Ethics

Ethics Study Guide 3. Prognosis communications with patient: It may be unethical to expect a physician to make a prognosis and inform the patient, if the patient’s culture does not embrace full and open discussion between doctors and patients about healthcare or death. 4. Pain management: Many ethical dilemmas stem from the use of pain-relieving drugs in terminally ill patients. Some people caution about the fear of addiction to narcotics, about the value of individual autonomy, and about the importance of treating symptoms. Morphine is the most commonly used narcotic for treating pain and other symptoms of the seriously ill. It is especially helpful at relieving the two most common symptoms experienced by dying patients: pain and shortness of breath. Some physicians are worried that the respiratory depression, a side effect of the morphine, may cause death, so they under-prescribe the drug, even for terminally ill patients who are in extreme pain. Research, however, has not found that narcotics shorten life or depress respiration in dying patients, even when given in high doses. 5. Nutrition and hydration: Some of the most emotionally and ethically challenging issues in end of life care relate to decisions about nutrition and hydration. This is primarily because of the nature and social meaning attached to providing people with food and water. The United States Supreme Court ruled in 1990 that, legally, artificial nutrition and hydration are not different than other life-sustaining treatments. United States courts have made the following rulings: 1. Competent adults can refuse these treatments, even if this choice hastens their death. 2. A health care surrogate may withdraw these treatments. 3. A health care surrogate may refuse these treatments on behalf of an incompetent adult. Another debate focuses on whether withholding food and water is similar to killing a patient or allowing a patient to die. Patients, families, and physicians need to come together to determine if this will be beneficial or burdensome to the patient. It should provide the patient with benefit that is enough to outweigh the burdens. This is called the principle of proportionality. 1. Antibiotic treatments: Many dying patients are susceptible to infection, often due to several co-morbid conditions. Antibiotics won’t cure the underlying terminal disease, but may relieve distressing symptoms. Some physicians think antibiotics are considered part of routine care. Others believe that an infection is a treatable condition and not related to the untreatable terminal illness, and hence find it difficult to withhold antibiotic treatment. 2. Medical futility: Medically futile treatments are those procedures or interventions that are highly unlikely to benefit a patient. The concept of medical futility leads to many ethical questions. First, can we prevent medical futility from becoming a judgment call made by the health care staff? Second, the fear that some treatments that health care professionals deem not beneficial may actually be considered beneficial by patients, and these may be eliminated. Third, andmost important, is that necessary treatments will be labeled as futile to save money. ©2018 Achieve Page 63 of 116