Withdrawal of Medication and Ethical Issues

Discuss about the Health Care Ethics Case Study Four.

Health care ethics define the core of healthcare practice where practitioners are required to uphold the highest levels of integrity and ethical standards to protect patients. This means that they can be held accountable for any action that can cause harm to the patient if it is established that they contravened ethical standards in one way or the other (McDonough & Park, 2016). The ethical dilemma that the health practitioner in case study four are facing is the issue of withdrawing treatment. This issue is based on the disagreement between the doctor and Archie Simpson parents who want the treatment to continue.

Life-sustaining medications are used to keep a patient alive with the hope that they will be able to recover. However, it reaches a point when the medication is no longer relevant to the patient and thus the need to withdraw. This is treated as both a clinical judgement and at the same time an ethical issue when the situation becomes complicated like the in the case of Simpson. In the modern world, technology and medications have developed to the point that they can be used to indefinitely support the life of a patient who if left without this medication or technology they definitely die (Hooff & Buijsen, 2014). Therefore, questions have been raised on when is the appropriate time when the patient should be left to die by withdrawing any life support interventions that have been put in place. Different countries and states have laws that guide the procedure to be followed in the case of withdrawing medication from a patient.

In the Simpson case, there is contention between the patient’s parents and the healthcare practitioner on whether the medication should be withdrawn or not. In most cases withdrawal of medication means allowing natural death to take place on the patient. Being characterized by severe muscle weakness and non-responsiveness to any stimuli, the doctors felt that she stands little chance of survival despite use of further therapeutic interventions. However, the parents felt that since there was a promise of a research that is almost through, then Simpson had better chances of surviving of the therapeutic intervention can be applied further. Withdrawal of medication from Simpson means allowing her to die naturally. The ethical issue issues in this case therefore are whether the doctors should withdraw the medication as per their expert opinion or heed to what the parents want and continue with the medication even if they know the results will be futile.

Patient Dignity and Human Rights

The ethical issues about the notions of human dignity, human rights, your professional codes of ethics/conduct, relevant professional policies/legislation, and the principles of health care ethics studied in this unit management.

According to Rosenberg & Speice (2013) observing patient dignity during end of life is one of the requirements that practitioners have to observe. Since dignity is a fundamental to all human beings, then there is need to focus on preserving it and creating comfort for every individual within the society. When practitioners choose to withdraw medication, then they have gone against the Hippocratic Oath of preserving life that they swore. Dignity has four defining attributed that are used in the area of patient care: respect, autonomy, empowerment, and communication (Adib-Hajbaghery & Aghajani, 2015). Respect focusses on acknowledging the rights of the patient which includes privacy, confidentiality and self-belief. Autonomy is the choices that people have before making decisions. In the case of Simpsons, autonomy means allowing the parents to decide on withdrawing the medication. Communication is the process through which information is passed to the parent or next kin to assist in making important medical decisions. In this case, dignity for the patient means giving the right information to the parents for them to make the decision on whether the medication should be stopped. Cook & Rocker (2016) suggests that through having a choice, patients and their loved ones can make the right decisions on whether to continue with the medication or to stop. Patients need to be assisted to die peacefully by being accorded enhanced care. Human dignity in the case of Simpson is to be assisted with enhanced care to reduce the pain that the disease can cause as death approaches.

Human rights are moral principles and norms that describe standards that should be used when treating other people or the behaviors that people should show towards others. These rights revolve around upholding human dignity and equality for all. According to the WHO, physicians and the state owe any patient the right to be treated accordingly like any other patient (Cohen & Ezer, 2013). This means that the concept of human rights should be applied to the right context and they need to be protected by all means. As part of her right Simpson’s parents have the right to be informed of any medical decision being made on her and at the same time they need to be consulted on what needs to be done on their loved one. The rights of information and informed consent define the approach that should to be taken in the issue of Simpson. The right to information requires the family to be enlightened in the simplest manner possible that they can understand on the options available for the patient’s condition (Chih, et al., 2016). From the right to information then the family can make a decision based on judging the situation and determining the best approach that they can use in the situation. Since consent requires the patient or the family to agree with the step taken by the practitioner, then withdrawal of medication can only happen if the consent has been given and the parents feel it is in the best interest of their loved one.

