This ethical scenario presents an 86 year old female with numerous health issues and chronic illnesses. Mrs. Boswell’s advancing Alzheimer’s disease makes it extremely difficult to initiate dialysis, leading her physician to conclude a poor quality of life. The ethical dilemma portrayed in this case is between nonmaleficence and autonomy. Health care workers should focus on promoting the patient’s overall wellbeing and weigh the benefits and risks of the course of action, while also considering what the family declares they want done. Since the patient is deemed unable to make decisions, the goal is to collaborate with family, assess patient quality of life, address prognosis, and establish realistic care goals.
The ethical principle of nonmaleficence demands to first do no harm and in this case protect the patient from harm since she cannot protect. Nurses must be aware in situations such as this, that they are expected to advocate for patients in a right and reasonable way. The dilemma with nonmaleficence is that Mrs. Boswell has no chance of recovery because of her increasing debilitating mental incapability and the obvious harm that outweighs the intended benefits. If the decision were to continue treatment, suffering of the patient and family would be evident. Autonomy is the right to making own decisions and freedom to choose a plan of action. When making decisions regarding treatment of another person, it is important to respect the expressed wishes of the individual. John says that his mother would want to live as long as she could, but questions arise related to her quality of life and perception of prolonged suffering by prolonging the dying process. In BOOK states that quality of life changes throughout one’s life and experiences. Mrs. Boswell has many debilitating health issues, and it is essential that suffering is minimized to the least extent possible. Although autonomy is very important, it is significant that the family fully understand all BOOK> To avoid violating autonomy, health care workers must fully understand the involved disease processes, the options available for treatment, and possible outcomes.
There are two different options evident concerning Mrs. Boswell’s treatment options. While considering both options, it is important to teach the family in depth the effects of the dialysis treatments along with her other chronic illnesses. The first option is to discontinue dialysis treatments and place her in a hospice facility. In hospice care, the goal is of focusing on minimizing pain and suffering, rather than to cure. Going to hospice care would allow Mrs. Boswell to forgo her stringent dialysis treatment and provide her comfort measures allowing her to endure her illnesses with optimal pain reduction. Along with treating the sole patient, hospice care allows for family to be there throughout the whole process while being provided bereavement support. The book p. 234 says that nurses play a pivotal...