Introduction
The featured case entails Mrs. Eleanor Thompson, a 72-year-old patient who has been fighting late-stage ovarian cancer, which has been unresponsive to previous treatments for over three years. Dr. Martinez, her oncologist, presents two options: the patient’s condition deteriorates as chemotherapy is no longer experimental, a hospice transition is considered for pain relief, or the disease progresses with little chance of stopping. This stirs up an internal debate within her family, where daughter Maria is a strong advocate of more intense treatment. At the same time, their son Michael supports palliative care to reduce the pain and suffering, while their husband Robert is in between. Central ethical issues are about Eleanor’s wellbeing and dignity in the face of the possibility of the development of her preferences that are influenced by her illness and include some things that are beyond longevity.
Analysis of Ethical Issues
The main affected group first is Eleanor, who has advanced cancer. Second is Robert, who is grieving the loss of his wife of 50 years. Third is the children, Maria and Michael, who are on the opposite side when it comes to the decision. Finally, Dr. Martinez is the one delivering the bad news after all the efforts. Over half of patients suffer from psychological distress after learning about their diagnosis. The main principles are beneficence to the patient, nonmaleficence to prevent harm, and autonomy to allow Eleanor to have self-determination.
An ethical decision-making model is a powerful tool that allows us to examine the factors formally. Moral judgment contemplates whether suffering is intended as a result of aggressive interventions or whether the quality of life goals are now being compromised. The line between reasonable and unrealistic expectations could have become blurred, and denial could now be the new hope. Ethical behavior comprises the assessment of Eleanor’s goals right now, which have been altered by deteriorating health, while family disagreements complicate the satisfaction of wishes. Ethical behavior takes us through a gradual shift from the prolongation of life to palliative care when medicine hits its limits, on the other hand. This challenges families psychologically. Interactive communication that is based on a systematic process can help the patient to express their needs.
Through the multiple and complex causes, the ethical dilemma of this end-of-life decision case is made. Eleanor’s life quality and aggressive treatment versus palliative care for comfort give birth to the stressful moments in her life. Family denial and resistance, as well as her shift of focus to longer life and cultural perspectives, provided for her clouded judgment. Those that come at the end give the advocacy for the selfless chance to be explained. The conflict between the adult children’s viewpoints and the need for a deep understanding of the current system poses a challenge for ethical analysis. In order to respect beneficence and nonmaleficence, in which the patient’s welfare and dignity are ensured through suffering, healthcare professionals must be mindful of the medical, emotional, and ethical aspects of the situation.
Evidence Support
The study by Molina-Mula and Gallo-Estrada (2020) found that the empowerment of people through shared power is the way to learn about health and disease processes and make decisions about them in an autonomous way and with the help of professionals. This indicates the need to work with palliative specialists applying the joint communication approach to give Eleanor’s words of gratitude regarding the usefulness of both treatment and hospice transition.
Communication Approaches
The case study described when Dr. Martinez told the family about the choices; they were quick to voice their dissenting reactions without a structured discussion of what Eleanor’s choices were. The absence of this responsible body will likely lead to the rule of emotion of family members over patient interest. Productive communication depends on a formal meeting led by Dr. Martinez to frame up the ethical framework using Eleanor’s values as a starting point and then responding to external interpretations. Establishing common rules for a patient-centered approach and clearly stating that there is no single right decision, as choices are context-dependent and personal, might help to overcome moral distress caused by the unavoidable illness progression. Finally, communication can be focused on maintaining the patient’s dignity and interests and, at the same time, hearing and communicating the family’s perspectives compassionately.
Response to Ethical Issues
Now, there is no concrete solution because no common vision of care values exists, as all family members have their thoughts. Giving two sides time to argue may be reasonable, but that ignores the fact that this is a platform meant to give Eleanor a voice to guide action. In order to get an agreement, the group needs to discuss family grief, ambiguity regarding prognosis, and cultural/religious factors that may affect opinions first. Initially, core teaching should include a palliative approach to allow for the transformation from an impossible curative quest to accepting the boundaries. This helps to work together smoothly through emotional chokepoints, which are triggered by highly charged admissions.
Proposed Solution
A solution that is being proposed is an ethics-based family meeting with Dr. Martinez, Eleanor, her husband Robert, and children Maria/Michael, which will be conducted using the REALM communication model. The objective of this is to disclose the clinical context, recognize Eleanor’s values, and plan the agreed care paths. Social workers, as well as palliative care teams, will jointly offer holistic support, tackling the decisions of life end and the grieving process. Collaborative perseverance, assuring her autonomy, and asking key stakeholders for their opinions are all part of a plan to achieve ethical consensus, that is to say, her wellbeing.
Conclusion
To summarize, the application of bioethical principles in conjunction with communication techniques enabled the care of the patient in such a way as to improve the quality of life of the patient and maintain individual choices in the face of end-of-life problems in a difficult family situation. Continuing research is very paramount for the development of refining models in the process of patients transitioning from aggressive interventions to hospice.
Reference
Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International journal of environmental research and public health, 17(3), 835.doi: 10.3390/ijerph17030835. PMID: 32013108; PMCID: PMC7036952.
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