In health care environments, ethical dilemmas can be caused by a conflicting position between what a terminally ill patient wants and the perceived duty of the healthcare professionals to extend a life. An example is a case in which a patient has a terminal and incurable illness that has indicated a wish not to continue with the treatment and allow nature to do its course. Hence, the healthcare team might be to consent to the further aggressive therapy, disregarding the patient’s autonomy. The ethical conundrum accentuates the conflict between a patient’s right to self-determination and healthcare workers’ duty to serve the patient’s best interests. Resolving such conflicts becomes vital because the quality of life of a patient, dignity, and overall well-beingwellbeing get influenced, among other moral and legal implications.
Step 1: Determine and Describe the Facts
The patient – a 68–68-year-old person – had an oncologist’s diagnosis of stage IV pancreatic cancer with metastasis to other organs. With me having undergone several treatments of radiation and chemotherapy, the disease has advanced in multiple ways, the prognosis being terminal with a less than six-month lifetime. When the symptoms come to the surface, the patient has openly explained the desire to stop any further life-threatening treatments and to use only relief care, as he wishes to have the rest of his life spent at home and does not want to go through further painful procedures. The patient’s children cannot make up their minds on the matter either. An argument between one child, which discourages the use of life support, and the other, which considers giving the patient all possible means of life, is evident to all the medical staff. The attending physician tries to balance both the patients and the medical staff’s needs.
Step 2: Determine the Ethical Issue
The ethical problems that have surfaced in this case are that, on one hand, the healthcare team believes that the patient has the right to die, and on the other hand, the healthcare team will be required to intervene and preserve life. First, the principle of respect for patient autonomy is the clue that mentally competent people have the right to make informed decisions concerning their health care, for example, the refusal of treatment. The issue becomes more complex as health professionals must follow their ethical and legal duties of ensuring the welfare of their patients, which could include employing existing medicinal interventions for lengthening a person’s life. Here, a patient stated clearly that he/she would instead choose not to undergo intense treatment but to be left to live at peace rather than continue the fight. However, the doctors will persist in believing that saving life till its last breath is their duty, even if morally it may not be the right thing after all. Such arguments come into direct contradiction, giving rise to an ethical dilemma with no single answer.
Step 3: Identify Relevant Principles and Laws
In dealing with the ethical conflicts that this situation has raised, a handful of principles and laws have to be comprehensively and considerately addressed because these principles and laws bring the key challenges into sharp focus. Respect forRespecting the patient’s autonomy is of prime importance because it ensures not only the patient’s right to self-determination but also the right to make choices about their health care without coercion or external pressure. This principle is highly pertinent, considering the patient’s explicit requests were promptly given beforehand when he was very lucid. Beneficence and benevolence, which calls members of the healthcare team to do a job which is in the interest and favour the patient’s wellbeing, gives them confidence that the chosen treatment may prolong their life. Consequently, therapeutic intervention is safeguarded on non-maleficence, which forbids actions that may result in unintentional harm or pain to the patient, considering the situation that the patient cannot bear anymore, courting the need for substituting with comfort measures. Along with that, laws and regulations of informed consent, advance directives, and end-of-life care represent a basis for managing these chronic situations and protecting the rights and privacy of people. Through detailed assessment of these related codes and laws, decision-makers can obtain a more layered awareness of the ethical domain, thus offering an insight into the path to a fair conclusion.
Step 4: List Possible Options
- Honor the Patient’s Wishes: Respect the patient’s autonomy and right to refuse treatment and transition to comfort care measures only.
- Overrule the Patient’s Wishes and Continue Treatment: Disregard the patient’s expressed desires and proceed with aggressive treatment based on the healthcare team’s assessment of the patient’s best interests.
- Seek Legal Intervention: Involve the legal system to resolve the conflict, potentially through guardianship proceedings or court orders.
Step 5: Advantages and Disadvantages of Each Option
Option 1: The possible benefits include respecting the patient’s right, the right to live with dignity in the end, and improving the utilization of healthcare resources. The disadvantages can come in the form of competing with the healthcare team’s ethic to save lives, seeing as one can be viewed as “abandoning” the patient, and the challenge of dealing with family members who do disagree.
Option 2: The possible advantages include keeping the duty of the healthcare team to save lives, the yearning of some family members to be treated with all the treatment options available that may be of help, and the avoidance of the possible legal implication of withholding treatment. Several disadvantages include undermining the patient’s individuality, prolonging the agony, and being viewed as superior and coercive.
