Preserving a Patient’s Autonomy by Resolving an Ethical Conflict
The existing conflicts about patient care situations should be resolved to preserve patient autonomy. The conflicts might be between a patient, doctor, and family. Healthcare professionals regularly encounter ethical challenges in inpatient care (Nelson, 2015). Ethical conflicts are addressed well when all the parties involved are provided with an opportunity to discuss and explain their values, concerns, and perceptions in a conducive environment. The decisions based on ethical processes help maintain three primary relationships in medical care. Leaders who implement the proper decision-making process influence patients, primary care physicians, and hospital management positively. It is significant when addressing competing values, including personal, societal, professional, and institutional values. This paper discusses the process of solving ethical conflicts and patient care situations, using a formal decision-making structure.
Articulation of the Problem
As the first step, we have to acknowledge an ethical dilemma; the dilemma is whether the patient will be moved to a better facility for better medication or put the patient in palliative and end-of-life care by discontinuing the ventilator support. We also need to note the assumptions from all participants, including the physician and the family. Mrs. R has pneumonia with other conditions, including coronary artery disease, stroke, and Alzheimer’s disease. Noteworthy, the family members are not content with the patient receiving continued ventilator support. They are worried that Mrs. R does not recognize them anymore, and ventilation support is not useful. Equally important, they assume that the patient would not like such care given to her at old age. Her primary care physician has a challenging task of choosing between mutually exclusive solutions. Doctor G’s is undecided about following the family’s advice or determining what is best for the patient. He has the experience and hopes that Mr. R will get better with time. The family is raising concerns about moral issues that have developed under his care. The conflict exists between the family and the primary care physician since they disagree on what should be done to the patient in this state. Mrs. R cannot take place in the process since she is ventilator support.
When applying the EDMM, the crucial next step after articulating the problem would be to gather facts that can serve as evidence (Louw, 2016). In this clinical case, it is essential to understand healthcare issues involving diagnosis, care, treatment options, and prognosis. Notably, the patient is not able to make decisions on her own. Each person has a stake decision, including family and a physician have the right to express their perspective regarding the moral conflict. In this clinical scenario, the decision-making process participants are the physician, patient, family members, and other medical facility professionals. The comprehensive discussions can be held in a group or individual sessions to clarify everyone’s perspective. The process of assembling information must include facts and emotions that feel important, including life quality, critically understanding the issue, relationships, and outcomes of the alternatives available (Louw, 2016). In this step, the perspective of all the concerned parties should be reviewed. One fact that can serve as data, in this case, is that the patient has a life-limiting illness with other underlying conditions such as stroke and the coronary artery. Secondly, her doctor is experienced and has handled this kind of situation before. The doctor’s opinion is critical in this decision-making model. Equally important, the patient is a rural hospital, and transferring her to a better facility may improve her conditions. Another pertinent fact, in this case, is the family concerns about the continued ventilator support. The family assumes that the patient would not have wanted this kind of care. The ethics committee ensures that all rules of healthcare decision making are followed in this case. The family members negotiate on the patient’s behalf since the patient has no advance directive. The nurse’s ethical role, in this case, is to focus on the emotional needs of the patients and appreciate their perspective in this patient care situation. This is done by having the family reflect on the patient’s values, what this sickness means to them as relatives, and how to best proceed. They also ensure that the proposals of the family members are within the principles of health care.
According to Slade (2017), the questions surrounding the case that needs clarification are identified from competing perspectives at this stage. Most people decide to avoid this stage leading to a lack of critical analysis of the case (Louw, 2016). In Mrs. R’s case, three strategies should be put into consideration. One approach is that the patient can be left in the life support machine and monitored in the same facility. From an ethical and legal perspective, this does not meet the patient-centered concept. However, this is the second-best strategy. It does not also provide the family with information needed to make informed choices since this is a rural hospital. The other one is moving the patient to a hospice for therapy and rehabilitation. This strategy embodies the principle of fidelity and veracity. Mrs. R’s family can fully explore their options in improving the outcomes of the patient. Among the three, this is the best strategy. The third approach is to put Mrs. R. under palliative and end of life care due to life-limiting illness. This strategy does not take into consideration the patient’s needs and preferences. Furthermore, it is not based on the principle of beneficence and justice. This is the last strategy to be considered in this case. The three options share a common goal; to improve the quality of life and health outcomes for the patient. However, only one strategy can be chosen at a time (Nelson, 2015). Consequently, the decision-makers must be willing to implement the selected option that does not go against the decision-making structure.
