Healthcare professionals often encounter ethical dilemmas when caring for different kinds of patients. Ethical issues can come in different ways while offering services to clients. Ethical dilemmas may result from discomfort or conflicting issues between the family and the health care. In my clinical practice, one scenario I experienced clashed with my thoughts while providing care. Protecting patient confidentiality often can result in ethical issues in health care dos. One of my patients was diagnosed with lung cancer. The client knew well about the diagnosis and initiation of chemotherapeutic agents and knew she had stage four cancer. As a nurse practitioner, I kept interacting with the client, and she stated to me I should dare tell her relatives about the state of her health. Acting as a link between the relatives and the patient, it was I should communicate the patient progress as well to the relatives; after the client hindered me from stating her condition to her relatives significantly impacted to think critically about it since the relatives kept enquiring about their client state of health. I stood firm to respect for the client’s views and requests despite conflicting thoughts on my side.
Protecting patent privacy and confidentiality are prominent ethical issues encountered by nurses. Nurses have a role in protecting their client’s rights and acting in their best interest. Nurses must respect patients’ autonomy. Patients independently make decisions about their state of health based on their cultural and religious practice. Despite this situation rings dilemmas, nurses and doctors stand to remain respectful of patients’ current state of health. Some circumstances may demand disclosure to prevent the spread of diseases; for instance, a person with HIV/AIDS may request no one to be disclosed about. Patient privacy and confidentiality s paramount, while some circumstances may present ethical dilemmas among the healthcare workers.
Situations, where critical patients do not have advance directives or do-not-resuscitate cases have always presented dilemmas while providing care to critically ill patients. Critically ill patients who cannot make decisions about the limitations of life-supporting medical interventions require no termination of life when there are no advance directives or medical orders that do not renew. Patients on a mechanical ventilator will continue to stay on a mechanical ventilator unless a decision is reached by the significant relative to concede about the situation. In the scenario where there is an absence of a close or surrogate with authority to limit life-sustaining therapies of clear evidence of the patient’s treatment preferences, it may be difficult to discontinue medicines such as mechanical ventilators for a chronically ill patient even when a lengthy trial has failed to achieve meaningful clinical benefit. Termination of sick, chronically patient therapies such as mechanical ventilation should never be driven by default. Informed, conscious medical decisions should be effectively written and communicated to avoid finding oneself in legal matters regarding the state of health of a patient.
The patient can withdraw from mechanical ventilation for palliative care. Palliative or compassionate withdrawal of a mechanical ventilator significantly supports the end of life to optimize comfort, relieve suffering, and allow natural death to occur peacefully. Appropriate planning and procedures are instituted to withdraw a patient from mechanical ventilation. The cost of end life should vehemently involve political input, such as insurance companies. Medicare and Medicaid offer comprehensive hospice services to benefit an array of services such as nursing care, palliative medications, curative services, and counseling services. To cut the enormous healthcare cost, critically ill patients should receive insurance assistance to relieve the payment of huge fees incurred for treatment.
References
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Hurlimann, T., Peña-Rosas, J. P., Saxena, A., Zamora, G., & Godard, B. (2017). Ethical issues in developing and implementing nutrition-related public health policies and interventions: A scoping review. PLoS ONE, 12(10), 1–25. https://doi.org/10.1371/journal.pone.0186897
Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19–20), 3446–3461. https://doi.org/10.1111/jocn.14542
Wiersma, E., Marcella, J., McAnulty, J., & Kelley, M. L. (2019). ‘That just breaks my heart: Moral concerns of direct care workers providing palliative care in LTC homes. Canadian Journal on Aging, 38(3), 268–280. https://doi.org/10.1017/S0714980818000624
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