of not knowing where to draw the line between extending the natural process of dying by applying aggressive forms of medical care and when to apply life support systems. Ethics require that medical practitioners and nurses put the interests of their patients and their families’ first rather than applying futile medical technology to save the life of the patient or prolong their dying process against the family’s wishes. Nurses in the care of critically ill patients are required to set proper goals and interventions for terminal are of patients.
End of life decisions should be made after consensus with all involved physicians. Critically ill patients in the intensive care unit get the most complex forms of treatment even in cases where their prognosis is poor. These patients also die under the most undesirable situations such as comatose conditions or under ventilatory support. Research studies have shown that critically ill patients are put through very aggressive forms of treatment which the clinicians would not want to undergo.
The same studies have shown that the majority of patients in the intensive care unit are on a life-limiting care. Only very few patients in the intensive care unit receive full life support treatment and CPR. Most nurses and medical care givers are faced with the burden of choosing whether to resuscitate a patient or not when their prognosis is poor. Categories of ethical problems Cost reduction Critical care of patients in the intensive care unit is the most expensive form of treatment. Critical patients who die are said to accumulate more expenses than those who survive.
This is because aggressive modern medicine for sustaining life is very expensive. Due to this the standard of care give in intensive care units has deteriorated as it focuses more on cost reduction rather than provision of quality health care. Medical care providers are often faced with the burden of how to establish when to provide full life support to patients and when to withdraw life sustaining support. These decisions are usually based on the patient’s age, type of illness or their prognosis.
In effect the medical care providers are influenced to make biased decisions. Defining the standards of care to be given in the intensive care units is based on reducing the incurred costs. (Lo B. (2005). Quality of care Most health care institutions have developed strategies of limiting life support on critically ill patients. Families of critical patients may wish to write do not Resuscitate orders if their patient’s rate of survival is low. In case this is done, this category of patients receives less attention from medical personnel and less care from nurses.
Strategies of limiting life support have been based on the patients’ age, prognosis and the family wishes. Patients who are categorized as old and with a poor prognosis tend to get less attention from the medical care providers and the care given to them is of less quality. Rather that receiving actual medical care these patients are given sedatives and narcotic analgesia. Terminally ill patients receive fewer medical interventions before death and are usually given narcotic analgesics to mitigate pain and sedatives to reduce their suffering.
Ethical guidelines urge that all patients be given quality care irrespective of their condition but medical care providers often base their interventions on biased decisions. The concept of futility Medical care providers use the concept of futile therapy to withhold or withdraw life sustaining treatment. In the clinical practice very few things are of absolute certainty and so physicians must avoid making decisions based on the futility of the treatment. The outcome of CPR application cannot be based on whether the patients’ family signed the Do not Resuscitate order.
Every other patient in the intensive care unit should be given quality care based on facts rather than assumptions. Decisions on withholding or withdrawing life support should be discussed with the patients or with their family members. This expresses respect for their rights and wishes and helps in avoiding conflicts which may lead to legal litigations. The medical personnel are faced with a dilemma in cases where the patient’s prognosis is poor and extending the natural process of dying through aggressive treatment would be futile.
In such cases some family members could insist on sustaining the patients’ life. The medical personnel thus have no option in deciding what is best for the patient. Putting such a patient through aggressive treatment enables the family to understand the realities of the concept on withholding or withdrawing the life support. Autonomy This principle demands that no form of treatment should be administered to patients without their own approval or that of their family members, except in cases of emergency where immediate intervention is required.
Patients and their families have the right to disapprove any form of treatment and their wishes should be respected. These wishes should be indicated on a written consent in form of advance directive. However, when writing the directive the patient may not have anticipated his present condition or he may decide to change his mind. Medical personnel are thus faced with burden of making the best decision for the patient by putting the patient’s interests first. In the intensive care unit, medical personnel deciding whether to apply CPR on a patient with a good prognosis or to follow his family wishes to withdraw life support.
The reliability of family members to represent the best interests of the patients is questionable because some family members may want to withdraw the patient’s life support for their own selfish interests. As a result, doctors and nurses are required to make the best decision for the patient irrespective of the family’s wishes. (Pozgar G. D (2005). Euthanasia and assisted suicide Euthanasia is whereby a medical care provider administers a lethal dose to the patient while in assisted suicide the killing drug is self administered by the patient with the help of a physician.
This practice is no widespread, although physicians all over the world are engaging in the practice. They justify their actions as a form of relieving their patients from pain and suffering. In some cases patients do not give consent for euthanasia but still physicians practice it. Most family members choose terminal sedation whereby patients are put in a comatose condition and then food and water is withdrawn. (Morton P. G (2005) Organ donation Patients in the intensive care unit requiring critical care may require an organ transplant to assist in sustaining their life.
Patients and family members might have advance directives which disapprove the idea of organ transplants. Medical care givers have a difficult time determining whether a patient should receive an organ donation or not. Performing an organ transplant without the patients or family’s consent could lead to a legal litigation. (Melia K. M (2004). The principle of beneficence In this situation the medical care provider is faced with a moral dilemma in making the best decision fro the patient with regard to his interests rather than those of the family.
The role of a physician to apply his best judgement for the patient’s interest is hindered by the patients’ family which rejects the concept of futility. Such family members impose unreasonable demands on the physician to extend the natural process of dying. This only prolongs the patient’s pain and suffering. Medical personnel should therefore be able to make the best decisions for the patients.
Ethical issues in the nursing field hinder the ability of physicians to administer quality medical care to critical patients in the intensive care unit. Physicians are urged to shoe humanity and compassion when applying intensive care to critical patients. Nurses and doctors should set goals and objectives when giving end of life care to patients with both good and poor prognosis. In regard to ethical issues in the intensive care unit, medical care givers should know that their duties are both directed towards the patients and the families. Before carrying out any medical treatment and procedure, nurses and doctors should obtain written consents form patients or their immediate family members to avoid ethical dilemmas which may lead to legal litigations.