Ethical principles in health care dictate that caregivers should put patient autonomy into consideration particularly when determining the most appropriate interventions to save life and during end-of-life care (Thomas, 2004, p. 494).
In most cases, advance directives including proxy, instruction, and combined directives play a vital role in terms of facilitating the decisions made by doctors relative to the patient’s wishes and those communicated by a surrogate. On the other hand, the Living Will, Health Care Power of Attorney, and the Advanced Health Care Directive do also serve the same purpose as other forms of advance directives (Pera & Van Tonder, 2005).
However, caregivers may find themselves in an ethical dilemma in case an incapacitated patient lacks an advance directive. This is the case scenario highlighted by Brudney in which the patient’s life partner (the closest family member) notes that the patient would not wish to undergo a high risk life saving procedure because of the perceived heath risks.
In this essay, two key questions to the patient’s life partner are listed followed by discussions regarding the ethical arguments for and against the life saving procedure. Subsequently, the essay highlights the most appropriate steps that should be undertaken by the healthcare team in the decision-making process from the patient’s perspective.
Considering that the patient lacks an advance directive, there is the need to ask the patient’s life partner the following questions;
Why should your patient consider writing an advance directive, and if your patient decided to appoint you as a health care representative, what would be your responsibilities relative to your patient’s wishes?
If your patient was in a position to make specific decisions while you still stand in as the health care representative, would your patient allow other family members to participate in decision-making?
Arguments for and against the lifesaving procedure
The fact that the autonomy of patients and their family members should be respected in any decision-making process before administering any medical intervention cannot be overstated; however, there is the need to understand that health care is a service that involves trained and specialized professionals whose clinical decisions are based on intellect and conscience (Burke, 2010).
Besides, with the recent advancements in technology and information sharing within the health care sector, there is reason to believe that the decisions made by health care professionals are evidence-based. Thus, the perceived health risks raised by the patient’s life partner may not hold before weighing the overall health outcome of the lifesaving procedure against the health risks involved.
Conversely, before administering the procedure, it is ethical to obtain an informed consent from the patient’s family members who should be given the opportunity to represent the wishes of the patient accordingly (Pera & Van Tonder, 2005).
Furthermore, there is no way the caregiver can disregard the issues raised by the patient’s life partner without restoring this person’s confidentiality relative to the benefits and risks associated with the lifesaving procedure. Overall, the caregiver should bring the life partner into perspective of the ethical issues for and against the procedure while factoring in the issues raised by the life partner.
The decision-making process from the perspective of the incapacitated patient
The absence of an advance directive in this case scenario puts the healthcare team in an ethical dilemma. However, taking the place of the patient, my hope will be that the healthcare team will invite the contribution of other family members besides the life partner before making the final clinical decision. Here, all parties involved should discuss the benefits, risks, and possible complications of the planned procedure before settling on the most appropriate and ethical decision.
Further, I will also hope that the decision-making process will be informed by the principles of ethics in healthcare, evidence-based care processes, and the healthcare rights of conscience, which dictate that the decision-making process should aim to achieve quality care at low costs, positive outcomes, and reduced health complications without contravening the medical malpractice standards (Burke, 2010, p. 471).
The foregoing discussions highlight the ethical considerations involved in administering high risk lifesaving procedures in the absence of an advance directive from the incapacitated patient. From the discussions, it is certain that the absence of an advance directive can make the decision-making process rather difficult in different clinical cases involving incapacitated patients.
However, with a strong moral and ethical foundation that incorporated the principles of evidence-based healthcare, any healthcare team should be able to achieve the expected results that suit all the parties involved.
Burke, D.M. (2010). Healthcare rights of conscience: A survey of federal and state laws.
Americans United for Life. Retrieved from http://www.scribd.com/doc/41170730/10-Healthcare
Pera, S.A. & Van Tonder, S. (2005). Ethics in healthcare (2nd ed.). Lansdowne: Juta & Co. Ltd.
Thomas, E.D., Blume, K.G., Forman, S.J., Appelbaum, F.R. (2004). Thomas’ hematopoietic cell transplantation (3rd ed.). Malden: Blackwell Publishing Ltd.