Ethical Decision Making
Ethical Decision Making End of Life Submitted by: Anthony Mcdew Ethical nursing care Nurses are faced with ethical decision making on a daily basis. This could be both stressful and challenging. The following case study I chose to walk through is: Mr. Clarke is a patient who has advanced AIDS with related pain syndromes and is also actively abusing drugs. The nurse is concerned about his abusing his pain medications and is not sure if she should give them to him as he leaves the hospital. It will be my assumption that this patient is nearing the end of their life.
The value, be, do ethical decision-making model will provide the framework I need to assess this case study (Schaffer and Norlander). I also will be using ethical decision making tools to guide my decision making process. What should I value? The first step of the value, be, do ethical decision-making model answers the question what should I value? It is time that I look deep into the meaning of my life in regards to my professional nursing practice. What do I value in life? The meaning of life for me involves personal and professional respect for my patient and his physician in charge of his care.
This involves respecting my patient and his situation. Also, trusting the prescribing Physicians education and training is something I value. Along with valuing respect; I value quality end of life care for my patient. Every individual deserves a peaceful death with minimal pain and suffering if possible. To obtain this, I also need to value my relationship with my patient. Developing a trusting relationship is important for him and also me when dealing with uncomfortable conversations that may have to take place. Finally, I think that I value my education and critical thinking skills.
These skills are important to value because I will have to make a decision if I think my patient can handle taking his own pain medications on his own. My education and critical thinking skills will guide me to problem resolution that has the best outcome for the patient. Who should I be? Not only is it important to understand what values impact my actions and decisions; it is also important to make sure my actions reflect my values. The values I have make sure that I am an advocate for my patient’s comfort as well as their safety.
They also help me be an active and compassionate listener as well as a teacher. If I am a trustworthy person; my patient will hopefully feel comfortable talking to me about his addiction. Finally, to ensure a quality end of life experience for my patient, I will stay educated on medication dosages, side effects, and other treatments for pain. By critically thinking, I should be able to educate my patient and help communicate to the Physician about the patients concerns regarding pain addiction and pain control. What should I do?
By understanding what I value and who I am; I now should be able to fulfill my actions. First, I feel that I should take time to analyze the patients past medical history and medications that helped his pain. Second, I will review the pain medications with the Physicians to ensure I have a proper understanding of his or her plan. Then I will review what is needed to provide quality end of life care with good pain control to a dying AIDS patient. After I feel that I have a great understanding of the situation; it is time I listen and talk with my patient.
Assure them that I am there as their advocate for safe and complete end of life care. This may require me to act as a counselor or bring in interdisciplinary team members to assist my patient. My number one goal is to provide safe end of life care; but as painless and comfortable as possible. Analyze response to case study It is always challenging to give patients medications knowing that they may become, or have become addicted. In my current practice we see many patients who go to pain clinics and have pain contracts to help with their addiction and pain management.
The difference is, my patients are not dying. Thiroux’s universal ethical principles allow nurses to take time and review the ethical situation. In my case study, I personally feel the Mr. Clarke has the right to a peaceful death if possible. The problem is that the medications we are giving him may kill him first. Thiroux’s principles allows for individual freedom and valuing life. My patient should have the freedom he needs to decide if the pain if worse or the addiction. Depending on how long he has to live, the addiction may be the least of his problems.
I feel that I need to value his life and quality of life. Also, I need to understand that death most likely is going to happen. (Blackboard). Thiroux’s universal ethical principles allow nurses to assess the client situation; as well as the caring and justice model (blackboard). This model enhances how nurses feel about ethical problems. Mr. Clarke’s situations force me as his primary nurse to understand how to be an advocate for him and his situation. It also reminds me to use my compassion and virtue when caring and talking with him about his pain addiction.
Finally, I have learned that solving or being part of an ethical dilemma can be easier on a nurse by incorporating spirituality. I think that by assessing Mr. Clarke’s spirituality; I may be able to help him with his addiction or suffering he is facing. Isaiah 43:4-5 says that “Since you are precious and honored in my sight, and because I love you, I will give men in exchange for you and people in exchange for your life”. It goes on to say that we should not be afraid because God is with us and will unite us together. This bible verses supports my belief that God is there for us as nurses and that he had a purpose for us.
