Thank you for contacting the Ethics Committee regarding Mrs. Mitsue Takahashi’s healthcare plans. As you are aware, 83 year old Mrs. Takahashi was recently admitted to the hospital immediately following a stroke. Through looking at her past medical history and running various tests, it was apparent that she suffers from several serious medical complications. Notably, she suffers from dementia which makes it impossible for her to make autonomous decisions concerning her healthcare. Despite poor prognoses from neurology, cardiology, and psychiatry consultations, the patient’s two grandchildren disagree over the next step in their grandmother’s healthcare. You have recommended to the family to have a DNR order written, withhold aggressive cardiac …show more content…
Takahashi’s past wishes will help the healthcare team understand the patient’s current quality of life relative to her being before the onset of dementia and even prior to the stroke. A person’s quality of life appears different to different people, hence the disagreement among grandchildren. Mrs. Takahashi has a 5-10% chance of returning to a life of meaningful quality with aggressive treatment that will more than likely include significant suffering. Physicians in the past have noted that when treating patients similar to Mrs. Takahashi the healing process was not always effective, patients were susceptible to other illnesses, and mobility was fixed to a wheelchair or bed at best. A study conducted by Morrison and Siu (2000) followed acutely ill patients with end stage dementia and a poor prognosis to determine if emphasis should switch from curative interventions to palliative care. The first group of participants included demented patients with either pneumonia or hip fractures, and the second group included cognitively intact older adults with similar injuries. The researchers found that for the elderly with pneumonia, the mortality rate was 53% in demented patients and only 13% for non-demented patients. An identical trend was seen in the participants with hip fractures, producing a mortality rate of 55% in demented patients and 12% in non-demented individuals. Both types of participants received an equal amount of intense procedures yet mortality rates drastically differed, leading to the conclusion that healthcare teams should focus their efforts to enhance comfort in the demented patient population (Morrison & Siu 2000). Given the poor prognosis, the Ethics Committee finds it imperative that the healthcare team learn more about Mrs. Takahashi’s preferences and family relationships prior to dementia and recommend treating the patient via palliative care if there is no substantial improvement in her health after a limited time of aggressive
Healthcare creates unique dilemmas that must consider the common good of every patient. Medical professionals, on a frequent basis, face situations that require complicated, and at times, difficult decision-making. The medical matters they decide on are often sensitive and critical in regards to patient needs and care. In the Case of Marguerite M and the Angiogram, the medical team in both cases were faced with the critical question of which patient gets the necessary medical care when resources are limited. In like manner, when one patient receives the appropriate care at the expense of another, medical professionals face the possibility of liability and litigation. These medical circumstances place a burden on the healthcare professionals to think and act in the best interest of the patient while still considering the ethical and legal issues they may confront as a result of their choices and actions. Medical ethics and law are always evolving as rapid advances in all areas of healthcare take place.
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.
Butler, R. (2008). The Carers of People with Dementia. BMJ: British Medical Journal , 336, 1260-1261.
Thanks in part to the scientific and technological advances of todays’ society, enhanced medicinal treatment options are helping people battle illnesses and diseases and live longer than ever before. Despite these advances, however, many people with life threatening illnesses have needs and concerns that are unidentified and therefore unmet at the end of life, notes Arnold, Artin, Griffith, Person and Graham (2006, p. 62). They further noted that when these needs and concerns remain unmet, due in part to the failure of providers to correctly evaluate these needs, as well as the patients’ reluctance to discuss them (p. 63, as originally noted by Heaven & Maguire, 1997), a patient’s quality of life may be adversely affected. According to Bosma et al. (2010, p. 84), “Many generalist social work skills regarding counseling, family systems, community resources, and psychosocial assessments are relevant to working with patients and families with terminal illness”, thereby placing social workers in the distinctive position of being able to support and assist clients with end of life decisions and care planning needs. In fact, they further noted that at some point, “most social work practitioners will encounter adults, children, and families who are facing progressive life limiting illness, dying, death, or bereavement” (p. 79).
One of the greatest dangers facing chronic and terminally ill patients is the grey area regarding PAS. In the Netherlands, there are strict criteria for the practice of PAS. Despite such stringencies, the Council on Ethical and Judicial Affairs (1992) found 28% of the PAS cases in the Netherlands did not meet the criteria. The evidence suggests some of the patient’s lives may have ended prematurely or involuntarily. This problem can be addressed via advance directives. These directives would be written by competent individuals explaining their decision to be aided in dying when they are no longer capable of making medical decisions. These interpretations are largely defined by ones morals, understanding of ethics, individual attitudes, religious and cultural values.
