Ethical Problems of Death and Dying
Death and dying are individual phenomena yet widely shared experiences. Death affects the perception of the identity and culture of a society. In the medical field, death is as well a critical concern. Individuals and the community expects the best to happen at the medical facilities. Hence, there are numerous ethical dilemmas associated with death and dying. The dilemmas are directed at physicians and especially nurses. In most cases, they are associated with some legal concerns. Furthermore, professional and personal values emerge from ethical dilemmas. There is a need to examine the ethical concerns, how they impact the physicians and nurses, the legal issues associated, and the values emerging.
Ethical Dilemmas
Giving quality care to the dead or a dying patient needs a physician who knows ethical issues, particularly those related to end-of-life. Exceptional ethical care may influence the autonomy of the patient positively before death even after the patient has lost the capacity to make decisions. It is challenging to identify medical futility in a medical facility. Medical futility can be regarded as measures that will not lead to the expected result of therapy. Hydration, and artificial nutrition, among other therapeutic interventions, may be paused or abandoned if medical futility is following the wishes of the dying patient. Terminally ill patients result in the nurses responsible for taking care of them performing physician-assisted suicide (John, 2018). Physicians and nurses are forced to analyze and determine the basis of the requests and liaise with a colleague to give comfort and support to the patients. Physician-assisted suicide may go against the traditions in the relationship between the physician, the nurse, and the patient. Medical practitioners are supposed to consider spiritual concerns in managing dead and dying patients.
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Individuals Impacted
All healthcare professionals, including physicians and nurses, are responsible for giving care to dead and dying patients. They confront many challenges and dilemmas. Offering quality care to dead and dying patients needs nurses responsible for being aware of the interventions and strategies for avoiding conflicts, and most importantly, having knowledge of the possible ethical dilemmas. A nurse needs to be at the frontline in making a decision and communicating effectively (Jeffrey, 2018). It is essential to respect the autonomy of the patient by keeping them at the center while making a decision. It is a significant aspect of ethical care. Physicians and nurses always need to understand ethical issues and principles comprehensively, for instance, legal ramifications, abandoning a medical intervention, and medical futility. There is increasingly more attention to euthanasia and physician-assisted suicide. Therefore, physicians and nurses ought to have knowledge of beliefs among other ethical issues involving death; and not only understand professional, legal, and ethical ramifications. Quality care for the dead and dying patients also suggests considering any spiritual issue. Hence, physicians and nurses are compelled to adjust and be comfortable in their roles when spiritual concerns are raised. Healthcare practitioners must understand ethic principles that form a basis for biomedical ethics. They should as well follow the relationship between the principles and the ethics and the quality of care to dead and dying patients. Giving decent care to a dying patient is among the ethical mandates of the core characteristic of the role of a physician and a nurse.
Legal Concerns
It is essential to address the issues faced by nurses who take care of dying patients to comprehend the basic principles of ethics in biomedicine. Among the ethical principles, the legal concerns associated with death and dying arise; they include; fidelity, justice, nonmaleficence, beneficence, and autonomy. Autonomy provides direction to decision making. Autonomy encourages the patient to make decisions. Hence, giving rise to the legal right to self-determination.
Self-determination
The nurse responsible is compelled to observe the self-determination right of the patient, even after the patients have lost capacities to make decisions. To preserve the right, the physicians and nurses utilize the advanced directives. Since there are challenges in discussions between physicians, nurses and the patients, physicians and nurses regularly ask caretakers to make decisions for the patient. The activity can turn out to be a defilement of the right of self-determination if a patient is still able to make a choice and has not given permission to any person to decide on behalf of the patient. It may also be a violation in case the patient is not able to make a choice, and the person making a decision on the patient’s behalf was not chosen by the patient or did not know the wishes of the patient.
Beneficence
Beneficence requires that a physician or a nurse should promote soothing that is beneficial or good to the patient. Regularly, the choices of a patient concerning death are not taken care of by advanced care. Individuals who take care of the patients do not know their wishes or those that know their wishes are not available. The role of the nurse to a dying patient is to ensure sound care. They should ensure the autonomy of the patient is not in violation while doing what they assume is the choice of the patient.
Hence, patient autonomy should not be restricted in any manner. Nonmaleficence requires that physicians and nurses should not cause intentional harm to a patient. It is viewed that physician-assisted-suicide violates the ethical principle (Jeffrey, 2018). The view is represented in the Osteopathic Oath, a requirement for any graduate in the osteopathic medical college. The oath states, “I will give no drug for deadly purposes to any person though it may be asked of me” (Hiniker, 2012). Justice requires that the provision of medical care should be fair. It applies to the situations in society by advocating for equal distribution of medical resources and to a single patient by advocating for fair consideration in an attempt to cure dying patients. In all situations, physicians and nurses are entitled to promote appropriate, equal, and fair treatment to dead and dying patients. Lastly, fidelity demands that physicians and nurses should be genuine and faithful to patients at the end of their life. They need to give updates on the conditions of the patient at appropriate times. They should also be true to medical concerns, such as prognosis and diagnosis. They should sincerely defend the decision and choices of the patients even after they cannot speak anymore (Jeffrey, 2018).
Professional and Personal Values
Ethical values sometimes restrict actions of the physicians and the nurses. For instance, currently, physicians are reluctant to utilize more narcotic analgesics dose in a patient who is terminally ill. They have a fear that the dose may lead to the death of the patient as a result of depression of the central nervous system (John, 2018). The consequence is overstated. Although there can be quick death to patients nearing their death as a result of the consumption of narcotic analgesics, ethics allow the administration of the dose. The administration is limited to extreme attention that the purpose is for reducing pains and not to quickening death. Hence, the double effect principle does tolerate afterward effects that are not intentional, for instance, quickening death. It is because the initial, primary intention is good, that is, to reduce pains. However, a person quickly assumes that the patients know the afterward unintended effects of the mechanism to manage pain (Miller and Truog, 2012).
Knowledge Gained
Nurses, patients, and physicians face numerous ethical dilemmas. There are multiple ways to avoid dilemmas, including the use of good dialogue. The dialogue needs to involve the nurses, physicians, and patients if possible. Always considering the autonomy ethical principle, especially the right to self-determination, is essential to ethical concerns of the dead and the dying patients; although, physicians and nurses should be considered as moral agents. Abandoning treatment efforts to a dying patient is acceptable and moral if the patient chooses so. In the case of pain in a dying patient, the double effect prescribes the best way to manage the pain. Physician-assisted suicide alters the relationship between the physician, the nurse, and the patient. It probably reduces integrity in the resolutions of the society to give care to dying patients.
In conclusion, death and dying create an ethical dilemma in healthcare. For instance, giving quality care to the dead or a dying patient needs a nurse and a physician who knows ethical issues. Furthermore, the patients need healthcare practitioners to be responsible and be aware of the interventions and strategies of avoiding conflicts, and most importantly, know the possible ethical dilemmas. Several legal issues emerge from ethical principles concerning death and dying. Some of the issues limit the efficiency of physicians and nurses.
References
- Hiniker, C. (2012). Osteopathic Medical School.
- Jeffrey, D. (2018). Patient-centered Ethics and Communication at the End of Life. CRC Press.
- John, M. D. (2018). Ethical issues in the care of the dying and bereaved aged. Routledge.
- Miller, F. G., & Truog, R. D. (2012). Death, dying, and organ transplantation: reconstructing medical ethics at the end of life. OUP USA.
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