God gave us the power to support all situations. The verses also leads me to believe that the purpose of life is to help others physically, emotionally, or spiritually with whatever gifts you may have. I truly believe that God gave me the guidance I need to make this ethical decision on how to help Mr. Clarke. I believe that with proper education and assessment of his pain protocol; Mr. Clarke deserves to have pain relief. This can be done by having his medications monitored. However, they should not be withheld. God does not want suffering and either do I. Quality guidelines
Domains of end of life quality care. The domains of end of life quality care that apply to my case study include: pain and symptom control, achieving a sense of control, and possibly strengthen the relationship with loved ones. It is my goal to provide quality end of life care to Mr. Clarke. This includes symptom and pain management. By allowing him to have a sense of control with his pain medications; he is able to help determine is end of life experience. Finally, by assessing Mr. Clarke’s relationship with his family I will be able to see if they can help him.
There help could be support, symptom monitoring, and medication management. They also may be able to help him with alternative measures at times including: guided imagery, music therapy, massage etc. Bill of last rights. Not only is it important to understand the domains of end of life quality care; it is also important to remember the bill of last rights. These rights are consistent reminders of the rights dying patients have or basic human rights. Mr. Clarke has a right to control, to be comfortable, and the right to hear the truth.
These rights remind me as his caregiver that he is part of this process as well as his medical care team. Even though I feel we still should prescribe his medications; I also believe that he is entitled to know that he has become addicted and how to work through it. Seven Promises. Another tool to use when assessing Mr. Clarkes case study would be reviewing the Seven Promises. The one promise that stands out the most to me is “never be overwhelmed by symptoms” (blackboard). This includes never having to “endure overwhelming pain, shortness of breath, or other symptoms (blackboard).
This promise reminds me as his care giver that his care team needs to consistently be assessing his pain protocol and symptom management. The other promise that I feel would be beneficial to remember when caring for Mr. Clarke is “make the best of everyday” (blackboard). This allows the care team to remember that Mr. Clarke is an individual and each day we need to make sure we are helping him. Not only is it important to offer medications for pain management; it is also important to offer alternatives. Each day as his nurse I can document what time of day his pain is worse, what stimulus increases and decreases pain.
Every day, I can do my best to help him make the best of his day. Precepts of Palliative care. The last option I have encountered that I can to do assess my patient’s situation is to analyze the organization. By reviewing the Precepts of care, I will be able to make sure the organization is not lacking in any areas that may help Mr. Clarke. This tools will allow us to make sure the organization is respecting the patients decisions, giving comprehensive care, utilize resources of team members, address caregivers concerns, and analyzing the environment (blackboard).
This can ensure that not only I am providing good ethical care to my patient, as well as the organization and medical care team. Actions/Response After analyzing and utilizing all of the tools available to me; I have decided that Mr. Clarke deserves to get his pain medication. He is actively dying and has the right to pain and symptom control. It is easier to monitor his addiction then his suffering. The Physician is prescribing only a certain quantity of medications at a time. This can help the care team to monitor his addiction.
I believe that the situation would be different if the patient was not dying. I believe that with my strong understanding of my values; I will be able to allow my actions to be appropriate. This will help guide me through “what should I do”? Ethical decision making is never an easy process. By having the proper tools, it can help medical care team members make a decision. It is my job to educate, counsel, support, and advocate for Mr. Clarke. I would need to be concerned with his medication addiction if he started to overdose.
The case study said he is only having trouble with addiction. However, his medication management still needs to be closely monitored for this scenario. Ethical situations can change depending on the situation. I hold strong to by choice that Mr. Clarke needs his pain medications. Reference Bethel College of Nursing Department (n. d. ). Bethel University NURS344 Blackboard Course modules 2010, St. Paul MN. Schaffer, M. , Norlander, L. (2009) Being present A Nurse’s resource for end of life communication. Indianapolis, IN: Sigma Theta Tau International. .
