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Transcript
1 Running Head: CASE ANALYSIS Case Analysis <Name> <University> Professor: <> Date: <> Case Analysis 2 Reason for the Case The primary reason for this case revolves around the decision to decide whether it is ethical to deem the patient refusal of any treatment that artificially prolong her life and prevent pain as being incapacitated to make decisions and therefore follow the normal treatment of a metastatic liver cancer. Summary of the Case The summary of a sixty-eight (68) year-old woman suffering from metastatic liver cancer that has spread to her lungs and pancreas is hereby addressed using the Jensen, Winslade, and Siegler model of four quadrants together with a synopsis of the engagements of interested parties with the patient; Medical indications Joyce is suffering from metastatic liver cancer. She has been in and out of the hospital for several years and a few days ago moved back to California from Oregon. Her illness case is critical as it comes with severe pain and cancer has spread to her lungs and pancreas. The goals of treatment basically are the cancer diagnosis through palliative care. The probabilities of success are constrained by the fact that Joyce clings on some beliefs about her pain that make her refuse pain medication. She has a POLST form from Oregon that indicates she does not want cardiopulmonary resuscitation and other treatments that will artificially prolong her life whose date concede with a cancer diagnosis. The plan is to classify her wishes as being grounded on an incapacitation to make decision as found by a psychological evaluation which says that she is clinically stressed. In sum, for her to benefit from the medical and nursing care, the decision need to be made on what harm to avoid, to avoid the harm of preventing her conform to her wish or to prevent harm to other Case Analysis 3 interested parties such as her daughter and the patients in the unit and have the cancer diagnosis and palliative care. Preferences The patient is not mentally capable of making decisions regarding her health. The evidence of this claim is constituted in the psychological evaluation which says that she is clinically stressed. This, therefore, places the ground on whether to disregard her preference of treatment that prevent any cardiopulmonary resuscitation-related treatment or pain medication. As per the case, despite the patient clinging to her preferred treatment, she is yet to receive any documented counseling regarding the benefits and damages of going her way. Since she is deemed incapacitated, the surrogate here is Nurse Green who is the nurse manager in consultation with Joyce daughter who are in a position to make a sound decision that will be of more good than harm. Joyce’s actual advance directive is archived in her former place of residence, a long-term care facility, in Oregon and it has been difficult acquiring it while she has also given her daughter a ‘Do Not Resuscitate” order. At the moment, she is unwilling to cooperate with medical treatment since the previous attempt to explain her cause, she states that “God is punishing me for my wrong-doings and abusing my body. I deserve it” and “Pain for purification and penance.” At the current state, Joyce right to choose may not be respected despite being supported by various ethical theories and principles. Not able to access her advance directive, being incapacitated to make a decision, and having her actions affecting other people such as the daughter and other members of the unit will be used as the ground to denounce her preference of treatment. Case Analysis 4 Quality of life There is no prospect of a return to normal life unless with a cardiopulmonary resuscitation that will prolong her life as she has reached state’s statutory requirement of a Physician-Assisted Suicide. If the treatment takes cause, there will be more mental and social deficit on the patient as she has been living in agony and alcoholism in the last 25 years due to unknown guilt. Her present condition of guilt and alcoholism represent are the only factors that can make her continued life undesirable. Plans to conduct a Physician-Assisted Suicide or giver her comfort by palliative care will be determined by the ethical decisions done by the Nurse Green who is the nurse manager. Contextual features The fairness issues expected to influence the decision are the fact that Joyce moaning is disturbing other members of the unit and the confusion of Joyce daughter on why her mother is taking such decisions. The nursing issue that should sway the decision is the psychology evaluation that shows clinical stress. Limits of confidentiality are from the fact that the medical team cannot be able to access Joyce’s actual advance directive and there is “Do Not Resuscitate” order given to the daughter. Synopsis of engagements Joyce has several discussions with two of them involving nurses who asked why she ought not to either take a Physician-Assisted Suicide or pain medication. The other one involve discussions with her daughter who don’t understand and is confused despite accepting the “Do Not Resuscitate” order. Case Analysis 5 Relevant Ethical Principles and Theories, Laws, and Policies Ethical principles Autonomy One person, as precisely a human person, does not have authority and should not have power over another human person Beneficence Beneficence is an action that is done for the benefit of others. Beneficent actions can be taken to help prevent or remove harms or to simply improve the situation of others. Physicians are expected to refrain from causing harm, but they also have an obligation to help their patients (Kockler, 2007). Non-maleficence Non-maleficence means to “do no harm.” Physicians must refrain from providing ineffective treatments or acting with malice toward patients. This principle, however, offers little useful guidance to physicians since many beneficial therapies also have serious risks. Advance health care directive An advance health care directive, also known as living will, personal directive, advance directive, or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. Double Effect The principle says that sometimes it is permissible to cause a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end. Case Analysis 6 Proportionality It is a moral principle that one may employ to determine objectively and concretely the rightness or wrongness of actions Theories Ethical Relativism Ethical relativism is the theory that holds that morality is relative to the norms of one's culture. That is, whether an action is right or wrong depends on the moral norms of the society in which it is practiced. Egoism Egoism is the theory that one’s self is, or should be, the motivation and the goal of one’s own action. Ethical egoism holds that actions whose consequences will benefit the doer can be considered ethical (IEP, 2014). Utilitarianism Utilitarianism, at its most basic, states that something is moral, or good when it produces the greatest amount of good for the greatest number of people, that is, greatest happiness principle. In