...Abstract This paper is written to discuss the ethical dilemma we come across when asking our self whether or not we should place a tube feeding in a patient with a history Alzheimer’s or Dementia. Will this prolong the patients’ life or just the inevitable death? Most often a decision needs to be made regarding the placement of a tube feeding. The question is not initiated by the patient themselves. This is the reason why educating our patients are so important. In this paper I will discuss how important the role of the healthcare professional plays in advocating for a patient. To help answer this ethical dilemma several issues will be explored. I will focus on the seven principles of ethics, education, utilitarianism, top-down theory alternate treatment options. Will Tube Feedings Prolong Life? While working with the majority of geriatric population, we frequently come across patients with Dementia and Alzheimer’s disease. The most common problem in these patients is the inability to swallow as well as the patients are failure to thrive. Many healthcare workers and family members become upset when the patient does not have proper nutritional intake. As human beings it is our nature to take care of our loved ones when they are ill, this is our ways of showing love and affection tore’s each other. We often question the situation regarding the need for artificial feeding. Care givers have misconceptions if we provide artificial nutrition it will help prolong...
Words: 2291 - Pages: 10
...and view each situation differently, that is not always a possibility. Such things as gender, religion, culture, traditions, and family are integral in shaping a system of beliefs or values that influence morality (Navran, 2010) and thus influences how nurses practice their profession. In accepting nursing as a profession, nurses vow to make the patient their chief commitment and must honor that commitment by giving unbiased care that is not influenced by personal values, morals, or beliefs. Personal Moral Compass There are many variables guiding a nurse in his or her everyday practice. Whether one is aware of the constant weighing of values and beliefs through critical thinking as they complete each shift or not, those intrinsic basics for their morality are what is guiding them to make these ethical decisions. The groundwork for the standards of professional behavior were laid in nursing school (Jane, 2010) and were meant to be continued throughout each student’s career. Patients should be given an equal opportunity to be cared for regardless of status and that care should be holistic. That is, it should extend beyond the patient to family and even to one’s co-workers and self. As a result, nurses are charged with the responsibility to utilize sound critical thinking...
Words: 1129 - Pages: 5
...nutrition for individuals who are unable to achieve adequate nourishment orally because of various medical problems. However, the delivery of nutrients by tube feeding can cause ethical dilemmas in cases where the effectiveness of tube feeding diminishes and medical complications increase. The decision to tube feed is often influenced by regional and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual’s right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for those who can no longer advocate for themselves. Keywords: Enteral feeding, tube feeding, ethics, persistent vegetative state, dementia, palliative care Introduction Nutrients are introduced into the body in two ways: by enteral feeding through the digestive tract, and by parenteral feeding through a tube inserted...
Words: 8277 - Pages: 34
...going to be answering the question is Physician-Assisted Suicide (PAS) ethically justified? The debate on Physician-Assisted Suicide has been a topic of debate for many years. Born and raised in Michigan I remember all of the news on Dr. Jack Kevorkian assisting terminally ill patients in their death and the controversy on it. The dilemma is whether or not a physician should be allowed to assist a person in ending their life even if they are terminally ill. According to a recent article on The New York Times website, New Mexico just legalized Physician-Assisted Suicide for terminally ill patients. This ruling would make New Mexico the fifth state to allow physicians to prescribe to their terminally ill patients a fatal dose of medications to end their life (Eckholm, 2014). Proponents of Physician-Assisted Suicide believe that terminally ill people should have the right to choose go to the doctors and ask for their help to end their lives and stop their suffering. Of course there would have to be certain steps taken to make sure they were making the right choice. Many supporters of Physician-Assisted Suicide believe that there should be some psychiatric evaluation to make sure that the patient is of a sound mind in their decision to end their life. Opponents of Physician-Assisted Suicide believe that a person does not have a right to end their own life and that it goes against the oath a doctor takes to keep people healthy. Many also believe that it is against God’s...