Charlotte’s parents thought otherwise, the Ethics Advisory Committee had to get involved. The debate surrounded if the doctors were in the right to control the life of someone who were incapable of deciding themselves, or is it the parents right. The Ethics Advisory Committee, stated that the parents were superior to those of the hospital and the hospital should conduct with less painful test. Charlotte’s parents wanted the doctors to continue testing until it was determined that her life diffidently had no chance of remaining. Because, of Charlotte’s parents’ desires unfortunately caused Charlotte to die a painful death without her parents. If the patient is unable to speak for their selves, the family should be able to have some say in the medical treatment, however; if the doctors have tried everything they could do, the hospital should have final decisions whether or not the patient dies or treatment
The ethical controversies between patients and families and health care providers, regarding advanced directives dilemma of research and conflict with providers of care towards end of life choices, or accidental injuries leading to comatose state with patients who had never made or signed their advance directives, deciding on how they preferred to be cared for when those times came. This complex issue has in the past to present resulted in countless lawsuits, against healthcare providers by families who believed that no matter the state, meaning whether comatose, or in situations where a loved one had no choice in deciding for them, families have always assumed they automatically gain the power of attorney in
In most facilities an initiative lifestyle has been organized to give people with dementia a voice in how and where they are cared for (White). This is how things should be everywhere in the world when it comes to people with dementia. People affected by this disease don’t need people to tell them what to do or make decisions for them, they need the freedom to do it themselves so they don’t give up. Although incapacity is common, many persons with dementia are capable of making their own medical and research decisions (Kim, Karlawish, and Caine). At the early stages of dementia, a will needs to be made so medical wishes can be granted. When people are given the freedom of choice, they are much happier, they live longer, and they have a better attitude about the disease they are suffering from. Individuals that get dementia did not get it by choice, but they live through it day by day with strength and the ability to live
Advance directives might have many guidelines for patient’s preferences with regard to any number of life-affecting, or end of life situations, such as chronic disease or accident resulting in traumatic injury. It can include directions for other health situations, such as short-term unconsciousness, impairment by Alzheimer disease or dementia. These guidelines may consider do-not- resuscitate (DNR) orders if the heart or breathing stops, tube-feeding, or organ and tissue donation. The directive might name a specific person, or proxy, to direct care or may be very general with only basic instructions given for treatment in time of the incapacitation of a patient. Some states say that if you do not have a written directive, a spoken directive is acceptable.
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
Attitudes are the foundation of quality of care for older adults. Among health care professionals, discrimination and stereotypical behaviors are very prevalent, even though more often than not these individuals do not realize their actions are ageist. “Ageism hinders people from seeing the potential of aging, anticipation their own aging, and being responsive to the needs of older people” (McGuire, Klein & Shu-Li, 2008, p. 12). Attitudes are directly correlated with how individuals age and whether individuals stay health and live longer (McGuire, Klein & Shu-Li, 2008, p. 12). The care that older adults receive from healthcare professionals is directly influenced by that provider’s attitude about growing older. All too often, health care providers rely on a patient’s chronological age rather than their functional age when determining their needs and what interventions are prescribed. Another issue lies in providers viewing the complaints of older patients as a part of “normal aging”, therefore potentially missing life-threatening problems that may have been easily resolved. “Age is only appropriate in health treatment as a secondary factor in making medical decisions, and it should not be used as a stand-alone factor” (Nolan, 2011, p. 334).
Individuals are living longer due to a shift in the mortality rate of diseases that previously were responsible for a higher incidence of death. An Increase in research and technology in the area of medicine have lowered the mortality rate among older adults, increasing the aging population. As noted by Halaweish and Alam (2015), the incidence of Alzheimer’s disease as a cause of death is steadily on the increase as the number of older adults climbs. This statistic indicates the necessity of healthcare sector preparedness in the capacity of end of life care. Emphasis reflecting trends in healthcare should focus on Alzheimer awareness, home health care and long term care facilities. As individuals begin to live longer and experience an increase in healthcare technology, the prevalence of chronic diseases increases. The inclination of chronic diseases and co-morbidities increases medical expenditures. The growing rate of older adults suffering from chronic diseases may increase the frequency of older adults having a disability. This increase in disability as a result of chronic disease will require emphasis on long term care options for older
As the population of the United States ages and lifespan increases, the U.S. is being faced with challenges that could either hurt the country or benefit it if plans are executed correctly. By the year 2050, more than thirty-two million Americans will be over the age eighty and the share of the 80-plus generation will have doubled to 7.4 percent. Health care and aging population has become a great deal considering the impact it is having on the U.S. The United States is heading into another century with an outstanding percentage of people within the aging population. Today’s challenges involving health care and the aging populations are the employees of health professions being a major percentage of the aging population, the drive into debt, and prevention and postponement of disease and disability.
According to DeBrew, author of “Can being ageist harm your older adult patients?” stereotypes and discrimination are evident in various aspects of patient care. “Ageism [is] defined as stereotyping or discrimination aimed at older adults and a lack of knowledge about normal changes of aging and presentation of illness in older adults (. . .)” (DeBrew, 2015). DeBrew (2015) states, “research findings suggest that ageism is common in healthcare” (DeBrew, 2015). Ageism is not only an issue in the healthcare setting, but also among older adults as well as their families. When ageism is present in the healthcare setting it poses
Knowing that dementia has no cure, most elderly with are concern and have requested to spend their last days with families and loved ones in their homes. Yet it is reported that their wishes are not granted and most die in hospitals or acute care centers with less trained providers that understand their illness. Bayer, A. (2006), reported a case in 2003 which occurred in london. Patients that had died with cases of dementia were not recorded or evaluated for cognitive dysfunctions(p.101). Although other forms of methods were provided such as the mechanical ventilation and central venous lines, however they were not used as frequent as they should have been. In addition, dementia patients did not receive adequate