John DeLeonibus
Marist College
Ethics in Healthcare Delivery PA 601
10/23/2016
Ethical Issues in the Care of Terminal Patients Dealing with patients who suffer with devastating, life-threatening disease is, unfortunately, a common and especially scary job for health care professionals who must bring together the principles of professional behavior, informed consent and end-of-life decision-making with their own expectations for the health, well-being and survival of such patients. The importance of understanding issues like this is made very real in the movie “WIT,” a film about an intelligent professor diagnosed with stage-four ovarian cancer who is poorly prepared to agree to undergo experimental treatment or to ultimately consent to the …show more content…
Kelekian describes Vivian’s diagnosis and planned treatment to her in the film is probably an exaggeration however the responses by Vivian indicate how important addressing the patient’s concern, lack of knowledge and questions is to ensuring that a proper and truly informed consent has been taken from the patient before papers are signed. Informed consent is part of a patient’s right of free-will and provides for controlling what happens to one’s “own body” and protecting it from “unwanted intrustions.”2(p53) Even before informed consent can be made however, it is important to establish that the patient has been properly informed of their diagnosis and what it means for them, as well as properly informed of the treatment that is recommended, including its benefits and risks.2(p54) A patient’s informed consent has a lot to do with the professional behavior of the health care professional who is taking and recording the patient’s consent and, for the terminal patient, much to do with the end-of-life decisions that they make. A physician who provides information on a specific treatment of his or her preference violates the patient’s independence and free-will when information on other treatment options that are available is excluded. This “paternalistic view” is exemplified in the behavior of Dr. Kelekian and, in most cases, is not acceptable, even if the concern is that the patient might refuse treatment if he or she knew …show more content…
In the film, Vivian’s loyal nurse Susie records, with Dr. Kelekian, her wish to not be resuscitated in the event that she should go into cardiac arrest. Unfortunately, when Vivian ultimately codes, the young resident physician Jason Posner immediately tries to resuscitate her, even as Susie exclaims that she is DNR. Although Dr. Posner and the code team ultimately stop, the scene exemplifies how difficult it can be for physicians to bring together the principles of professional behavior, informed consent and end-of-life decision-making with their own expectations for the survival of their patients. Jonsen and Siegler make a compelling point concerning DNR orders, emphasizing that there are cases where “a policy of required reconsideration” of a DNR order might apply when it comes to their enforcement, for example, in the case of the patient who has consented to elective surgery.2(p43) Pozgar submits that there are “no effective hard and fast rules or guidelines to govern ethical behavior when faced with life or death decisions.”1(p60) In Vivian’s case however, her terminal prognosis and decline, even with treatment, was still not enough for Dr. Posner to assume a DNR order. Most likely similar situations occur in the real world, where a physician or other health care professional might fail to see a DNR order or fail to enforce it, even if
Marist College
Ethics in Healthcare Delivery PA 601
10/23/2016
Ethical Issues in the Care of Terminal Patients Dealing with patients who suffer with devastating, life-threatening disease is, unfortunately, a common and especially scary job for health care professionals who must bring together the principles of professional behavior, informed consent and end-of-life decision-making with their own expectations for the health, well-being and survival of such patients. The importance of understanding issues like this is made very real in the movie “WIT,” a film about an intelligent professor diagnosed with stage-four ovarian cancer who is poorly prepared to agree to undergo experimental treatment or to ultimately consent to the …show more content…
Kelekian describes Vivian’s diagnosis and planned treatment to her in the film is probably an exaggeration however the responses by Vivian indicate how important addressing the patient’s concern, lack of knowledge and questions is to ensuring that a proper and truly informed consent has been taken from the patient before papers are signed. Informed consent is part of a patient’s right of free-will and provides for controlling what happens to one’s “own body” and protecting it from “unwanted intrustions.”2(p53) Even before informed consent can be made however, it is important to establish that the patient has been properly informed of their diagnosis and what it means for them, as well as properly informed of the treatment that is recommended, including its benefits and risks.2(p54) A patient’s informed consent has a lot to do with the professional behavior of the health care professional who is taking and recording the patient’s consent and, for the terminal patient, much to do with the end-of-life decisions that they make. A physician who provides information on a specific treatment of his or her preference violates the patient’s independence and free-will when information on other treatment options that are available is excluded. This “paternalistic view” is exemplified in the behavior of Dr. Kelekian and, in most cases, is not acceptable, even if the concern is that the patient might refuse treatment if he or she knew …show more content…
In the film, Vivian’s loyal nurse Susie records, with Dr. Kelekian, her wish to not be resuscitated in the event that she should go into cardiac arrest. Unfortunately, when Vivian ultimately codes, the young resident physician Jason Posner immediately tries to resuscitate her, even as Susie exclaims that she is DNR. Although Dr. Posner and the code team ultimately stop, the scene exemplifies how difficult it can be for physicians to bring together the principles of professional behavior, informed consent and end-of-life decision-making with their own expectations for the survival of their patients. Jonsen and Siegler make a compelling point concerning DNR orders, emphasizing that there are cases where “a policy of required reconsideration” of a DNR order might apply when it comes to their enforcement, for example, in the case of the patient who has consented to elective surgery.2(p43) Pozgar submits that there are “no effective hard and fast rules or guidelines to govern ethical behavior when faced with life or death decisions.”1(p60) In Vivian’s case however, her terminal prognosis and decline, even with treatment, was still not enough for Dr. Posner to assume a DNR order. Most likely similar situations occur in the real world, where a physician or other health care professional might fail to see a DNR order or fail to enforce it, even if