Words: 2808 - Pages: 12
...strategies adopted in the clinical area to meet the needs of this client group. At the same time one pain, management strategy will be chosen critically evaluated and explored in light of the available evidence. The final part of the assignment will identify the improvements that need to introducing in the clinical area, in order to improve the management of pain. The student of this assignment works on a busy medical ward admitting both young and elderly patients with acute and chronic pain. However, most of the patient’s admitted to unit have dementia. The British Pain Society (2010) states that, “pain is under recognised and undertreated in older people,it is a subjective personal experience only known to the person who suffers”. Dementia is said to be caused by a variety of conditions with a complex of symptoms characterized by progressive global deterioration of cognitive functioning. Patterson et al (1999). The chronic pain coalition ( 2007) states that poor pain management impacts on quality of care and recovery and patients’ morbidity and mortality resulting in prolonged hospital stay coupled with economic implications for the health service. Pain has many defintionss have defined pain differently, the International Association for the study of pain (IASP,1989 ) has defined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage has defined pain differently.McCaffrey (1968) defines pain as “whatever the person experiencing...
Words: 4052 - Pages: 17
...Working on an acute inpatient psychiatric unit in the City Health Care System is not a job for the faint of heart. On a daily basis nurses have to choose between whether a patient should be left alone to commit, self-harm, harm to others or be place in four points restraint. This ethical dilemma can lead to several hard consequences. The primary nurse rapport that was built with the patient has now been diminish the patient trust no-ones and continues to decompensate. In my conversation with some of the patients in regards to care and treatment, proved that the health care system that was supposed to help and protect this population failed in such endeavors. This system was cited by many to be broken, cruel and misrepresented. One patient quoted “being in restraint reminds me of my miserable past, my stepdad got revenge by tying me to my bed as a form of punishment for standing up to him whenever he physically abuses my mother.” In my capstone project I will try to provide an alternate to the frequent use of restraint by designing and incorporating music as an outlet for expression. In this project I will try to show the effect therapeutic music and involving the patient in the selection process can reduce the violence, self- harm and subsequently the ultimate use of four- point restraints. Music is an ancient art that has soothed minds for centuries. Music helps people regain inner peace and is the voice that binds people together. It has been used to treat the sick since...
Words: 501 - Pages: 3
...avoid confusion later on. Advance directives centers around the principle of your right to die and death with dignity. With an advance directive, you can express how much or how little you want done for you when you are no longer able to make decisions. (Advance Directives) Legal documents can ease end-of-life decisions. Congress passed the Patient Self Determination Act (PSDA), which became effective in 1991. The act requires all health-care institutions that receive Medicare or Medicaid funds to provide patients with written information about their right under state law to execute advance directives, but it does not require states to adopt or change any substantive laws. The written information must clearly state the institution’s policies on withholding or withdrawing life-sustaining treatment. The PDSA also requires facilities to document in each patient’s medical record whether an advance directive has been executed, to educate staff and the public about the right to forgo treatment, and to ensure institutional compliance with state law. Violation of the act can lead to loss of federal funding. (Markus) One type of directive that patients in many states can execute designates an agent to make healthcare decisions for them if they become mentally incapacitated. The process involves drafting a durable power of attorney, which is simply a document...
Words: 1635 - Pages: 7
...to die. At that time you expressed a desire to travel to Holland and participate in its physician- assisted suicide program. As your primary care doctor and oncologist for the past fifteen years I am very empathetic and very concerned not only with your physical health but your emotional health and experiences as well. Even though we have exhausted all therapeutic treatment options; I would really like for you consider hospice care here in the United States. Because I truly believe that hospice care can provide comfort and support to you, family, and friends. Hospice care is designed for those who are nearing the end of life. All care services are provided by a team of health care professionals who maximize comfort for a terminally ill patients by reducing pain and addressing physical, psychological, social and spiritual needs. To help families, hospice care also provides counseling, respite care and practical support. You are considering traveling to another country to end your life but if decide to stay here hospice gives you the option to receive this care in your home. In addition to hospice care for your consideration; the Federal Drug Administration has recently approved a new pain medication that wasn’t available before. This medication is was formulated and strictly marketed to treat pain associated with an illness' such as yours and of magnitude. The drug will be available in two weeks and it will be readily available. I have also investigated the probability of...
