Essay Sample on Dilemmas of End of Life Care

Introduction

Provision of care to patients during their end of life is probably the most difficult task in the field of nursing care (Chen-Scarabelli et al., 2015). Some of the dynamics that come into play to complicate matters include patients' emotional jerks, loss of ability to perform certain basics like talking and movement, and certain demands and expectations of close relatives. Unfortunately, most of these difficulties caregivers go through are not sufficiently studied and published. Accordingly, to contribute to the discussion, the paper seeks to investigate some of the ethical dilemmas caregivers often find themselves in as they discharge their duty to patients who are in their end of life phase.

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Ethical Conceptual Framework

The ethical standards within the nursing industry are based on four major principles which include autonomy, justice, nonmaleficence, and beneficence. These four revolves around the kind of relationship that exists between the caregiver and the patient. The presence of an atmosphere where the patient has fairly sufficient autonomy, enjoys a just treatment, nonmaleficence and beneficence handling, constitute a fulfillment to both the patient and the caregiver. Adhering to these principles is, in most cases, the measure of ethical conduct of a nurse.

However, it is important to realize that different people from different cultural as well as ideological backgrounds could have different and contrasting views regarding what brings fulfillment to a human being. For instance, if a nurse stops administering medication to a patient because the patient requested so, a lot of people would find it unethical even though the action is in line with the spirit of autonomy of patients. It is such situations that lend nurses a life of multiple dilemmas. However, such confusions can be diffused by seeking to understand such dynamics as the meaning of what is good and what is bad, one's values, one's ethical desires and expectations, and what they regard as a fulfilling action.

Dilemma and Ethical Conceptual Framework

As pointed out, ethical issues in the field of health care revolve around the four principles of nonmaleficence, justice, autonomy, and beneficence (Ganz, Wagner, & Toren, 2015). It is these ethical principles that provide the framework within which every decision regarding care has to be made. Occasionally, however, sticking by the provisions of the principles become technically untenable thereby giving rise to a situation of a dilemma.

Analysis of the Dilemma

Dilemmas in nursing care often prove to be very tricky particularly because they tend to be the thin line between life and death of a patient. Such situations are even worse when the patient is at their end of life phase. During the end of life, expectations, as well as emotions, tend to be high and if this is coupled with a state of dilemma, things get so thick that some nurses end up with psychological problems or even give up the responsibility of offering care (Emanuel et al., 2016).

In one instance where I was part of the nurses offering care to a patient suffering the final stage cancer, an air of confusion erupted. Because of the excruciating pain the patient had been feeling for some hours, he opted to request for euthanasia; a request that caught the nurse on the shift by surprise. While trying to assess the patient's cognizance of what he had requested, the patient passed out but regained consciousness after a few hours. For the next couple of days, it was a period of intermittent pain and passing out. At this point, the nurse was frustrated and distressed for he did not want to revive the topic of euthanasia but at the same time, out of an inner call to respect the autonomy of the patient, silently contemplated acting on the patient's request.

Being unable to decide whether to pursue the course of euthanasia or let the patient be meant that the nurse was confronted with a dilemma. The dilemma, in this case, is one that is linked to the ethical principle of ensuring patients autonomy at all times. The fact that the patient fainted before giving further clarification about his request for euthanasia and his subsequent silence on the topic, to the nurse, suggested a change of thought. On the other hand, it was also true that the patient had expressed his will concerning his life and this ought to be followed through, according to the principle of autonomy of patients.

Role of Moral Agent

When the nurse in charge intimated to me about the situation and how undecided he was, I sought to help him look for a solution that would still bind to requirements of the four principles. As a moral agent, I advised my colleague to start consulting widely from colleagues who, probably, had encountered a similar dilemma or had an idea about what could be done to solve the impasse. Though my contribution was not an advocacy against any wrong deed of a colleague to warrant my being a moral agent, the piece of advice which I gave was an act of moral agency.

Even though the patient latter passed on without any assistance, I have never regretted that I offered the kind of advice that I gave. After consulting, as I had advised, the colleague received the necessary support which took his mind off the path of euthanasia thereby relieving him completely from the dilemma. Had I taken a pragmatic approach as an active moral agent and condemned the colleague's failure to grant the patient's request for a euthanasia, I would have intensified the indecisiveness of the nurse and probably invoked chaos. As such, I consider my decision to involve other practitioners a soft approach in moral agency.

Personal Leadership Style

After taking the Keirsey Temperament Sorter 11 assessment questionnaire, it came out that I am among those who posse idealist temperament. This came out from the result of the survey linking my traits to elements such as authenticity, focus on personal growth and integrity. After checking all the appropriate boxes on the temperament sorter template and circling the numbers correctly, the result gave me the code INFJ, which essentially meant that I would make a good counselor under the idealist temperament (Drozdovski, 2015). Generally, idealists are helpful in their quest to develop themselves and others and this, somehow, could vaguely reveal the reason for the decision I made in helping out the colleague in dilemma. As a matter of fact, a greater percentage of what influenced my decision to intervene in the manner I did can be attributed to the temperament I manifested.

Conclusion

From the discussion, it is clear that the nature of work nurses do often push them to situations of dilemma, particularly when caring to patients in their end of life phase. Most of the dilemmas involve situations which threaten to contravene the provisions of basic principles of practice (Smebye, Kirkevold, & Engedal, 2015). At all times, nurses are expected to adhere to the principles of autonomy, nonmaleficence, beneficence, and justice. It is, however, allowed that if a nurse detects some element of contravention on the part of their colleagues, they should advocate for correctional measures; an act of moral agency. Moral agency, though helpful, should be complemented with appropriate leadership and temperament.

References

Chen-Scarabelli, C., Saravolatz, L., Hirsh, B., Agrawal, P., & Scarabelli, T. M. (2015). Dilemmas in end-stage heart failure. Journal of geriatric cardiology: JGC, 12(1), 57. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308459/

Drozdovski, A. K. (2015). The connection between typological complexes of properties of the nervous system, temperaments, and personality types in the professions and sports. Open access journal of sports medicine, 6, 161.Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445952/

Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Jama, 316(1), 79-90. Retrieved from: https://preview.thenewsmarket.com/Previews/JOUR/DocumentAssets/440789.pdf

Ganz, F. D., Wagner, N., & Toren, O. (2015). Nurse middle manager ethical dilemmas and moral distress. Nursing ethics, 22(1), 43-51. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.954.1506&rep=rep1&type=pdf

Smebye, K. L., Kirkevold, M., & Engedal, K. (2015). Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study.

BMC health services research, 16(1), 21. Retrieved from:https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1217-1