Research Paper on "Overcoming Decision Making Conflicts in Palliative Care"

Research Paper 5 pages (2899 words) Sources: 5

[EXCERPT] . . . .

This deliberate act to relive suffering through the termination of life is referred to as euthanasia. Some nations that have made this legal include Australia, Belgium, Holland and even some states in the U.S. A major dilemma is posed by euthanasia with regard to palliative care as healthcare professionals are not equipped with skills to end life on purpose. Thus efforts have been made to reduce its necessity. Analgesics use, prescribing terminal sedation properly and the uptake of palliative care all have worked to make euthanasia less of an option. Mohanti (2009) thus says that for those in the healthcare profession, priority should be given to palliative care as it is a better legal option for all involved.

When a decision involves the treatment of a child, a conflict may arise as to whether the parent should make all the decisions or whether the child should be involved in this. While it is generally agreed that the parent may know best and have the best interests of the child in mind, at the same time they cannot be expected to be entirely objective when making treatment decisions. Some are of the opinion that the parents' input should be considered but the final decision should not rest with them. Shaughnessy (2004) states that the children should be allowed to participate in the decisions which relate to their own care. When decisions relate to palliative care of a child, they can be particularly distressing for all who are involved and conflicts may come up. In such cases, the existence of an ethics committee can be of help. These committees can objectively analyze a situation, take into account all views and try to resolve the disagreements. Nevertheless some disagreements end up in the court systems. Shaughnessy (2004) notes that in most of the cases that go to court, the party pushing for extension of life of the child has better chance of winning.

Where a family makes a decision to have treatment that is basically "comfort care only," they must be fully informed of the consequences of opting out of life prolonging interventions. Both the medical professional and the family should conference and ideally reach a joint decision. This will enable the healthcare professional to make room for the autonomy of the patient and at the same time provide beneficent care. Where decisions have not been reached or where a conflict emerges, then the physician has a duty to continue the efforts to sustain life. Mani et.al, (2012) however note that there is no moral or legal obligation on the part of the physician to start new courses of treatment which he judges inappropriate given accepted standards of care.

Conclusion

In cases of terminal illnesses or advanced stages of cancer, palliative care is required. Ethics must be adhered to when dealing with pain, controlling symptoms, giving psychosocial attention and even dealing with end of life. Modern and Hippocratic principles of justice, autonomy, beneficence and non-malfeasance must be the guide in this care. It is the responsibility of the healthcare providers to ensure dignity and honesty is maintained. Accessing relief from pain through alternatives such as morphine is a human right. Palliative care can be improved through studies and research. Ethics and palliative care should go hand-in-hand and in this way the patient can be well taken care of as well as ease the mind of his family (Mohanti, 2009).

H. no. 7, Bl. No. 3, New Island, Washington D.C.

Ted Williams

Minister for Health

Downing House

Downing Street

Washington D.C.

27th November, 2015

Dear Minister,

I am writing to express my disappointment over the Palliative Team organized this year to form out strategies to carry out ethical measurements during end of life care. Several strategies were formed, which were accepted by the team members, however, at one point, the physician in the team, Dr. Robert Blank, proposed his opposition for Euthanasia. Dr. Blank presented a detailed presentation on his opposition for Euthanasia, and I would like to present some factual information that clearly describes the use of Euthanasia in Palliative care as positive and useful.

Possible Negative Consequences of Excluding Assisted Suicide

Considering the negative outcomes of not allowing euthanasia is important;

(1) Providing care to the patients who request euthanasia would become difficult if it is not allowed. The units would prevent the patients from getting admitted and receiving the care that would basically result in changing the decision of the patient. These patients would have to be transferred to other units time and again, which would be equal to abandonment. The families and the patients might feel that they are a burden to the healthcare facility (Bigler, Jean-Michel, et al., 2006).

(2) Allowing a person who is terminally ill, to end their life is a compassionate, rational and humane choice as they continue to suffer endlessly against their wish. The right to private life gives a choice to every person to end their life when they cannot suffer any further (Chand, 2009).

(3) Several arguments have come in place that euthanasia shortens life, but according to a Dutch report in 1991, it was found out in eighty six percent of the cases that the life of the patients who opted for euthanasia was only shortened by maximum of a week or a few hours. It was their last escape from pain that was unbearable (Morris, 2013).

(4) Many doctors end the lives of their patients one way or the other without telling them. In a 2012 study in Britain, it was discovered that fifty seven thousand patients die every year without being informed that efforts to keep them alive are not being carried out anymore (Morris, 2013).

(5) When you look at it economically, euthanasia helps the patient and his family in the economic sense. According to CNN, the families have been swallowed under debts because, one in every four Medicare money that is spent, goes to the beneficiaries and forty percent of the families exceed their bills (Morris, 2013).

(6) The Hippocratic Oath itself means that a patient should not be kept alive artificially when death is preferable and there is more harm in allowing him to suffer and die from suffering (Morris, 2013).

In order for a team to work effectively and properly, it requires good communication and networking so there is a larger benefit, and a serious case like this needs a strong team. The facts presented clearly state the need for Euthanasia, however, in order to resolve the conflict between the team, I as one of the leader of the team, would like you to assist in the negotiations between the team members and Dr. Blank, so that the conflicts can be resolved and the strategies can be carried out without any further delay.

Looking forward to hear from you

Yours sincerely,

Dr. Wood Green

References

Baker, J., Hinds, P., Spunt, S., Barfield, R., Allen, C., Powell, B., . . . Kane, J. (2008). Integration of Palliative Care Principles into the Ongoing Care of Children with Cancer: Individualized Care Planning and Coordination. NCBI, 223 -- xii. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2577813/

Bigler, Jean-Michel, et al. "Physician-Assisted Suicide Has No Place in Palliative Care." The Right to Die.Ed. John Woodward. San Diego: Greenhaven Press, 2006. At Issue. Rpt. from "Assisted Suicide and Euthanasia Should Not Be Practiced in Palliative Care Units." Journal of Palliative Medicine 11.8 (2008): 1074-1075. Opposing Viewpoints in Context.Web.

Chand, K. (2009). Why should we make Euthanasia Legal? The Guardian. Retrieved from: http://www.theguardian.com/society/joepublic/2009/jul/01/euthanasia-assisted-suicide-uk

Crawford, G., & Price, S. (2003). Team working: palliative care as a model of interdisciplinary practice. The Medical Journal of Australia.179 (6): 32. Retrieved from: https://www.mja.com.au/journal/2003/179/6/team-working-palliative-care-model-interdisciplinary-practice

Hinshaw, D. (2008). Ethical issues in end-of-life care. NCBI, 122-8.

Mani, R., Chawla, R., Amin, P., Divatia, J., Khilnani, P., Myatra, S., . . . Uttam, R. (2012). Guidelines for end-of-life and palliative care in Indian intensive care units: ISCCM consensus Ethical Position Statement. NCBI, 166-181. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506078/

Mohanti, B. K. (2009). Ethics in Palliative Care. NCBI, 89-92. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902121/

Morris, M. (2013). 10 Arguments for Legalizing Euthanasia. Listverse. Retrieved from: http://listverse.com/2013/09/12/10-arguments-for-legalising-euthanasia/

Periera, S. M., Fonseca, A., & Carvalho, A. S. (2011). Burnout in palliative care: A systematic review. Nursing Ethics, 317-326.

Shaughnessy, J. (2004). End of Life Care: An Ethical Overview . The Indianapolis, 1-75 .

Spruyt, O. (2011). Team Networking in Palliative… READ MORE

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