Words: 773 - Pages: 4
...Task 1 Western Governors University Organizational Systems and Quality Leadership Task 1 Upon review of the scenario involving Mr. J, a 72 year old retired Rabbi, I can conclude that there were a number of quality nursing indicators that could be addressed to identify issues that would interfere with Mr. J’s care. Mr. J is identified as a fall risk as evidenced by his hospitalization for a fall with injury. Because of this recent fall and his dementia he is quickly labeled as a fall risk while in the hospital. Despite his dementia, Mr. J is able to answer questions appropriately. Mr. J appears to have not been given any alternative to restraints. Alternatives to restraints would include medication to help calm him, bed alarms, and distractions such as games, music, or television. Another alternative would be to offer a sitter at the bedside. Last resort would be to restrain Mr. J. In this case Mr. J appears to have not been offered any alternative to restraints. (Hinshaw, 2010) Another quality nursing indicator is the prevalence of pressure ulcers. He was found to have an area on his lower spine that was reddened and depressed, indicating the development of a possible pressure ulcer. The nurse in this case was not notified by the CNA that found the reddened area and the daughters concern was ignored by the CNA. Assessing skin, especially given Mr. J’s immobility would be a priority for the nursing staff. Developing a turn schedule and making all staff aware...
Words: 934 - Pages: 4
...Research Online Faculty of Informatics - Honours Theses (Archive) University of Wollongong Thesis Collections 2005 Ethical Issues arising from the Real Time Tracking and Monitoring of People Using GPS-based Location Services A. Mcnamee University of Wollongong Publication Details This thesis was originally submitted as McNamee, A, Ethical Issues arising from the Real Time Tracking and Monitoring of People Using GPS-based Location Services, Bachelor of Information and Communication Technology (Honours), University of Wollongong, 2005,71p. Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: research-pubs@uow.edu.au Ethical Issues arising from the Real Time Tracking and Monitoring of People Using GPS-based Location Services Abstract The Global Positioning System is a constellation of 24 satellites which have the ability to calculate the position, time and velocity of any GPS receiver. Ethical concerns arise when a person carrying a receiver has their location transmitted to second party. This type of tracking has a wide variety of applications including tracking dementia sufferers, tracking parolees and law enforcement. A literature review found that the ethics of GPS tracking has not been thoroughly assessed. This paper investigates the ethical issues arising from the real time tracking of people using GPS-based location services. Usability context analysis and an observational...
Words: 20727 - Pages: 83
...presentation of an illness in an older adult can appear as a subtle, nonspecific, or unusual manifestation that is outside the normal range of signs and symptoms for a specific illness. Nursing care of an older adult requires a through assessment of acute, chronic or complex illnesses. Illness in older adults is complicated by numerous medical problems and the physical changes of aging. Identification of an illness can be overlooked simply because symptoms might be reported vaguely. Multiple overlapping factors such as environmental, sociologic, physiologic and psychologic aspects need to be considered in the nursing assessment. It’s essential that nurses recognize atypical presentations of illness in older adults early to help improve patient care. Early detection can reduce the risk of missed diagnoses, death and/or prolonged hospitalization, and reduce rates of co-morbidity from treatable geriatric syndromes (GrayMiceli, 2007). Aging causes physiologic changes to the body. These normal age related changes could be similar to changes seen in the presence of pathological conditions. This causes a problem when normal changes mask early signs of an acute illness. Changes to the musculoskeletal system can affect a patient’s ability to function. Reduced bone mineral density leads to osteoporosis and an increased risk for fall-related fractures (Ebersole, Hess, Touhy, & Jett 2012, p. 48-49). Age related changes to the cardiovascular system are myocardial and blood vessel stiffening...
Words: 1781 - Pages: 8
...the services are provided to people or communities by agents of the health services or professions for the purpose of promoting, maintaining, monitoring, or restoring health. According to the Institute of Medicine, they defines health care quality as the extent to which health services provided to individuals and patient populations improve desired health outcomes. The care should be based on the strongest clinical evidence and provided in a technically and culturally competent manner with good communication and shared decision making. While dementia or senile are often synonymous with the elderly. Senile is a condition in which the brain has decreased, causing a decline in memory of a patient with severe and cannot even take care of you. Dementia or senile is a disease and not alarmed foreign to the Malay community, since time immemorial have been recorded by type as Munshi Abdullah, in his famous book. It usually only pose problems to a family member when the disease came too early from the age norm. If the patient began suffering from dementia when he reached 80 years were normal and not a problem. But if the patient was only 60 years old, is suffering from dementia, so it is very stressful for the family. The health needs of old people are now a matter of concern in all industrialized and developing countries. This concern reflects the growth in the aged population. According to United Nations estimates, old people, that is those 65 years of age and over, now about 200 million...
