End-of-Life Case Study

Abstract

The ethical issues that arise in decision-making process to end-of-life care will be addressed. Patients autonomy and preferences about treatment and end-of-life care should be respected by all parties which are inclusive of, but are not limited to; health professionals and family members. A patient may be incapacitated and may, thus, be unable to make decisions. In such a case, the values and preferences of the patient should be respected through an advanced directive. The said document comprises of the treatment preferences of the patient and an attorney who is allowed to make decisions when the patient is not able to do so. The case study below will come in handy in efforts to discuss the end-of-life care for a patient, who should make decisions in a case when there is no advance directive.

In North America, the adoption rate of advanced directives in low. When the rate is low, problems regarding who will make decisions in line with the values and preferences of the patient may arise owing to the fact that it may be hard to determine the person who will play the role of the surrogate. In the absence of advanced directives, about fifty states have set laws that determine who would play the role of surrogate in decision-making. Further, practices to increase the adoption of advanced directives in the American population will be highlighted. Towards the end the public policies that help increase the adoption rates as well as possible alternatives which are inclusive of, but are not limited to educational interventions and community programs will be discussed.

Introduction

This case study examines a case on end-of-life-care. The decision to end the life of a patient is a challenging process to both the family and the patient. This is more so the case given that the wishes of a patient need to be followed irrespective of their capability to make decisions. The patients autonomy must be taken into consideration in relation to end-of-life care. In this case, we focus on a case of a woman named Cynthia. Cynthia had a car accident which led to brain damage. As a consequence of this damage, she was in coma and was, thus, unable to move, speak, drink or even eat. Later, her husband-Robert emphasized that Cynthias desire was that all feeding tubes be removed. Cynthias sisters and mother argued that their daughter wanted the feeding tubes removed. After Cynthias mother sought assistance from the court, the case was ruled in her favor since no written request or directive was available. Cynthia died from an infection fourteen months after the court ruling. It was at that time that Robert found a note whereby Cynthia had requested not to be sustained by artificial means. This essay will discuss ethical and legal dilemmas in decisions to end-of-life care. Further, it will also address the importance of advance directives. Towards the end, it will provide possible solutions for such dilemmas.

Discussion

To start with, autonomy is the main ethical dilemma in this case. It would be prudent to note that autonomy is both a quality of human beings and a bioethical principle whereby an individual has the right to make her own decisions. Bioethical principles act as a guide to physicians - which ensures that the patients right to self-determination is preserved even when they are not able to do so. Lima, Rego & Siegra-Batista (2015) suggest that this is an intrinsic quality of human dignity that should be respected. In the present case, the said patient is not able to decide whether or not to continue with the feeding tubes owing to the fact that she is in coma. According to Karnik and...…available. Practices such as Community-Based Programs and Educational Interventions in Formal Care Settings could be implemented. It is possible to accomplish the Community-Based Programs since such programs are customized to meet religious, cultural and social needs of a population (Carr & Luth, 2017). The other alternative is based on educational interventions in hospitals, long-term care facilities, and other formal care settings. One of the well-known programs is Respecting Choices. In this program, educational materials are provided to patients and health care providers are able to talk to them about end-of-life care. The program also ensures the availability of advanced directive in the medical records of the patient. In such a program, the patients are able to visualize different circumstances and analyze the available options through educational videos.

Conclusions

Decisions to end-of life care can be more complex especially if the patients involved do not have an advance directive. When an advance directive does not exist, this may create disputes among those involved as it was seen in the case of Cynthia. In each state, there are laws that provide mechanisms for dispute resolution, predetermine surrogates and address the issue of decision-making for incapacitated patients.

In the case of Cynthia, the husband and the family members involved may both be right about the patients preferences but they had to go to court and resolve their dispute. To a large extent, it is not clear on what basis the court ruled in favor of the mother. In my opinion, autonomy must be respected if it does not cause harm. If I was involved in this case, I would act the same way as Cynthias husband by respecting my partners wish. To avoid such disputes as in the case of Cynthia, my primary doctor has my advance directive and my family knows what my wishes are. The population should be educated on…