Care for End of Life
Chapter 5 states different ethical
guidelines when it comes to caring for patients at the end of life. The chapter
begins by explaining the importance of having advance care planning. The
purpose of advance care taking allows physicians to know the patient’s wishes
or demands are when it comes to near death experiences. Advance care planning
can be done at any point of a person’s life at any health standpoint or age. As
the planning is being discussed, physicians should consider the patient’s life values
and views on quality of life. Different concerns and expectations are discussed
during this planning period such as different care treatments. Patients are
usually asked what or would not want in tough recovery situations from an
injury or sickness. A surrogate is also decided with a physician for situations
when the patient cannot make life making decisions for themselves and are
expected to be part of every advance care planning. Any note taking that
physicians write down during the discussion of planning goes onto medical records.
If the patient has a documentation stating any advance care planning, a copy
goes towards medical records and surrogate. When it comes to advance care taking, it is
important for the physicians to have the patient participate in discussions to
fulfill the patient’s wishes when an unfortunate illness or injury event
occurs. Advance care taking plays an important role to where physicians are
prepared to respect the patient’s wishes when a serious injury or terminal illness
occurs.
Physicians are responsible for respecting
the patient’s wishes or the surrogate’s if the patient is unable to decide for
themselves. The chapter discusses different scenarios where advanced care
taking comes into play. Scenarios such as withholding or withdrawing
life-sustaining treatment, orders not to attempt resuscitation (DNAR),
interventions, sedation to unconsciousness in end-of-life care,
physician-assisted suicide and euthanasia typically have similar guidelines to
follow. The guidelines begin when physicians first examine the patient’s
circumstances whether the patient can participate in any decision making. If an
advance directive has been placed, physicians determines if the situation still
meets with the patient’s beliefs. Next, physicians discuss with a patient if a surrogate
was chosen and written on a legal document. If a surrogate is responsible for decision
making, it is understood that the surrogate must respect the patient’s wishes. If
there is a situation where a physician and surrogate cannot agree on a treatment,
a third party is involved or physician discusses it with the ethics committee. In
any situation where a surrogate has not been chosen or reached or any advance
directive cannot be found, physicians steps in to decide how to approach the
situation medically. Any treatment decision is written and kept in medical
records.
Physicians
typically does a good job when it comes to respecting a patient’s wishes. Even
if a surrogate or physician is responsible for any decision making, the main
goal is to follow what would be best for the patient. This is an example of the
Utilitarian Approach. Whether the physician agrees or not with the patient’s
wishes or surrogate’s choice, physician has no choice but to accept the
decision and follow the guidelines. On the online textbook, Code of Medical
Ethics, it states the guidelines to follow when it comes to interventions with surrogates
or patients. Interventions are requested by physicians when a physician does
not agree with the patient or surrogate’s wishes to go upon an illness or
injury. Interventions also discuss the situation of the patient to inform the
surrogate or family members the condition the patient is in and ways to go upon
that. In the textbook, Code of Medical Ethics, the guidelines states, “Physicians
should discuss with the patient the individual’s goals for care, including
desired quality of life, and seek to clarify misunderstandings. Include the
patient’s surrogate in the conversation if possible, even when the patient retains
decision-making capacity. Physicians should reassure the patient (and/or
surrogate) that medically appropriate interventions will be provided unless the
patient declines particular interventions. Physicians should negotiate a
mutually agreed-on plan of care consistent with the patient’s goals and with
sound clinical judgement. Physicians should seek assistance from an ethic
committee or other appropriate institutional resource if the patient (or surrogate)
continues to request care that the physician judges not to be medically appropriate,
respecting the patient’s right to appeal when review does not support the
request. Physicians should seek to transfer care to another physician or
another institution willing to provide the desired care in the rare event that
disagreement cannot be resolved” (6,7). Interventions
are a way for physicians to communicate with the patient or surrogate to decide
on treatment. The level of state of moral development is at level 1 for
Obedience and Punishment Orientation.
Physicians main goal is to follow
the guidelines and avoids making decisions that they think might be best, but
understands that ethically, the patient’s wishes will always be acknowledged
first. Factors such as religion, culture and law can influence any end of life
situations for the patient. Physicians should consider the patient’s background
and thoughts on quality of life when it comes to discussing the advance care
taking. For example, when it comes to decisions about withholding or
withdrawing life-sustaining treatment, Code of Medical Ethics states, “Physicians
should review with the patient the individual’s advance directive, if there is
one. Otherwise, elicit the patient’s values, goals for care, and treatment
preferences. Including the patient’s surrogate in the conversation if possible,
even when the patient retains decision-making capacity” (4). It is important
for physicians to include the patient and surrogate when any decision making is
involved and to consider different factors that can affect the decisions.
Any end of life situation can be
stressful and emotional towards any physician, surrogate or patient. Many
factors come into play when it comes to decision making such as religion,
ethnic backgrounds or personal opinions on quality of life. Physicians are
responsible for making sure any decision making involves the patient’s wishes.
Sometimes surrogates and physicians will never meet a common ground and that is
when a third party comes into play. The chapter does a good job on explaining
how physicians involves the patient to understand how to undergo any life-threatening
situations. The chapter does a good job on explaining the guidelines for every scenario
that a physician has to follow. The chapter expresses the importance of having
an advance care taking and chosen surrogate. With the help of an advance care
taking directive, physicians are aware how treatment for a patient should be done.
Advance care taking plays an important role to where physicians are prepared to
respect the patient’s wishes when a serious injury or terminal illness occurs.
Source
AMA Council on Ethical
and Judicial Affairs . “Chapter 5: Opinions on Caring for Patients at the
End
of Life.” Code of
Medical Ethics , 8th ed., American Medical Association, 2016, pp.
1 www.amaassn.org/delivering-care/ama-code-medical-ethics.
Accessed 12 Sept. 2017.
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