Introduction
Quality care benefits patients, old and young, physicians and families. However, people exhibit fear of pain, indignity, desertion and breach of law when they deliberate about death and dying (Paterson, 2003). These aspects create ethical dilemma thereby requiring reasonable decision-making plans. Such ethical conflicts occur in medical fraternity especially when patients hold no advance directive or living will. These directives reveal which direction or action to be taken when patient’s health conditions deteriorate even after the support of advanced and extraordinary life sustaining measures (Paterson, 2003). It is imperative to note that there are other dilemma concerning care of young and elderly in the society. This questions the significance of universal health care for all patients regardless of their age. There paper will analyze a case of an artist with metastatic pancreatic cancer. The case will be assessed in relation to the principles of medical ethics.
The Case
Mr.S, a metastatic pancreatic cancer patient was in miserable pain and did not like depending on other people. The patient requested to be admitted in hospital so that his unbearable pain could be controlled. The nursing officer requested the patient to be given morphine in order to relief his pain and make him relaxed (Parker, 2002). In the presence of his family, the patient insisted that he be provided with more morphine regardless of whether he was conscious or not. Other nurses thought that the nursing officer was asking for too much drug for the patient and requested him to withdraw his order. Nevertheless, the nursing officer declined since he was doing it on patient’s request. Additionally, the drug created tolerance and prevented respiratory depression. The hospital lawyers were called in and engaged resident physicians, nurses in a hot discussion regarding Mr. S. Issues of assisted suicide were discussed and their opinions greatly differed. The nursing officer argued that morphine has analgesic effects and his intention was not to hasten death, but to create comfort. The lawyers, resident physicians and other nurses objected further administration of morphine (Parker, 2002). In this regard, the nursing officer requested them to explain to the patient why he could not take the drug anymore in the presence of his family, wife and daughter. The patients with much resentment and frustrations left the hospital and died after a week.
The ethical agents involved in this case were the patient himself, the wife, daughter, the nursing officer, resident physicians, other nurses and the hospital lawyers.
According to Knowlton (2005), instructions and wishes of patients should be considered. Medical practitioners should understand what actions to take when a patient is seriously ill and faced with serious choices. The principle of non-maleficence and beneficence should apply. Nurses are required to do good and not bad for the benefit of the patients (Knowlton ,2005) . Regarding Mr.S case, the nursing officer administered morphine to enhance the comfort of the patient. Non-maleficence on the other hand, allows practitioners not to do harm. Through administering morphine, the nursing officer offered easiness and respected the dignity of the patient despite recognizing the gloomy prognosis.
The second standard that should guide practitioners is autonomy. Patients with sound mind should make decisions regarding their health. The nursing officer did what the patient in the presence of the family wanted. Knowlton, 2005 stresses on the third principle, which is justice. He asserts that all patients be provided with enough medical resources (Knowlton, 2005). The nursing officer declined to withdraw the morphine dose he had offered since he thought that less doses would do no good to patient. The last principle is respect of human life’s purity and upholding human dignity even in end-of life care. Remember that Mr.S requested to be admitted in the hospital since he did not want to depend on others. As an elderly person and a patient, he had the right to hospital resources just like other patients.
Nevertheless, while it is appropriate for a patient to exercise autonomy, it is important that the physician adequately inform him on risks and benefits of the provided treatment. In this particular case, the physician was receiving information from the patient himself. Ethics committee in this case is represented by the hospital lawyers, who fully understood the consequences of unlawful procedures, polices and processes. They however acted contrary to the patient’s wishes.
Resolution
In such a situation, I would have chosen the second principle, the principle of autonomy. This principle would have prevented the patient from further suffering and that of the family. The benefit of my decision is that it would have upheld the patient’s rights to making independent decisions, which would have fostered his dignity and created comfort during his last days (Pfeiffer & Forsberg, 2005).
References
Knowlton, L.( 2005).Ethical Issues in the care of the elderly. Geriatric Times, 3(2).
Parker, R.(2002). Caring for Patients at the End of Life: Reflections after 12 Years of Practice. Annals of Internal Medicine, 136(1): 72-75
Paterson, I.(2003). The ethics of assisted suicide. Nursing Times.net, 99(7): 30
Pfeiffer, R.,& Forsberg, R.(2005). Ethics on the job. New York: Cengage
