Most of the time patients and families do not understand the interventions used in these situations, they think what they see on television is an accurate representation; however when they are educated they are able to make the right decision for themselves. Santiago describes the dilemma that occurs when healthcare workers and those that are making decisions for the patient disagree over the benefit and value of the continuation of aggressive medical interventions (27). When they feel as if they are unable to appropriately advocate for their highest risk patients, clinicians may experience tremendous anguish and torment, which can lead to compassion fatigue and moral distress (27). It is easy for us as nurses to take this distress that Santiago describes home with us and this can cause distress in our personal lives. Ideally the patient will have their wishes known about their code status and end of life care before they are in a situation where they are unable to voice their opinions.
Some doctors may give narcotic pain medications or other medications to keep patients comfortable in their last hours. Although the APA neither endorses nor opposes assisted suicide, they encourage psychologists to take active roles in both clinical practice and research involving end-of-life issues and in providing competent, culturally sensitive care to the dying and their families (Rosenburg, 80). Dilemmas of this nature may be handled in many different ways; some may go before the ethics committee if a decision cannot be reached or if the nurse and the doctors do not agree on the course of action. The purpose of the ethics committee is case discussion and consultation, policy review and development, and other appropriate interventions, and focuses on considerate and respectful decision-making that accords with fundamental precepts of health care ethics and human rights (UNC Health Care, 2013).
The committee may meet at the request of the family or employee, many by an anonymous telephone call. Technology has brought healthcare to new higher standards than it has been held to in the past. This improvement has brought with it the promise of more efficient treatment techniques, extending life inappropriately and futile prolonging of patients suffering have become commonplace for critical care nurses caring for dying patients (Browning. 144). Seeing these patients sustained longer than the nurse feels is ethically responsible may cause a large amount of turmoil in his or her personal life, the profession of nursing is one that requires much of you. Nurses are there for their patients in ways that sometimes the families are unable. The patients right to choose is a major player in the ethical debate about end of life care.
According to Rosenburg the patient has the right to accept or decline any or all treatment, also Rosenburg says that in addition to upholding patients dignity and relieving suffering, (clinicians) join their health care colleagues in ensuring that patients receive support for their autonomous decision making throughout care, and particularly in the context of their death (78). The patient or family may choose no intubation, no Cardiopulmonary Resuscitation (CPR) or may decide to sign an order of Do Not Resuscitate (DNR) as their nurse we should provide education and answer any questions they may have. Moral distress occurs when nurses are unable to perform according to what they believe to be ethically correct (Browning, 144). Often times as the patients advocate the nurse feels that he or she may know whats best or what the patient would want. By being at the bedside of many patients in similar situations nurses see what the patients are put through during life sustaining acts.
Sometimes these acts are more traumatic than the illness that brought the patient into the hospital; many times in the emergency room this writer has heard nurses say, things like were not doing them any favors. This saying is normally when uttered when CPR is in progress or has brought back a patient that has a poor prognosis. Ethics is something that we encounter on a daily basis in much of our decision making especially with these critical patients, even outside the hospital in everyday lives ethics are in play. When it comes to decision about end of life care, it is best for the patient to make their own decisions but if that is not possible the family needs to be educated about all aspects of the processes and in terms that they are able to understand. End of life care is a very sensitive subject that should be approached with honesty while providing the patient with the utmost dignity.
Browning, A. M. (2013). MORAL DISTRESS AND PSYCHOLOGICAL EMPOWERMENT IN CRITICAL CARE NURSES CARING FOR ADULTS AT END OF LIFE. American Journal Of Critical Care, 22(2), 143-152.
Rosenberg, T., & Speice, J. (2013). Integrating care when the end is near: Ethical dilemmas in end-of-life care. Families, Systems & Health: The Journal Of Collaborative Family Healthcare, 31(1), 75-83. doi:10.1037/a0031850
Santiago, C., & Abdool, S. (2011). Conversations about challenging end-of-life cases: ethics debriefing in the medical surgical intensive care unit. Dynamics, 22(4), 26-30.
UNC Health Care. (n.d.). UNC Health Care. Retrieved June 23, 2013, from http://www.unchealthcare.org