Option 3:
Possible advantages include the fact that it provides the legal basis for resolving the conflict, clarifies borders, and benefits from being the third party. However, they might take a long time, be expensive, and be psychologically exhaustive for everyone involved; thismore is needed to help the ethiethicalue in question.
Step 6: Potential Consequences and Affected Parties
The decision outcome of this morally challenging context has an enormous effect on various stakeholders. The treatment path that the patient will follow will have a far-reaching influence on the patient’s quality of life, level of suffering, personal dignity, and autonomy on the terminal days. Acceding to the patient’s requests may bring relief but at the expense of the treatment’s intent to prolong life. Retaining their life in this manner is trying to save a life, but it is ignoring patients’ rights and making them more emotional. For the family, disagreements over the acceptable path may damage the relations and push family members to confront each other’s burning positions. Such kind of dismissing some family members’ wishes and demands, which they make as regards the patient’s therapy, is a direct violation of theirs.
Along with the healthcare workers, there are also the team who experience moral distress if they administer ethically questionable act that goes against their professional beliefs. Legal consequences encompass withholding care or breaching informed consent, which are among the choices made if either path is followed. As a result, the issue involves significant ethical issues in recognizing patients’ autonomy over their health versus the doctor’s duty to save a life, even if it interferes with that autonomy. The question of weighing principles and consequences is a thorny one.
Step 7: Determine the Best Decision
In balancing these deep ethical considerations, the leading guiding theory here is the patient autonomy principle. A mentally competent patient might have unequivocally communicated their choice not to opt for aggressive life-sustaining procedures. Honoring such a desire protects people’s basic rights to determine their healthcare path. This way of thinking is compatible with the ethical grounds of respect for autonomy and not causing excessive suffering (non-maleficence). The healthcare team’s perspective is indeed order oriented. It is to preserve life when possible. Of course, this duty must be carefully balanced, especially against the patient’s clearly expressed preferences and their right to choose the quality of life over aggressive interventions. The legal system can be involved through court orders or guardianship proceedings, which provide an external framework. However, the protracted conflict between autonomy and the preservation of life may be unresolved since the legal system does not necessarily help to resolve the core ethical dilemma. In this tricky case, the ethical thing to do would be to respect the autonomy of a mentally competent patient who, after significant consideration, sees the seriousness of the situation.
In conclusion, the tension in this ethical dilemma represents the patient’s right to self-determination and the medical professional’s obligation to preserve a life. UsingUsing the Seven-Step Decision Making Model, the different solutions were analyzed and the pros, cons, and outcomes were evaluated. In the end, by refusing to engage in aggressive treatment and switching to comfort care instead, what is most appropriate is to adhere to the ethical principles of autonomy and non-maleficence while simultaneously upholding a person’s dignity and preferences, according to the principle of respect for autonomy which is the most agreeable ethical theory in this situation. Understandably, the team of healthcare professionals wants to extend life, but by ignoring the expressed will of the patient, you are abrogating his/her fundamental right to self-determination. Autonomy respect does not just grant people the ability to make choices about their lives and healthcare; it also gives them the power to do so even in the face of a terminal illness. In the process of resolving ethical problems in healthcare, it is necessary to reach a balance between opposing ethical principles and to examine the individual circumstances of each case. Establishing an open and sympathetic communication with the patient and other family members may help resolve the challenges and reach a decision that corresponds with the patient’s preferences and values and yet does not create moral distress for the healthcare professionals. In addition, well-defined policies and guidelines on advance directives and end-of-life care acts as guidance and support for healthcare team to whom similar cases have occurred.
References
Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care. SAGE Open Medicine, 9(9). https://doi.org/10.1177/20503121211000918
Gómez-Vírseda, C., de Maeseneer, Y., & Gastmans, C. (2020). Relational autonomy in end-of-life care ethics: A contextualized approach to real-life complexities. BMC Medical Ethics, 21(1). https://doi.org/10.1186/s12910-020-00495-1
Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119
World Medical Association. (2022). WMA – the world medical association-wma declaration of venice on end of life medical care. World Medical Association. https://www.wma.net/policies-post/wma-declaration-of-venice/
Zeeshan, M. S., & Ramzan, Z. (2021). Current controversies and advances in the management of pancreatic adenocarcinoma. World Journal of Gastrointestinal Oncology, 13(6), 472–494. https://doi.org/10.4251/wjgo.v13.i6.472
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