Patient Ethical Dilemmas

Patient and Family Involvement to Ethical Issue on Care Decision Making

Purpose: Decision making is a crucial element in the field of medicine and health care. The physician has to determine what is wrong with the patient and recommend treatment, while the patient has to decide whether or not to seek medical care, and go along with the treatment recommended by the physician.

Patients have both rights and responsibilities when it comes to their health and the health care services they receive. Patients have the right to care, treatment, and services that safeguards their personal dignity and respect their cultural, psychosocial and spiritual values. They have the right to participate in decisions about their care and to
set the course of their treatment. This means that patients must be given accurate information. Patients have the right to know their diagnosis, prognosis and treatment options. Health care professional must discuss all treatment options with their patients, which includes the option of no treatment. Further, they need to know the risks, benefits and potential medical consequences for each treatment option.

Scope: Patients and family involvement when it comes to decision making really plays an important role in achieving the best care for the patients. With the guidance of the physician and all the health care staff, the goal for the patient’s wellness and comfort will be achieved. Accompanied with the health service rendered by all the health care staff and physician are the rights of the patient that are to be respected and followed to fully achieved their rights to dignity.

A. Right of Unconscious Patient

All patients, competent or incompetent, with some limited cognitive ability or in a persistent vegetative state, terminally ill or not terminally ill, are entitled to choose whether they want life-sustaining medical treatment. • If the patient is unconscious or otherwise unable to express his/her will, informed consent must be obtained whenever possible, from a legally entitled representative. • If a legally entitled representative is not available, but a medical intervention is urgently needed, consent of the patient may be presumed, unless it is obvious and beyond any doubt on the basis of the patient's previous firm expression or conviction that he/she would refuse consent to the intervention in that situation. • However, physicians should always try to save the life of a patient unconscious due to a suicide attempt. Family members are best qualified to make substituted judgments for incompetent patients not only because of their peculiar grasp of the patient's approach to life, but also because of their special bonds with him or her. It is they who provide for the patient's comfort, care and best interests, and who treat the patient as a person, rather than a symbol of a cause. Where strong and emotional opinions and proponents exist on an issue involving the treatment of an incompetent, extreme care must be exercised in determining who will act as his or her surrogate decision-maker. A family member is generally the best choice

B.
Right to Dignity

Dignity is: • A term used in moral, ethical, and political discussions to signify that a being has an innate right to respect and ethical treatment. It is an extension of Enlightenment-era beliefs that individuals have inherent, inviolable rights, and thus is closely related to concepts like virtue, respect, self-respect, autonomy, human rights, and enlightened reason.

Maintenance of patient dignity is an important element of nursing care that is highly valued by patients. Despite this, dignity is seldom defined and there are few guidelines that nurses may use in their practice to safeguard individual patients' dignity. Important elements in the meaning the nurses ascribed to the notion of patient dignity were the elements of respect, privacy, control, advocacy and time. The characteristics that patients attributed to dignity and its maintenance included respect, privacy, control, choice, humour and matter-of-factness.

The health professionals and givers should know how to respect the patients’ dignity. The only way is to respect all their rights as a human being, as a patient and their values and beliefs in
life.

C. Right to Appropriate Care based on Religion and Personal Belief

Ethics and religion can be intellectually analyzed as different enterprises. Both faith and reason are grounded in a way of life. Moral reasoning can be shared with the world in the assurance that it will be accepted by all persons of good will. Reasons are important and become most convincing when they lead to live a life of charity and truth.

One basic moral foundation for the vocation of health care workers is justice. Paul VI taught that "Justice is love's absolute minimum." The ideal of "just care" requires that all human beings be treated with dignity and equal respect. All humans are made in the image of God and as morally equal cannot be discriminated against or denied care. No one earns their intrinsic dignity which is a gift from God. All human beings no matter what their abilities or stage of growth possess an inalienable dignity granted by the Creator.

Just care demands accountability from all. Everyone is responsible for good work according to the highest moral standards. Professional competence and effort is required from all who must also strive to make human institutions and social structures just. Our spirituality should be always social and mindful of human dignity. Health professionals respect the dignity of their patients by being the best nurse, physician, or health care worker that they can be.

Patients have their dignity respected in just care and their responsibilities are also recognized. Care giving is a relationship and patients who are equal in moral dignity can share in their treatment when it is possible. They can cooperate in their care and healing. They can communicate their privileged knowledge so it is important for care givers to take time to inform them and to listen to them. Patients have information and resources for cooperating in their treatment and healing.

A patient's spirituality and spiritual resources should be respected as well. Care givers should neither fear, nor censor a patient's explorations or expressions of spirituality. Spiritual autobiographies are enlightening, especially for atheists and agnostics. A patient might easily feel freer to share intimate sexual matters, than bring up prayer or experiences of God.

Should care givers speak of their own spirituality?
Perhaps they should be reticent, unless asked or in response to the patient's lead. In any situation where there is an asymmetry of position, power, or health, it is important to avoid intrusiveness or subtle coercion. We should speak of our faith and spiritual hopes and practices only if asked. We could pray for a patient and for guidance, but not pray with them unless it was specifically requested. Yet surely, spiritual resources should be offered and made available to patients, unaccompanied by pressure. Our commitment to benevolent care and the relief of suffering can be communicated in large and small ways. As St. Francis said, "Always preach the gospel, sometimes use words." Deeds and empathy, beneficence, courtesy and respect for the dignity of patients as fellow children of God will convey the good news. A care giver should be trustworthy and never lie, but always make an effort to offer patients hope for as full a life as is possible for them-- even if no cure is possible. We can be grateful for their vocation by demonstrating gratitude to our patients for the privilege of caring for
them.

The patients have the right to freedom of religion. They also have the right to be with people they choose to be with.

• Do NOT force anyone to go to a religious activity unless they want to • Help people go to the religious groups they choose • Encourage them to choose the groups and activities that they want • Help them get to any social, recreational and/or patient rights groups that they want to go to