Case Study: End Of Life Care Dilemma

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End of life care dilemma: a case study

Nurses encounter various decision-making in daily practice, these decisions are intricately linked to patients’ and family members’ values or beliefs that coupled with emotional burdens in end-of-life care (Quinn et al. 2012; Gallagher et al. 2015). Legal and ethical issues often arise when the patient is incompetent as well as when the surrogate decision maker is unclear (Torke, Alexander & Lantos 2008). In this case, Lewis, who was admitted to the hospital for colostomy, followed by a dramatic physical deterioration, became incapable. The decisions on Lewis’s end-of-life treatment between Lisa, Lewis’s new partner, and Lewis’s two daughters are contradictory to each other’s. In this particular scenario,
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(Atkins, Britton & De Lacey 2011). However, in Lewis’s case, as his illness progressed, urinary output decreased, mentally, he became confused, which ultimately led to incompetency for decision-making. In the situation when the patient is unable to make choices, a substituted decision maker would be appointed to determine one’s treatment. Guardianship and Administration Board (2014) states that the ‘person responsible’ as a substituted decision maker can consent patient’s treatment. In the hierarchy of ‘persons responsible’, spouse or unmarried but in a significant relationship with the patient has the priority for medical decision-making in the absence of the patient’s guardian (Guardianship and Administration Board 2008). Although Mr. Lewis and Lisa are not married, they have been living together for the last six months. She often came to the hospital to visit and company him since Lewis has been ill. To Lewis, he is happy to see her. Lewis’s has two daughters, however, both them live interstate without much contact for years. In this situation, Lisa understands Lewis’s current situation better than his two daughters, and therefore she could be considered as a significant person in his life. In addition, when Lewis was mentally capable, he has appointed Lisa as his next-of- kin, which has been documented in nursing notes. Thus, Lisa is in the …show more content…
Lewis’s health situations and the relationship among nurses, Lewis, his two daughters, Lisa and Lewis’s doctor pose the unique complexities in making end-of-life decision. Perhaps, before Lewis underwent the surgery, he could have ACD done and documented. In fact, according to Department of Health and Human Services (2015) that everyone should have ACD, particular those who are in chronic diseases or in palliative care. Before Lewis was admitted to the hospital, he has had COPD as a long-term condition and history of MI which is often lethal leading to perform cardiopulmonary resuscitation, thus, he could have been encouraged to complete ACD and kept in the place where is easy to access. After his surgery, when the nurse observed that his urinary output was still below the reasonable range even though his IV fluid has been increased, the nurse in that shift failed to communicate with all relevant stakeholders for further treatment and possible outcomes in time. Consequently, his two daughters, living away from Lewis were not fully informed about their father’s health conditions. One of his daughters Alice was completely unaware of his father’s bowel cancer, which could be the reason she tried to push for aggressive treatment. Thus, it is critical to start the decision-making process by identifying all relevant stakeholders and keeping them informed (Ulrich

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