Considering hospice or palliative care is often the last resort for many people. It’s a tragic conclusion after you’ve exhausted most of your choices for loved one’s or your treatment.
Hospice care targets people close to passing. Healthcare professionals form teams to provide these services together. These teams help a terminally ill person by increasing comfort, reducing pain, and accommodating the patient’s needs, including social, physical, and psychological ones.
In contrast to other fields, hospice care doesn’t focus on curing the ailment. Instead, it tries to maintain the highest quality of life for the patient’s remaining time on earth.
One has to partake in tough decision-making for a patient nearing the end of their life. These may include the type of medical treatments they would want if they’re no longer able to decide for themselves. Conflicts between what the patient wishes and what their family desires are quite prevalent in medical settings.
Often, there might be conflicts between the doctors’ prescribed approach, which they consider best, and the patient or their family’s approach to the situation.
Ethical decision-making and patient care necessitate nurses and physicians to follow four essential principles of autonomy, nonmaleficence, beneficence, and justice. Pick any terminal degree in nursing, and you’ll find these ethical considerations at the top of priorities in learning outcomes.
Let’s discuss some basic principles of treating someone with a terminal illness and the difficulties you might face during this endeavor.
Table of Contents
Basic Principles
Autonomy
Autonomy means agreeing to respect patients’ right to determine a course of action and regard their independent decision-making. At times, nurses struggle to deal with patients deciding against their medical advice. Yet, even if a caregiver doesn’t see eye to eye with a patient’s decision, they should support it.
Suppose a nurse has been taking care of a terminally-ill cancer patient for some months at a healthcare facility. Out of nowhere, the patient decides to forego his cancer care and go home to spend time with his family. Certainly, the nurse values their relationship with this patient and wouldn’t want them to suffer. Still, they must also accept their patient’s wishes regarding treatment.
Beneficence
Another essential principle is “doing good,” otherwise known as beneficence. Beneficence consists of four different parts, including:
- Do good and promote good.
- Don’t cause harm or evil.
- Remove harm or evil.
- Prevent evil or harm.
At times, the difference between doing well and not doing harm may become blurry, which is nonmaleficence. Often, it is easier to determine what is harmful or wrong than what is beneficial or good.
Nonmaleficence
To refrain from causing unnecessary harm is known as nonmaleficence. And though several patient interventions might cause some pain, nonmaleficence concerns the moral justification behind the reason for that harm. The deed is justifiable if it’s for the patient’s ultimate benefit and not to cause them intentional harm.
For instance, take a recurring situation in end-of-life care where a near-death patient is in pain and needs pain medication to alleviate discomfort. The caregiver holds back from administering the medication due to the apprehension of accelerating death. However, the caregiver is morally obliged to intervene and manage symptoms in near-death patients, even if the intervention quickens death.
Justice
This principle governs fairness and social equality. Justice, in medical terms, includes deciding if a patient should receive a life-saving resource. The nurses’ code of ethics emphasizes their commitment to those in their care despite their social or economic backgrounds.
Healthcare professionals know sometimes they have to balance the pros with cons to decide a patient’s eligibility for receiving a specific type of care. Medical futility occurs when the clinician continues a medical treatment or intervention without leading to the patient’s benefit or cure.
Informed consent And Capacity
Informed consent implies that the caregiver respects patients’ autonomy and allows them to make an informed decision based on factual information. For instance, a patient needs a crucial spine surgery that might be a life-threatening procedure. When the patient acquires this and other necessary information from the doctor and decides against the operation, it is an informed decision.
Capacity means someone’s ability to comprehend information, make decisions, and consent to medical treatment. Let’s use the previous example of whether a patient should or should not have life-saving spinal surgery. Assume that this patient is cognitively impaired. In that scenario, they wouldn’t have the capacity to make an informed decision about their care, and someone else might have to do the job for them.
Decisions in Terminal Care
Sometimes, nurses may witness the tough and life-altering decisions their patients and families have to make when providing end-of-life care. Similar to their patients, nurses are individuals having unique values, morals, and beliefs. If a caregiver’s values don’t align with the patient’s, an internal conflict may arise.
Caregivers should concentrate their efforts on assisting their patients to ascertain the treatment’s advantages and disadvantages instead of on the treatment’s nature.
Terminal/palliative sedation
Palliative sedation is an intervention for patients near to passing. Typically, this sedation is the final attempt to reduce the patient’s suffering. It involves sedating the patient to the extent where the caregiver can still manage their refractory symptoms. Clinicians sedate the concerned patient to varying degrees of consciousness to achieve the goal of controlling symptoms. Loss The intention of palliative sedation is not to accelerate or cause death but rather to alleviate the pain unresponsive to any other treatment.
Do Not Resuscitate (DNR)
Many patients opt for DNR orders in their end-of-life care. These orders imply that a patient has chosen against initiating CPR (cardiopulmonary resuscitation) in case they suffer a cardiac arrest. CPR may involve cardiac medication, chest compressions, and the insertion of a breathing tube. As tough of a decision it sounds like, it is quite common for patients in end-of-life care.
Withdrawing Medical Interventions
A common dilemma facing caregivers today is associated with the withdrawal of medical care or intervention to a patient. These may include minor interventions, for example, a non-critical medication, to more complicated ones, such as automatic ventilation.
The reasoning behind the withdrawal of these interventions is their cost-benefit analysis for the patient. In some circumstances, vital therapies might induce more suffering than comfort while decreasing the patient’s life quality.
Wrapping It Up
Even when facing death, we have to make choices that affect the quality of our lives. None of us have control over the causes of our demise, but we can decide if we wish to pass over peacefully or not.
Is there such a thing as a peaceful death? Yes! And it involves people choosing the way they want to pass on. Nurses and clinicians are integral in helping patients define what a peaceful end resembles.
To fulfill this role appropriately, medical professionals must follow the principles of autonomy, justice, beneficence, and nonmaleficence. They also need to acknowledge the difficulties in hospice care, such as terminal sedation, DNR, and intervention withdrawal.
Consequently, when it’s time to say goodbye, caregivers can help patients choose what’s best for them and their families.