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The presented scenario is complicated by the ethical dilemma that a decision maker faces. It is essential to consider both the will of the patient and the wishes of his wife. However, when those two differ dramatically from each other, the situation requires an in-depth investigation. The first option is to consider the wishes of the 57-year-old patient and place him in the hospital to receive the end-of-life care. The second option is to take a side of the patient’s wife and leave the patient at home. Both scenarios are appropriate for the patient’s diagnosis, however, they contradict each other.
In case the first option is chosen, the patient will be able to spend the remaining time at the in-patient unit at a hospice. This scenario is appropriate if the patient is sound and is capable of making decisions on his own. However, if this is not the case, the appropriate step would be to look at the advance directive of the patient. It is a possibility that the patient does not have one, however, in case he does, it will give a clear understanding of the patient’s wishes. As Spencer, Mrig, Matlok, and Kessler (2017) state, family members are important factors at the end-of-life care for patients. They can be primary caregivers or make health-related decisions when appropriate. In this case, assessing the information about the patient diagnosis and the current state is crucial to make a correct decision.
The information that needs to be gathered through health assessment and diagnostics is the severity of his current state, the diagnosis, previous health history, and his advance directive. There are several forms of the illness, those are primary lateral sclerosis, progressive muscular atrophy, progressive bulbar palsy, and pseudobulbar palsy (Zarei et al., 2015). Some of them are fatal and are characterized by “progressive loss of the upper and lower motor neurons (LMNs) at the spinal or bulbar level” (Zarei et al., 2015, p. 171). Due to the fact that hospices are specifically designed to accommodate people that have only about six months or less to live, it is essential to understand the prognosis of the patient in question. In addition, the subjective data or what the patient thinks of his condition can help create a better vision of the diagnosis and further steps (Forbes & Watt, 2016).
As an advanced practice nurse, I would respond to this case by adhering to the patient’s wishes. Although I do understand the concerns of the wife and her wish to spend the remaining time of the man’s life with him, it is essential to understand and respect the wishes of the patient. American Nurses Association (n.d.) states that the objective of the profession is “to provide and advocate for safe, quality care for all patients and communities” (para. 3). In addition, the association acknowledges the importance of the end-of-life care issue in the society. Respecting the dignity and autonomy of the individual should be the primary objective of any nurse (American Nurses Association, n.d.).
Overall, the decision-making process of the end-of-life care for the patient should be based on his diagnosis, prognosis, and wishes. It is crucial to consider the decisions of the person in question to provide the patient with proper healthcare. In this case, gathering additional information should be helpful in deciding whether the appropriate step in the scenario is to send the patients to a hospice or leave him at home.
References
American Nurses Association. (n.d.)Ethics and Human Rights. Web.
Forbes, H., & Watt, E. (2016). Jarvis’s physical examination and health assessment (2nd ed.). Chatswood, Australia: Elsevier.
Spencer, K. L., Mrig, E., H., Matlok, D. D., & Kessler, E. R. (2017). A qualitative investigation of cross-domain influences on medical decision making and the importance of social context for understanding barriers to hospice use. Journal of Applied Social Science, 11(1), 48-59. Web.
Zarei, S., Carr, K., Reiley, L., Diaz, K., Guerra, O., Altamirano, P. F., … Chinea, A. (2015). A comprehensive review of amyotrophic lateral sclerosis.Surgical Neurology International, 6, 171. Web.
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