Mrs. Beaudoin appears to be in a real ethical dilemma given the fact that she does not have formal power of attorney and her husband also lives in the same facility with her with moderate dementia and is very frail. The ethical issue involved in this case is that Mrs. Beaudoin’s health is failing steadily. She is known to have cancer throughout her body, a failing heart, moderate dementia and diabetes type II. Due to the cardiac arrest she suffered after a short stay in the intensive care unit she subsequently suffered a severe brain injury occasioned by lack of sufficient oxygen. Since she cannot make healthcare decisions on her own and her husband is in a state that is just as bad, the ethical issue here is; who will make healthcare decisions and end of life decisions on her behalf?
Given that Mrs. Beaudoin is also suffering from brain damage and inability to consume enough calories to sustain her body weight her health is on the decline. The other ethical dilemma is that the presumptive substitute decision maker i.e. Mrs. Beaudoin’s eldest daughter does not agree with the assessment of the team taking care of her mother. She disagrees with the idea that the treatment plan should only focus on comfort and exclude any CPR. It appears that Mrs. Beaudoin is not leading a meaningful life and she is suffering at the hands of the team trying to keep her alive. Generally, the ethical issues involved include the capacity of the patient to make decisions, the right of the patient to refuse to take treatment, withdrawal and withholding of treatment to sustain life, hydration and nutrition issues, assisted suicide, and no code decisions (McCabe, M. S. & Coyle, 2014).
It is the responsibility of the acting administrator of an LTC facility to make sure that they maintain an approach that is in line with the ethics of decision making. Further the administrator has to implement decisions that are morally upright (Thorns, 2010). The administrator must have sufficient facts, knowledge, and experience concerning Mrs. Beaudoin’s conditions and the expected outcome. Furthermore, the administrator ought to be willing to collaborate and communicate perfectly with the colleagues in order to arrive at the best decisions that are compliant with the patient’s best interests (Thorns, 2010).
In order to deliver medically and ethically appropriate healthcare decisions for patients without surrogates and for the patients who lack the capacity to make their own decisions it is important to consider several factors. A decision that is made without the knowledge of what the patient would have specifically wished for in those circumstances must be made in the best interest of that patient (Santa Clara University, 2019).
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Appropriate care decisions have to be defined by the provision of ethical interventions as well as avoidance of any interventions that do not benefit the patient or interventions that, to the patient, would be a burden. Interventions that contravene healthcare standards, which are generally accepted, or intervention that are medically ineffective, must be avoided (Santa Clara University, 2019).
According to Holt (2017) medical interventions are increasing in quantity and so in the patient’s life span. The increase in both these numbers has led to numerous ethical concerns during end of life. The basic principles of ethics including justice, double effect, beneficence, non-maleficence, and…
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…where more than a single person meets the criteria to become a substitute decision maker then the person is entitled to assume the capacity of a substitute decision maker on behalf of the patient. All the substitute decision makers are allowed to collectively make a decision as to which one will be the de facto substitute decision maker (Shulman, 2016). The long-term care administrator will not decide as to who among the ranking substitute decision makers is fit to act. Although the substitute decision makers may hold different views about the long-term care, the administrator will only rely on the decision of the de facto substitute decision maker identified by the other substitute decision makers.
• Because we know Mrs. Beaudoin’s desire to live to be 100, must we ensure that “everything is done” in an attempt to prolong her life?
Although Mrs. Beaudoin has a desire to live until she is 100 so as to be spotlighted on Willard Scott’s The Today Show, it would be unethical to negate the principles of non-maleficence and beneficence and inflict suffering on Mrs. Beaudoin in order to keep her alive. Given her health condition, it is clear that Mrs. Beaudoin is not living a meaningful life and that any medical interventions aimed at extending her life would be done at the expense of inflicting suffering on her (Holt, 2017). Although ethical guidelines with respect to end-of-life, vary, depending on the organization, it is safe to say that the wishes of a patient must never be fulfilled at any expense for the sole purpose of prolonging their life. This would be contravening the principle of beneficence. Doing so would be tantamount to inflicting suffering on the patient and using….....
Hamilton Health Sciences (2015). Making decisions for others, your role as a Substitute Decision Maker. Retrieved 21 March, 2019 from http://hamiltonhealthsciences.ca/documents/Patient%20Education/SubstituteDecisionMa ker-trh.pdf
Holt, J. (2017). Ethical Issues at the end of Life. In Key Concepts and Issues in Nursing Ethics (pp. 129–143). Springer International Publishing. https://doi.org/10.1007/978-3- 319-49250-6_10
Macauley, R. C. (2018). Ethics in palliative care: A complete guide. New York, NY: Oxford University Press
McCabe, M. S., & Coyle, N. (2014). Ethical and Legal Issues in Palliative Care. Seminars in Oncology Nursing, 30(4), 287–295. https://doi.org/10.1016/j.soncn.2014.08.011
Santa Clara University (2019). Healthcare Decisions for Incapacitated Patients without Surrogates, Markkula Center for Applied Ethics. Retrieved 21 March, 2019 from https://www.scu.edu/ethics/focus-areas/bioethics/resources/healthcare-decisions-for- incapacitated-patients/
Schroder-Back, P., Duncan, P., Sherlaw, W., Brall, C., & Czabanowska, K. (2014). Teaching seven principles for public health ethics: Towards a curriculum for a short course on ethics in public health programs. BMC Medical Ethics. BioMed Central Ltd. https://doi.org/10.1186/1472-6939-15-73
Shulman, R. (2016). Consent for Treatment and Conflicts between Substitute Decision Makers: Options for Resolution. Retrieved 21 March, 2019 from https://www.allaboutestates.ca/conflicts-substitute-decision-makers/
Thorns, A. (2010). Ethical and legal issues in end-of-life care. Clinical Medicine, Journal of the Royal College of Physicians of London. Royal College of Physicians. https://doi.org/10.7861/clinmedicine.10-3-282
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