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End-of-LifeDilemmas and Health Care Ethics Committees

If I had my way, we could spend a whole semester on this topic alone! I have been a nurse for many years. There is nuance to the issues and even the way we phrase things can make a difference:

-starvation vs fasting
-neglect vs withdrawal of treatment
-giving too many opioids that respiration is depressed vs giving enough opiods to reduce pain

Our country’s history of dealing with these issues have played out over the news. It has been politicized with terms like “death panels”.

We look this week a spectrum of end-of-life dilemmas as well as landmark legislation that affected how our society treats our most vulnerable citizens.

As health care workers, we are a source of information to our families, communities, and to our society. We are responsible to be aware of the discussion and how it evolves over time. Even if your health care career does not put you in a position of working with end-of-life issues, our role as workers in health care requires us to be up to date.

Ethics Committees help patients, families, caregivers, and managers sort out the issues when there are conflicts. Sometimes there is no good choice, rather several that make the decision very difficult. Guidance for patients, families, and caregivers is available and I include two links to ethics committee websites. You might want to explore what is offered at your institution.

Let us first look at the pragmatic; the practical. Below are links to forms/policies on end of life paperwork.
Advanced directives used to be a simple “Living Will”. Now they encompass legal forms, lists of wishes, and physician orders, designating a Health Care Power of Attorney, POLST, Living Will, Advanced directives of Health Care, and others.
I do not expect you to know the details of each, but I do want you to know they exist.

AND, do you have advanced directives? As a hospice nurse, I found most people do not. These are very important decisions to consider. In the days before marriage equality same-sex partners did not have the right to visit at hospitals and nursing homes. Even today with same-sex parents, if one is not on the birth certificate, that parent may not be allowed to make medical decisions, a real problem when the child and the other parent are in an accident.

Who would make decisions for you if you are incapacitated?

Right now, by Illinois law, it goes generally in this order: spouse, parent, adult child, adult sibling. To ensure the person you would want to be your decision maker is able to do so, you need to prepare a Health Care Power of Attorney.

Question 1

Chapter Three of Pozgar highlights the passage of the Patient Self-Determination Act of 1990.
Describe how this important piece of legislation has played out in a health care setting and include at least one of the concepts of ethics (justice, beneficence, nonmaleficence, autonomy) in your posting.
To do this, please select one of the highly charged areas described in this weeks chapter or additional readings.

-physician assisted suicide

-Oregon’s Death with Dignity Act

-advanced directives/appointed decision makers

-futility of treatment/withdrawal of treatment

-terminal fasting

Be aware that each of these areas has multiple dimensions (ex. Withdrawal of treatment patient in a persistent vegetative state, not in a persistent vegetative state, removal of life support equipment, feeding tubes), and your response should reflect this. You are encouraged to seek out additional source material (journal articles, online sources).

*Question 2

This module we also look at hospital ethics committees.

You have read Pozgar and looked at Loyolas and UNCs ethics consult websites.
If you work in a hospital, I encourage you to also look at your institutions ethics consult website.

Below are three issues that have come before ethics committees.

Scan them then select ONE to read in depth.

The first looks at treating short children and teens with growth hormones.

The second reports of a man with ALS wishing to donate his organs.

The third looks at hormone treatment and surgery to keep disabled children from growing.

This week you will look at the issues of the ethics consult issue of one of the three articles.
In two to three paragraphs, explore the issue from the patients side, the family’s side, and from the side of a member of the ethics committee.How is the individual at risk ethically? How is the caregiver? How is the health care professional? How is society? Use the concepts of ethics to explore the conflicting issues presented.

Use Pozgar to support your statements. Feel free to be creative in your initial posting.

1-Children’s Hospital of Philadelphia. (2017, January 25). When should doctors treat short children and teens with growth hormone? Endocrinologists issue new clinical guidelines for managing, treating children with growth failure. ScienceDaily. Retrieved February 4, 2017 from www.sciencedaily.com/releases/2017/01/170125092600.htm

2-A dying mans wish to save others hits hospital ethics hurdle

3-Stopping growth in severely disabled children

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