Implement the Strategy
Ethics compels us to choose the best course of action while being conscious of our behaviors. Nurses need to use the existing timeline to discover the patient values and family perspectives in the patient care situation. The physicians also need to consider the feelings, emotions, and experiences of the family and the patient involved. The main objective is to work with Mrs. R and her family and decide together on the current plan that aligns with patient values and satisfies all the parties of the decision-making procedure. The strategy to be used in Mrs. R’s case should be agreed upon by all the process participants. When implementing the priority strategy, the decision-makers should consider how it affects the family and the patient. The strategy to be implemented has to satisfy the demands of each participant in the decision-making process. Noteworthy, the principles of effective decision making should be adhered to by the strategy to be implemented. From an ethical perspective, the best strategy is to take the patient to a better healthcare facility for treatment and rehabilitation. The ethical team must ensure that the family has all the requirements to make informed decisions. These tools include efficient information and the consequences of each option/
The first strategy, leaving the patient in the life support machine and monitoring in the same facility, may not be the most efficient action course. Consequently, the family members may disagree with this choice because the patients’ health conditions are deteriorating at the moment. The strategy does not meet the principle of justice and beneficence. The principle of fidelity and veracity are not met as this is not the most suitable course of action. The second strategy, moving the patient to a better medical facility, strongly aligns with the principles of veracity and fidelity. The information offered to the healthcare executive and the family is truthful and honest, as it is in the best interest of the patient (Nora et al., 2016). . It also attempts to discover the patient values that will affect the final decision making of the family. Consequently, time is needed to move the patient from a rural hospital to a better medical facility. This places the patient at greater risk during the transfer. The third option, placing the patient under palliative and end of life care, is a passive action that lacks effective communication. It does not consider the principle of justice and fidelity and veracity (Nora et al., 2016). It may not be a negative option since the patient is critically ill, but it does not consider the patient’s values (Nelson, 2015). Additionally, the strategy is almost against all the ethical principles. The option may cause moral distress in the organization staff, as they cannot explore better patient plans under their care.
The classical analysis of the case has helped us establish the existing issues encountered when helping patients and their families make critical decisions in difficult patient care situations. Since most ethical decisions are made in a vacuum, all participants’ perspectives must be considered before making the final decisions. Being aware of every situation that might cause an ethical conflict in patient care is an essential quality of a nurse. The principles of autonomy, patient-centered approach, justice, and maleficence should be considered throughout the ethical decision-making process. Disseminations learned from helping patients and families make decisions help handle situations involving moral conflicts in the future.
Nelson, W. (2015). Making Ethical Decisions. Retrieved 13 October 2020, from https://www.ache.org/about-ache
Nora, C., Deodato, S., Vieira, & Zoboli, E. (2016). Elements and strategies for ethical decision-making in nursing. Texto & Contexto-Enfermagem, 25(2). http://dx.doi.org/10.1590/0104-07072016004500014
Louw, B. (2016). Cultural competence and ethical decision making for health care professionals. Humanities and Social Sciences, 4(2-1), 41-52. https://doi.org/10.11648/j.hss.s.2016040201.17
Slade, M. (2017). Implementing shared decision making in routine mental health care. World Psychiatry, 16(2), 146-153. doi: 10.1002/wps.20412.
Nelson, W. A. (2015). Making ethical decisions: A six-step process should guide ethical decision making in healthcare. Healthcare Executive, 30(4), 46-48. https://www.ache.org/-/media/ache/about-ache/ja15_ethic_reprint.pdf