Words: 4442 - Pages: 18
...time in the history of nursing. As a result, nurses must confront the fact that they now owe a higher duty of care to their patients, and by extension, are more exposed to civil claims for negligence than ever before”(Weld and Bibb, 2009, p 2). “Negligence is described as failure to use such care as a reasonable prudent and careful person would use under similar circumstances” (Weld and Bibb, 2009, p3). Common examples of negligence are malnutrition, inadequate hydration, physical injury was done, and it was the result of the nurse’s care or lack thereof. There are five main elements in a nursing negligence case and all five elements have to be proven for a case to be valid 1. The nurse had a duty to perform. 2. The appropriate care was not apparent in the situation. 3. There was a breach of violation of care 3. There was injury proven to result from the nurse’s negligence and 5. There is proof that damages occurred as a direct result of the situation. (Avery, 2009). Gross negligence is a more serious form of negligence and goes further than carelessness. While regular negligence is seen as a person falling below the standard of care, gross negligence is seen as complete failure to show care and in fact implies recklessness or a willful disregard for the safety of a human being. An example of this would be “At a nursing home, a patient with dementia is difficult to watch and control. The nurses restrain the women for most of the day and night, leaving her with joint problems...
Words: 1167 - Pages: 5
...The ethical dilemma of euthanasia Euthanasia is a sensitive and controversial topic that is enveloped in endless ethical debate and ambiguity. There are several forms of euthanasia, each having arguments for and against. Active euthanasia is when death is brought about by an act – carried out by a person to cause the patient to die, for example giving the patient an overdose of medication. Passive euthanasia is when death is brought about by an omission – withdrawing life extending treatment. Voluntary euthanasia is when the patient wants to die and requests help to do so. Non-voluntary euthanasia usually occurs when a patient does not have the capacity to make their wishes known, for example a patient who is severely brain damaged. Involuntary euthanasia is often viewed as murder, when a person does not want to die but is killed anyway. (bbc.co.uk, 2009). Euthanasia is currently illegal throughout the UK, reflecting the status quo of most countries, although there are a few countries where acts of euthanasia are legally permitted under certain highly regulated conditions. Under the Suicide Act 1961 any person that “aids, abets, counsels, or procures” in the suicide (or attempted suicide) of another will be liable for a prison sentence not exceeding fourteen years. (Suicide Act 1961 section (2) 1). However people are not prevented from using services where euthanasia is legal. This attracts no liability if the patient is capable of coming to this arrangement by themselves...
Words: 1048 - Pages: 5
...keep me going like a vegetable!’ I’ve said it myself to loved ones after dealing with a serious situation with a friend of the family after a stroke. After being resuscitated three times in one week, another elderly friend with a pacemaker wanted her life to end in peace. And so it goes with many terminally ill patients; they plead to die. For the doctors and judges this is a debatable question and for relatives a painful choice. But who really has the right to make the decision? Sometimes, there is a senseless prolonging of life within hospitals by the many machines that the patient is hooked up to and it seems like technology has taken over and these machines are the only thing keeping the person alive. When death is unavoidable and the prolonging of life is due extraordinary medical procedures and efforts, many questions arise regarding the right to die with dignity. I would like to think that I have some right in this regard to my final situation and have the option for my death to be agonizing or peaceful? Demonstration Moral Reasoning The utilitarian theory when applied to this very sensitive ethical question and topic offers a unique perspective. The overall general principles states that it’s a difficult task but morality should be guide and instruct each one of us so that our efforts are rational and not solely emotional. If this is the case with utilitarian theory I question, how is this possible with such...
Words: 2307 - Pages: 10
