Duties of the Nurse
A nurse is a crucial element of the healthcare industry who provides the kind of service that doctors, by virtue of the nature of their responsibilities, are unable to provide. Due to the unique nature of their relationships with patients, nurses are in the position to offer emotional and psychological support to the patients in the course of their stay in healthcare facilities, which is a vital part of the recovery process. Moreover, evidence shows that these nurse-patient relationships have a significant impact on patient outcomes (Irvine, Sidani, & Hall,1998).
In the case under study, the patient in question is assumed to be advanced in age and has cancer of the breast, which biopsy and other investigations have shown be metastatic. From the medical perspective, there is no significant chance of her situation improving. Due to this unfortunate situation, the patient is lucid and precise regarding her willingness to stop fighting the disease, probably, due to the various abilities being lost in the course of the previous treatments, which leaves her with little desire to liveThe patient goes into cardiac arrest later that evening, and a code is called. However, the woman remains unresponsive and is placed on a ventilator. The doctor suggests hospice care as there is not much that can be done to help her medically. Nevertheless, the family members remain not receptive to this idea.
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As the situation stands at the moment, the life of the woman will effectively be terminated should she be taken off the ventilator, and the suggestion of the doctor is that she be taken into hospice care. It will essentially mean placing her in a holding pattern because should she come out of her unresponsive state, her condition will not get any better and might even worsen following the effect of the cardiac arrest on her cancer-ravaged system. The family does not seem to lean towards taking her off life support.
The ethical issue here is that although the patient’s condition is severe and whose appeal is it to end her life, she can still be kept alive in a hospice. The situation concerns the right to live and the freedom of decision-making, both being a common issue in healthcare practice. In addition, whether she can retain and continue a healthy life, which is gradually being eroded by her condition, can be questioned. Therefore, these rights cannot be realized as she can no longer make those calls for herself.
Nevertheless, the patient, when she was lucid and capable, expressed a desire and readiness to pass away, which, however, was not translated into signing a DNR form. Adams, Bailey, Anderson, & Docherty, 2011) suggest that initiating conversations into end of life bare the DNR instruction, which should take place once it is clear to the care providers that the condition of the patient is approaching its terminal stage. That said, it is the duty and responsibility of the healthcare providers to care for and meet the patients’ needs and, should such instructions be given, adhere to them. It brings out the role of the nurse as a patient advocate. In the light of a given discussion, the concept of advocacy in health care is one that raises some fundamental issues. One of these issues is the possibility that the advocate, while in a position to represent the wishes of the patient as in the given case, might face the conflict of personal opinions and the patient’s wish, especially when the cognizance of the patient could be questioned. According to Schwartz (2002), the advocate of the patient has a number of definite roles, which include informing the patient to the end of promoting an informed consent;being a protector of the rights of the patient in those situations, where he/she is unable to do so for him/herself; protect the autonomy of the patient and represent the views and desires of the patient (and not necessarily the personal ones, especially when both views are conflicting). In the view of the author, the main issue here is the question of the conflict of opinions. It is inherent in advocacy because of the risk of paternalism. Since advocates are to inform the patient and guide him or her through the decision-making process, it is not excluded that the information they provide to the patient may be based on their own motives. In the healthcare practice there are caseswhere, instead of providing all the information as it is, they interpret it in a manner that guides the patient towards conclusions that are desired by the care providers. It represents an enormous ethical conflict, more so when such conclusion could benefit them professionally or financially.
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The options available to this patient include pulling her off the respirator, which is the patient’s original desire and the suggested hospice care, which is essentially a palliative measure and does not provide any relief from the original problem, but could solve some of the sequelae resulting from the cardiac arrest. Taking her off life support relieves her from cancer-caused pain, an action that can be regarded as the very definition of euthanasia. This practise is yet illegal except a few countries in Europe. Given the facts that there is not any definitive medical help that can be provided to this patient, it seems a logical choice except for the legal backing which as yet is withheld by regulatory authorities. Here, the decision of taking the patient off life support entirely depends on her family’s decision, which, as it is obvious from the case study, is willing to continue the provision of the healthcare to her. Therefore, assigning this patient to hospice care would probably be the best and the only legally feasible option given the existing laws on euthanasia and other end-of -life decisions. (Syracuse University, n.d.) In addition, the above stated option is the medically and ethically correct course of action, although precedents exist of families that decide to take a loved one off life support (Vogel, 2011). However, there is no particular consistency on such rulings.