utilitarianism, good is defined as the existence of pleasure and the absence of pain or utility (Britannica, 2002). Kant’s Moral Theory Kant's theory is an example of a deontological moral theory–according to these theories, the rightness or wrongness of actions does not depend on their consequences but on whether they fulfill our duty (CSUS, n.d.). Natural Law Theory Case Analysis 7 Natural law theorists believe that human laws are defined by morality, and not by an authority figure, like a king or a government. Therefore, we humans are guided by our human nature to figure out what the laws are, and to act in conformity with those laws (McKenna, 2013). Case Analysis To make the evident ethical decisions, in this case, there is a need to agree on some basic principles and standpoints on what actually represent the moral conduct. The major ethical issues revolving around the case of Joyce treatment include; the intention of doing no harm, the desire to do good while being just, fair and sensitive to individual freedom. Nurse Green can easily make a decision basing on the basic aspects of utilitarianism. To discover what she ought to do in this case, she needs to first point out the various courses of action that are at hand and feasible. Secondly, she will classify all of the likely goods and harms that will result from each feasible course of action to all the involved and affected by such action. Thirdly, she needs to select the course of action that offers the greatest happiness, benefit, and less harm, after all has been taken into consideration. According to the principle of double effect such situation like this, whatever action with both good and bad effects is permissible when there is "proportionate reason" to tolerate the evil outcome. The case of Joyce present just that, the action of proceeding with her diagnosis is both beneficial as it makes others around her happy while allowing the hospital to do what it ought to do, however, it comes with the bad consequence of not honoring Joyce individual freedom to choose her cause. Similarly, the principle of totality justified attacks is referenced as the case of Joyce the whole body will not benefit if she is allowed to moan in agony. She will die finally Case Analysis 8 going contrary to this principle which says that if a suffering has a "proportionate reason" to benefit the whole body in the long run, then there is need to tolerate the suffering. Autonomy is a relevant ethical principle in this case because Joyce preferred not to have any pain medication nor cardiopulmonary resuscitation treatment done on her while the principle say that no one should exercise authority over another. Beneficence is also evident as the case present Nurse Greens, the nursing manager with the decision of preventing or removing harm while also weighing and balancing the possible benefits of going against Joyce preferred treatment. The issue of Advance directive is evident in the case as we are told that actual advance directive is archived in her former place of residence and she has also given her daughter a “Do Not Resuscitate” order. The principle of double effect comes into this case since Nurse Green has to rely on some specific guidelines to determine if it is morally permissible to go against Joyce will in pursuit of a good end of prolonging her life and making other interested parties happy while knowing its opposite of what she would wish. This involves the conducted psychological evaluation to deem her incapacitated to make decisions. This will use the proportionality principle to determine the rightness or wrongness of those actions. The case will render favoring the critics of Ethical Relativism who says that ethics is an inquiry into right and wrong through a critical examination of the reasons underlying practices and beliefs and should, therefore, make it immoral if Nurse Green decides to disregard Joyce culture and belief. Egoism theory will be employed in this case as its weak version says that although it is always moral to promote one’s own good, it is not necessarily never moral to not. This means that there are situations avoiding Joyce personal interest may be a moral action. Case Analysis 9 According to utilitarianism, a moral action is one that increases the total utility and offers the greatest happiness. Having Joyce to go through palliative care or cardiopulmonary resuscitation treatment will bring peace and no disturbance in the unit while it will restore joy to Joyce daughter. Her preferred treatment only benefits her alone. Kant theory is important to this case as the philosopher was not concerned with consequences because he believed that if two people, Joyce and Nurse Green, propose different action for the right reasons, then both are morally worthy, even if the actions may lead to bad consequences. This, therefore, is the point of contention and the reason why Nurse Green need to make a decision. According to the Natural law theory, solving ethical dilemmas such as the case of Joyce treatment should be based on the basic belief that everyone has the right to live their life. This can be used by the nursing manager to project Joyce from herself and let her live by prolonging her life and averting her pains. Recommendations From the case study of Joyce treatment dilemma, an ethical decision should take center stage. The decision needs to be done based on the greatest happiness coverage as it involves different interested and affected parties other than Joyce. Also, in efforts to respect Joyce preferred treatment, the issue should be driven outside the clinical setting to offer her counseling to help her make sound decisions. This will also help her recover from the clinical stress and be in a capacity to make other decisions. Impacts of old-fashioned cultural belief inclinations should be instilled in her to ensure she does not allow her obligation to such beliefs take her life while there was another perception of life. If a decision is made to proceed with palliative care or cardiopulmonary resuscitation Case Analysis 10 treatment, then care should shift from managing the effecting of going against her wish and facilitate her continued life. To sum up, the case of Joyce treatment should have the pertinent ethical issue as whether the benefits outweigh the burdens such as pain and abandonment of the daughter. At the end, Joyce must be compelled or made to see the potential benefits of a medical and nursing care outweigh her preferred treatment due to the potential harms. 11 Case Analysis References Britannica. (2002). Utilitarianism. Retrieved from http://www.utilitarianism.com/utilitarianism.html CSUS. (n.d.). Kantian Ethics. Retrieved from http://www.csus.edu/indiv/g/gaskilld/ethics/Kantian%20Ethics.htm IEP. (2014). Egoism. Retrieved from IEP: http://www.iep.utm.edu/egoism/ Kockler, N. J. (2007). The Principle of Double Effect and Proportionate Reason. Retrieved from AMA Journal of Ethics: http://journalofethics.ama-assn.org/2007/05/pfor2-0705.html McKenna, B. (2013). Natural Law Theory. Retrieved from Study: http://study.com/academy/lesson/natural-law-theory-definition-ethics-examples.html