Healthcare Ethics in End-of-Life Situations

Connolly, Miskolci, Phelan, & Buggy (2016) suggests that in end of life situations four principles of healthcare ethics are applied; autonomy, beneficence, non-maleficence and justice. Autonomy requires the patient to be free to make their own choices or to be assisted by their loved ones. Justice requires fairness in all clinical processes accorded to the patient. Even though Simpson seems to be in the last states of end of life, justice needs to be accorded by ensuring that the best care is accorded to uphold her dignity in the last days. Cook & Rocker (2014) suggests that bbeneficence is the ability of the practitioner to improve the patients’ health and doing well to them. This implies that the practitioners need to ensure that the patient is in the best state of life care whether the medication has been withdrawn or not. Lastly. Non-maleficence is based on doing no harm to the patient (Curtis & Rubenfeld, 2014). The fact that the therapeutic medications were not responding, the patient had every right to be treated in the best condition for all.

Lastly, professional policies and codes of ethics need to be practiced by every practitioner in the field when treating the conditions of patients. This means that the professionals should approach the issue based on putting the patient first and tailoring care based on the condition of the patient. Simpson needs to be treated with a care process based on what meets the condition that she is facing rather than applying generalized care processes.

When approaching patient issues in end of life care, practitioners need to uphold every principle and observe the healthcare standards defined in their field (White, Kupeli, Vickerstaff, & Stone, 2017). Through application of the right principles, practitioners can observe the rights of patients and create the best conditions that allow easy transition in the end of life process.

On the other hand, practitioners are supposed to follow the right policies and principles in meeting the conditions of their patients. Since the role of healthcare practitioners is to uphold life, then the medical decisions need be made in conjunction with patients or their loved ones (Schmit, 2016). The issue of treating the patient as a participant in the medical process has been described to yield results by improving patient outcomes. Consultation and involvement of patients reduces problems that can arise between the patient and the practitioner in the case of violation of rights. Since ethics requires practitioners to be accountable for every decision that they make, then there is need for professional to observe the highest standards management.

Professional Policies and Codes of Ethics

Therefore, in the case of Simpsons, there is need for practitioners to give the family appropriate information regarding the situation of the patient and allow them to make an autonomous decision on whether to withdraw medication or not. Withdrawal of medication without consent means that the rights of the patient have been infringed and can lead to legal implications. By allowing autonomy and use the informed consent of the parents, then practitioners will have used the required standards for their profession. Further, should the parents agree for the medication to be withdrawn, then adequate care has to be given to the patient to make her comfortable in the last days of end of life.

References

Adib-Hajbaghery, M., & Aghajani, M. (2015). Patients Dignity in Nursing. Nursing and Midwifery Studies, 4(1).

Chih, A.-H., Su, P., Hu, W.-Y., Yao, C.-A., Cheng, S.-Y., Lin, Y.-C., & Chiu, T.-Y. (2016). The Changes of Ethical Dilemmas in Palliative Care A Lesson Learned from Comparison Between 1998 and 2013 in Taiwan. Journal of Medicine, 95(1).

Cohen, J., & Ezer, T. (2013). Human rights in patient care: a theoretical and practical framework. Health and Human Rights, 15(2), 7-19.

Connolly, C., Miskolci, O., Phelan, D., & Buggy, D. J. (2016). End-of-life in the ICU: moving from ‘withdrawal of care’ to a palliative care, patient-centred approach. British Journal of Anaesthesia, 117(2), 143-145.

Cook, D., & Rocker, G. (2014). Dying with Dignity in the Intensive Care Unit. The New England Journal of Medicine, 370, 2506-2514.

Cook, D., & Rocker, G. (2016). Dying with Dignity in the Intensive Care Unit. The New England Journal of Medicine, 12(4), 20-30.

Curtis, J. R., & Rubenfeld, G. D. (2014). No escalation of treatment” as a routine strategy for decision-making in the ICU: con. Intensive Care Medicine, 40(9), 1374-1376.

Hooff, v. d., & Buijsen, M. (2014). Healthcare professionals’ dilemmas: judging patient’s decision making competence in day-to-day care of patients suffering from Korsakoff’s syndrome. Medical Health Care Philosophy, 17(4), 633-640.

McDonough, J. E., & Park, J. J. (2016). America’s healthcare dilemma. BMJ Journal, 355.

Rosenberg, T., & Speice, J. (2013). Integrating care when the end is near: ethical dilemmas in end-of-life care. Journal of Colaborative Family Healthcare, 31(1), 75-83.

Schmit, J. (2016). Perspectives on death and dying: a study of resident comfort with End-of-life care. BMC Medical Education, 16, 1-6.

White, N., Kupeli, N., Vickerstaff, V., & Stone, P. (2017). How accurate is the ‘Surprise Question’ at identifying patients at the end of life? A systematic review and meta-analysis. BMC Medicine, 15(1).