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Linda is a 91-year-old retired teacher, who is eligible for free healthcare services. She has been diagnosed with breast cancer, hypertension, and chronic bronchitis, all of which developed over the course of 15 years. After a week of constant coughing, shortness of breath, and chest pain, Linda was transferred to an emergency clinic. There, a doctor ordered a couple of tests, including a pneumococcal urinary antigen test and a chest X-ray, which showed that Linda had pneumonia. In addition to that, the doctor suspected heart failure and moved the patient to an intensive care unit. Linda was immediately intubated and put on life support by a mechanical ventilator. A broad-spectrum antibiotic therapy was also a part of Linda’s treatment plan.
It is important to apply a bioethical decision making model to Linda’s situation. Considering the patient’s age, existing health condition, and a range of other risk factors, the doctor warned Linda that a ventilator may become a life-long addition, which meant that returning home would not be possible. The woman’s husband has passed away recently and she had no one to take care of her except for her son, who lived in another state and traveled for work most of the time. After Linda was placed on the ventilator, it was evident that the suggested therapy was successful. However, medics failed to cease ventilated support for almost a month. As a result, Linda expressed her desire to be removed from life support and encouraged the personnel to disconnect her from a medical ventilator. Linda’s son, his wife, and two children opposed treatment withdrawal, which posed an ethical issue for the medics.
Thus, a clinical scenario described earlier is a source of an ethical dilemma: Who should make a final decision about treatment withdrawal in Linda’s case? Her recovery was unlikely due to multiple organ dysfunction syndrome worsened by cancer and various chronic conditions. Therefore, being connected to a mechanical ventilator can be considered an equivalent of postponed death. Since there was a lack of chances for possible recovery, Linda chose to end her life. Her family, on the other hand, refused withdrawal of treatment and asked the medical staff to help them convince Linda to change her mind. While healthcare providers could influence the woman’s decision, that would be regarded a violation of patient autonomy.
In order to analyze Linda’s case further, it is crucial to apply ethical principles. Beneficence means that medical professionals have to ensure their actions benefit the patient both physiologically and psychologically. Withholding treatment as per Linda’s wish may be considered as non-beneficent as it does more harm than good. Nevertheless, the patient communicated her decision to refuse medical ventilation because of severe pain and distress in breathing it caused her. In addition, give the information doctors provided her with, Linda assessed that her suffering outweighs an almost non-existent chance of ever recovering. Thus, respecting the client’s right to autonomy must be deemed superior to the principle of beneficence.
As for non-maleficence, it is evident that a set of medical interventions integrated into Linda’s care plan have harmed her mentally and physically. Hence, it would be better to go along with Linda’s decision for the sake of her well-being. Lastly, the principle of justice dictates that withdrawal of Linda’s treatment would allow the hospital to distribute limited resources among intensive care unit patients who might have a higher chance of recovery. According to a bioethical evaluation of Linda’s case, it is safe to conclude that the woman should be the one making the final decision, and not her family. As patient advocates, nurses must ensure that Linda’s wishes are prioritized.
In a clinical setting, a patient may feel vulnerable and uncomfortable, which creates a threat of others easily taking advantage of them. A nurse has a task of enforcing patient advocacy by “being a patient representative, defending the patient’s rights and universal rights, protecting the interests of the patient, contributing to decision-making and supporting the patient’s decisions” (Davoodvand et al., 2016, p. 2). A nurse must provide all the necessary conditions for the patient to rely on them for information, education, and respect. Other dimensions of nursing advocacy include “physical, emotional, and financial support, protecting and representing the patient, and continuity of care” (Davoodvand et al., 2016, p. 2). Despite nurses having a number of extremely important roles, patient advocacy is one of the most crucial ones. The goal of patient advocacy is protecting the fundamental rights of clients and ensuring they receive high-quality care. Despite that, achievement of these objectives is often threatened by the lack of resources, absence of dedication to the nursing profession, as well as external factors. This puts patients at risk, which makes advocacy all the more important.
In conclusion, although it is a relatively modern concept, patient advocacy in nursing has already been integrated in the majority of codes of ethics of healthcare institutions. Nurses, more than anyone else, are responsible for remaining in close contact with the patient in order to assess their needs and provide appropriate services. Thus, since the need for justice is one of the primary human concerns, nursing professionals have to act as advocates for patients. This way, a nurse becomes a bridge connecting an individual in need of medical assistance and the healthcare system.
Reference
Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses’ viewpoint: A qualitative study.Journal of Medical Ethics and History of Medicine, 9(5), 1-8. Web.
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