Patient Ethical Dilemmas

The case study outlines a story about a lethargic and stuporous patient with a diagnosis of a cerebrovascular accident. He has no family members, but did have one friend visit him all day, every day from home. In a few days, the staff found out that the friend has growing dementia. The main ethical dilemma here is the lack of a capable person to make the decision about the patient’s medical condition. The solution to the problem should be based on the best interest of the patient. In hospital setting, the principle theme is patient and family-centered care. In this specific situation, it is no different from these principles.
Data
An ethic is a moral concept of what is right or wrong. An ethical dilemma is a debate between two moral principles, where two sides can argue about
what is wrong or what is right. However, there is no real answer to an ethical dilemma. Two conflicting moral claims both prevail in an ethical dilemma. According to Beauchamp and Childress (2001), “a conflict can be experienced when there is evidence to indicate that a certain act is morally right and evidence to indicate that the act is morally wrong, but no evidence is conclusive” (Burkhardt & Nathaniel,2014, p. 153). In this specific scenario, this type of dilemma exist: whether or not to do all the necessary medical treatment to save his life and prolong his life. Most will think it is the morally right to do all necessary treatment but others will believe it is morally wrong to prolong the life without any legal papers when the prognosis is very poor.
The patient was admitted to an acute hospital from an assisted living home. He is lethargic and stuporous. He has no family. The patient was admitted with a diagnosis of a cerebrovascular accident. He has a friend who visits him all day, every day from home. The medical staff relied on his information and especially in what extend patient want to be treated. The friend stated, “Do everything for him.” After few days the medical staff started to suspect that the friend has growing dementia and that the information provided by the friend might be wrong in reflecting the care that the patient would wish to receive.
Given to the scenario, the patient is lethargic and stuporous. According to his present physical condition, he is not able to make his own decision about medical treatment. The very first ethical dilemma appeared when the hospital staffs require to decide what type of treatment is necessary for him and what type of treatment can be given. Secondly, the doctors and nurses started to rely any information and decision from the friend. However, the friend cannot be the responsible person to give any decision. Moreover, the friend has signs and symptoms of growing dementia. The information was given by the friend may not be accurate. Consequently, either the patient or the friend is unable to make any resolution of medical treatment.
Possible solution
The very first thing the staff should look through are the papers from the patient’s assisted living residence.
Is there any family member’s name or phone number? Is there any legal paper with the patient such as a living will, durable power of attorney or advance directives which will help the health care providers to make decision according to the legal records? If the there is no legal documents, two physicians are able to sign in the progress notes for emergency treatment. For long-term treatment, a social worker needs to get involved. Besides the nurses, the social workers deals with ethical dilemma in everyday work with different situations. If the patient’s prognosis of physical condition is very poor palliative care team will also need to be considered. The bioethical committee from the hospital may needs to get involved. The state should be notified for the recommendation for guardianship or custodianship who can make decision in the future for any emergency or long-term situations. The ethical committee should also focus the attention to the friend who has growing dementia and who always stays with the patient. The friend may need some kind of counseling and treatment for
dementia.