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Ethical issues arising in the process of nursing practice and the interaction of junior medical staff with patients often concern not only the insignificant nuances of communication but also serious aspects of professional activity. The ability to make the right decisions is an important component of the work of specialists in different conditions, including caring for distinctive categories of the population. As a research topic for this work, an ethical dilemma will be examined, as well as potentially effective ways to resolve it.
The situation is as follows: a 41-year-old patient with a diagnosed developmental delay and progressive breast cancer asks to cancel all therapeutic procedures, thereby voluntarily agreeing to palliative care and, consequently, a faster death. To address this issue, various aspects of professional practice should be affected. As a model of behavior, the mirroring rule may be applied since one of the most successful styles of conduct is to interact with others the way one wants to be interacted with in the future. Accordingly, regarding the dilemma considered, the patient’s desire is conscious and reasonable, and the observance of her will is a testament of respect and understanding.
Effective Communication
Since the case of an oncological patient is complicated by her developmental delay, establishing effective communication before making an appropriate decision to switch to palliative care should be a mandatory activity. Wiener, Weaver, Bell, and Sansom-Daly (2015) state that compassionate and, at the same time, honest interaction can reduce the woman’s anxiety and give her confidence in the correctness of her own decision. For this purpose, the involvement of family members is a crucial measure because the support of loved ones is an additional incentive to create a calm care environment. The patient’s relatives can help medical staff by being near the woman and helping her to adapt to a new regimen.
Both the patient and her family members should be aware of all the features of palliative care and the consequences of this practice. Wiener et al. (2015) note that the information delivery should is to be as clear and accessible as possible so that all interested parties could understand the specifics of interventions. After obtaining consent and its approval, a work plan should be compiled. At all subsequent stages, any activities should be accompanied by explanations from the staff for the patient to be aware of the need for these procedures. Such effective communication contributes to a more comfortable interaction of all involved individuals and helps minimize emotional stress.
Compiling a Palliative Care Plan
The preparation of a detailed palliative care plan is mandatory in this case. According to Zimmermann et al. (2016), some medical providers facing similar situations delay the adoption of appropriate decisions, which ultimately affects the condition of patients negatively. Based on the woman’s request for the cessation of cancer therapy and related procedures, a new course of care should be designed to make the patient’s life less difficult. Following the prepared plan will allow avoiding possible errors and, at the same time, will not be an obstacle to making the necessary adjustments at the stage of interaction.
As the basic components of the plan, standard intervention algorithms may be utilized. Regardless of the physical or mental development of the patient, appropriate practices should be aimed at reducing pain, maintaining the normal functioning of internal organs, and other important procedures. Tuffrey-Wijne et al. (2016) argue that people with disabilities face challenges in the process of palliative care due to the insufficient qualifications of medical personnel. Accordingly, in addition to planning, appropriate training should be carried out in order to prevent crucial mistakes and not to worsen the patient’s condition.
Patient Sedation
After establishing productive communication and drawing up a palliative care plan for the patient, it is essential to consider the deeper nuances of further interaction, in particular, the possibilities of sedation. As De Vries and Plaskota (2017) note, this issue is acute in cases when the target audience of providers is young and can hardly tolerate any medical interventions. Despite the fact that the patient in question is 41, she has a diagnosed developmental delay, which may also affect her taking the necessary sedatives adversely. Nevertheless, this aspect of care is mandatory because, along with targeted cancer drugs, appropriate sedatives are prescribed to minimize stresses and nervous breakdowns.
Any interventions associated with sedation should be accompanied by clear medical instructions. De Vries and Plaskota (2017) mention cases when too strong a suppression of patients’ emotions led to their unwillingness to eat, which exacerbated progressive diseases. For palliative care, the peace of mind and adherence to the necessary prescriptions are important components. In addition, a well-designed sedating patients program simplifies the work of the staff and reduces the burden on medical employees. Therefore, to address this issue, a separate stage of work is to be identified, and the specifics of this aspect of care should be thought out in accordance with the physiological and psychological characteristics of the patient in question.
Active Provider’s Position
Finally, when completing the set of measures that are necessary to resolve the ethical dilemma presented, an active provider position may be considered an important element of the patient’s palliative care strategy. As Pfeil, Laryionava, Reiter-Theil, Hiddemann, and Winkler (2015) state, in case of end-of-life care, some patients are prone to unrealistic expectations regarding possible health outcomes. The task of medical specialists is to create the necessary conditions for interaction through active participation in the lives of those people who receive palliative care.
In the case in question, the patient has the right to rely on competent support. In addition, the aforementioned model of treating other people from a position of respect is addressed comprehensively if the staff does everything possible and performs their immediate duties in good faith. The evaluation of the proposed ethical dilemma concerning the possibility of palliative care and patient refusal from further cancer treatment depends on how objective this decision is.
In this situation, when the chances of recovery are minimal, medical providers should do everything possible to ensure the most favorable stay of the patients in the clinical environment. The active position of employees implies adapting to changing care conditions, and if a person expresses such a desire, it can be satisfied as a decision made consciously and voluntarily.
Conclusion
The ethical dilemma in question may be resolved in favor of the patient not only due to the objectivity of her arguments but also personal respect for her right to choose. The interaction model that involves the type of communication that a provider oneself would like to experience is an appropriate framework to justify such a decision. The proposed stages for solving the dilemma are the important aspects of nursing practice and can be considered the steps of intervention for the transition of cancer patients to palliative care.
References
De Vries, K., & Plaskota, M. (2017). Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer. Palliative & Supportive Care, 15(2), 148-157. Web.
Pfeil, T. A., Laryionava, K., Reiter-Theil, S., Hiddemann, W., & Winkler, E. C. (2015). What keeps oncologists from addressing palliative care early on with incurable cancer patients? An active stance seems key. The Oncologist, 20(1), 56-61. Web.
Tuffrey-Wijne, I., Wicki, M., Heslop, P., McCarron, M., Todd, S., Oliver, D.,… O’Farrell, J. (2016). Developing research priorities for palliative care of people with intellectual disabilities in Europe: A consultation process using nominal group technique. BMC Palliative Care, 15(1), 36. Web.
Wiener, L., Weaver, M. S., Bell, C. J., & Sansom-Daly, U. M. (2015). Threading the cloak: Palliative care education for care providers of adolescents and young adults with cancer. Clinical Oncology in Adolescents and Young Adults, 5, 1-18. Web.
Zimmermann, C., Swami, N., Krzyzanowska, M., Leighl, N., Rydall, A., Rodin, G.,… Hannon, B. (2016). Perceptions of palliative care among patients with advanced cancer and their caregivers. Canadian Medical Association Journal, 188(10), E217-E227. Web.
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