Posted: October 22nd, 2023

Ethical Dilemmas in Palliative Care: Balancing Patient Autonomy

In 1,000-1,250 words, identify an example of a health care related ethical dilemma, describe it, and identify the stakeholders involved in the situation. Put yourself in the place of the health care administrator to answer the following questions related to your example:

Which ethical principles are at risk in this dilemma? Describe how each is being threatened. For example, a patient’s autonomy is being threatened if an overbearing family member is not listening to the patient’s wishes.
Describe how the Christian worldview could be used to apply ethical patient-centered principles, values, and culture to this situation.
Describe the importance of interprofessional collaboration when resolving an ethical dilemma versus attempting resolution in silos.
Explain the ethical decision you would make in this dilemma and provide the rationale for your decision.
Explain how professionalism, integrity, and self-confidence all have a role in achieving a resolution in this ethical dilemma.
This assignment requires three to five scholarly peer-reviewed articles.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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Ethical Dilemmas in Palliative Care: Balancing Patient Autonomy and Family Wishes
Palliative care aims to relieve suffering and improve quality of life for patients facing serious illnesses (World Health Organization, 2022). However, providing palliative care also presents complex ethical dilemmas as care teams must balance respect for patient autonomy with addressing family concerns. One such dilemma involves an 87-year-old patient, Mrs. Smith, with advanced lung cancer who was recently admitted to the hospital with respiratory distress. Upon admission, Mrs. Smith expressed to her palliative care physician, Dr. Jones, that she did not wish to be intubated or placed on life support if her condition deteriorated further. However, her daughter felt strongly that “everything should be done” to prolong her mother’s life. This scenario presents an ethical dilemma involving balancing respect for Mrs. Smith’s autonomy against her daughter’s wishes.
The key ethical principles at risk in this dilemma are patient autonomy and beneficence. Regarding autonomy, Mrs. Smith’s right to self-determination and make her own medical decisions is threatened by her daughter’s conflicting preferences (Beauchamp & Childress, 2013). While family input is important, ultimately it is the patient’s values and goals that should guide care. Beneficence, or acting in the patient’s best interests, is also challenged as reasonable people could disagree on how to define Mrs. Smith’s “best interests” (Jonsen et al., 2019). Her daughter may feel more interventions are in her mother’s best interest to prolong life, while Mrs. Smith values quality of life over purely extending length of life (Pellegrino & Thomasma, 1993).
From a Christian worldview, a few key principles could help guide resolution of this dilemma in a patient-centered manner. First, the principle of dignity and worth of every person supports respecting Mrs. Smith’s autonomy and right to self-determination regarding her own medical care (Cahill, 2020). Second, the principle of compassion calls the care team to understand Mrs. Smith’s values, priorities, and goals to guide care in line with her wishes and relieve suffering (Pellegrino & Thomasma, 1993). Third, the principle of stewardship or wise use of resources suggests that overly aggressive interventions against Mrs. Smith’s wishes would not honor her or make best use of health care resources (Jonsen et al., 2019).
Interprofessional collaboration between Dr. Jones, nurses, social workers, chaplains, and Mrs. Smith’s daughter could help achieve resolution (Mitchell et al., 2018). Rather than the physician making the decision alone or the daughter feeling ignored, open discussion of values, priorities, prognosis, and options could help all parties understand each other’s perspectives. A consensus approach honors various viewpoints while upholding the priority of the patient’s autonomy (Beauchamp & Childress, 2013). The team may also suggest a trial of limited interventions to avoid overly aggressive measures up front while continuing discussions (Pellegrino & Thomasma, 1993).
Given the above analysis and principles, the ethical decision would be to have an open discussion with Mrs. Smith and her daughter, honor Mrs. Smith’s expressed wishes regarding intubation and life support, but suggest a trial of more limited interventions for now to avoid overly aggressive care against her values (Cahill, 2020). The rationale is that Mrs. Smith’s autonomy and right to self-determination must be the top priority from both an ethical and legal standpoint. While her daughter’s input is important, ultimately Mrs. Smith’s values and goals expressed to her physician must guide decisions. Professionalism, integrity, and self-confidence are shown by the physician and team openly and compassionately addressing this complex issue rather than avoiding difficult conversations or making a unilateral decision.
In summary, this case highlights the importance of balancing respect for patient autonomy with addressing family concerns in palliative care. Key principles of dignity, compassion, and wise stewardship from a Christian perspective, combined with interprofessional collaboration, can help navigate such dilemmas in a patient-centered manner (Mitchell et al., 2018; Pellegrino & Thomasma, 1993).
References:
Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). Oxford University Press.
Cahill, L. S. (2020). Theological bioethics: Participation, justice, and change. Georgetown University Press.
Jonsen, A. R., Siegler, M., & Winslade, W. J. (2019). Clinical ethics: A practical approach to ethical decisions in clinical medicine. McGraw-Hill Education.
Mitchell, P. H., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C. E., Rohrbach, V., & Von Kohorn, I. (2018). Core principles & values of effective team-based health care (Vol. 89, Issue 5, pp. 719-724). National Academy of Medicine. https://doi.org/10.31478/201805f
Pellegrino, E. D., & Thomasma, D. C. (1993). The virtues in medical practice. Oxford University Press.
World Health Organization. (2022, March 3). Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care

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