Long Term Care Administration

Long Term Care Administration What are some of the ethical issues in this case? Mrs. Beaudoin appears to be in a real ethical dilemma given the fact that she does not have formal power of attorney and her husband also lives in the same facility with her with moderate dementia and is very frail. The ethical issue involved in this case is that Mrs. Beaudoin’s health is failing steadily. She is known to have cancer throughout her body, a failing heart, moderate dementia and diabetes type II.

Due to the cardiac arrest she suffered after a short stay in the intensive care unit she subsequently suffered a severe brain injury occasioned by lack of sufficient oxygen. Since she cannot make healthcare decisions on her own and her husband is in a state that is just as bad, the ethical issue here is; who will make healthcare decisions and end of life decisions on her behalf? Given that Mrs.

Beaudoin is also suffering from brain damage and inability to consume enough calories to sustain her body weight her health is on the decline. The other ethical dilemma is that the presumptive substitute decision maker i.e. Mrs. Beaudoin’s eldest daughter does not agree with the assessment of the team taking care of her mother. She disagrees with the idea that the treatment plan should only focus on comfort and exclude any CPR. It appears that Mrs.

Beaudoin is not leading a meaningful life and she is suffering at the hands of the team trying to keep her alive. Generally, the ethical issues involved include the capacity of the patient to make decisions, the right of the patient to refuse to take treatment, withdrawal and withholding of treatment to sustain life, hydration and nutrition issues, assisted suicide, and no code decisions (McCabe, M. S. & Coyle, 2014).

It is the responsibility of the acting administrator of an LTC facility to make sure that they maintain an approach that is in line with the ethics of decision making. Further the administrator has to implement decisions that are morally upright (Thorns, 2010). The administrator must have sufficient facts, knowledge, and experience concerning Mrs. Beaudoin’s conditions and the expected outcome.

Furthermore, the administrator ought to be willing to collaborate and communicate perfectly with the colleagues in order to arrive at the best decisions that are compliant with the patient’s best interests (Thorns, 2010). In order to deliver medically and ethically appropriate healthcare decisions for patients without surrogates and for the patients who lack the capacity to make their own decisions it is important to consider several factors.

A decision that is made without the knowledge of what the patient would have specifically wished for in those circumstances must be made in the best interest of that patient (Santa Clara University, 2019). Appropriate care decisions have to be defined by the provision of ethical interventions as well as avoidance of any interventions that do not benefit the patient or interventions that, to the patient, would be a burden. Interventions that contravene healthcare standards, which are generally accepted, or intervention that are medically ineffective, must be avoided (Santa Clara University, 2019).

According to Holt (2017) medical interventions are increasing in quantity and so in the patient’s life span. The increase in both these numbers has led to numerous ethical concerns during end of life. The basic principles of ethics including justice, double effect, beneficence, non-maleficence, and autonomy have to set the foundation for all end of life decisions making (Holt, 2017).

The new medical interventions and extension of life trends has led to a situation where patients are allowed a way to put their own lives to an end through physician assisted suicide (Holt, 2017). Similarly, the situation has allowed healthcare professionals to utilize euthanasia in order to relieve the suffering of their patients. These are various ethical guidelines provided by various medical organizations with regard to this subject (Macauley, 2018). These ethical guidelines may be helpful in solving the clinical problems at end-of-life situations which can lead to complex ethical dilemmas.

It is a fact that provision of good care for a patient who is dying requires that the patient has enough comprehension of the ethical issues regarding end-of-life healthcare. Advance planning for patient care can ensure that there is autonomy for the patient even at the moments where they are unable to make their own decisions. If the patient wishes that hydration and artificial nutrition be withheld in line with their wishes then this can be done without breaking any ethical code. In the case of Mrs.

Beaudoin there is no legal surrogate to assist in decision making since she had no formal power of attorney. Although the eldest daughter does not agree with the decision of the medical team (i.e. to offer comfort care alone and avoid any CPR if such a need arises) it is important that the physicians’ integrity as the moral agent within the clinical setting be honored and recognized. This is because the healthcare team has the moral imperative to ensure that the dying patient receives good care.

The dilemma in this case is whether to follow the expert opinion of the oncologist or to go by the wishes of the eldest daughter. One of the principles of ethics in public healthcare according to Schroder-Back et al. (2014) is the non-maleficence principle. This principle requires the healthcare professional to act in a manner that is not harmful even when the client or patient requests it. The non-maleficence principle has historical antecedence and is related to the renowned Hippocratic Oath in medical ethics.

The second ethics principle is the beneficence principle (Schroder-Back et al., 2014). The principle speaks about the obligation to ensure there is benefit for clients or patients. It is the obligation of the physician to assist and heal the patient to their best judgment and abilities. The non-maleficence principle involves omission of any harmful actions while the beneficence principle speaks to the active support for the welfare of other people. The health maximization principle speaks to the gap that non-maleficence and beneficence does not fill.

Both the principles do not mean that the health outcomes of the population are maximized. Maximization of the health outcomes of the public and improvement of care is fundamental to the success of healthcare (Schroder-Back et al., 2014). On efficiency there is a global need for better health outcomes although the resources available are not enough to produce the expected outcome. For this reason, the scarce resources must be utilized efficiently. This is the moral duty of health professionals because efficiency will enable better health benefits.

The autonomy of the patient has to be respected (Schroder-Back et al., 2014). The justice principle in health equity must be observed as well. The patient has equal moral value and any form of unequal treatment must be followed by proof. • Who is the appropriate substitute decision-maker (SDM) in this case? Mrs. Beaudoin substitute decision maker in this case is the eldest daughter.

This is because the husband is also a resident in the long-term care facility and has moderate dementia and is quite frail hence making it impossible for him to make health decisions on behalf of Mrs. Beaudoin, his wife. It would also be unwise for the acting administrator to rely on the input of the husband as a surrogate. The only logical surrogate capable of acting in the best interests of Mrs. Beaudoin is the eldest daughter.

She is the only one in a position to make healthcare decisions on her behalf. • If there is more than one SDM, what should you do if they disagree? Where there are more than one substitute decision maker and they are unable to agree to the long-term care process, the administrator should act in the best interests of the patient as alluded to by Schroder-Back et al. (2014).

Any decision made on behalf of the patient in circumstances where what they specifically wished for is not known must be made in the patient’s best interest (Hamilton Health Sciences, 2015). Even when the substitute decision makers do not agree on principle the oncologist’s opinion based on the prognosis of Mrs. Beaudoin should be honored. This is because the oncologist in this case employs his integrity, professionalism and knowledge in this situation.

The oncologist is therefore the moral agent in the long-term care facility and their views ought to be honored and recognized. According to Shulman (2016) where more than a single person meets the criteria to become a substitute decision maker then the person is entitled to assume the capacity of a substitute decision maker on behalf of the patient. All the substitute decision makers are allowed to collectively make a decision as to which one will be the de facto substitute decision maker (Shulman, 2016).

The long-term care administrator will not decide as to who among the ranking substitute decision makers is fit to act. Although the substitute decision makers may hold different views about the long-term care, the administrator will only rely on the decision of the de facto substitute decision maker identified by the other substitute decision makers. • Because we know Mrs. Beaudoin’s desire to live to be 100, must we ensure that “everything is done” in an attempt to prolong her life? Although Mrs. Beaudoin.