Being a health service manager, I would like to apply the basic ethical principles; Beneficence, Least Harm (Non-malfeasance), Respect for Autonomy and Justice when it comes to making a decision in the above-mentioned case. Before making any ethical decision, in my opinion, it is prudent to understand the facts of the issue and consider what group of people; including patient himself/herself and his/her next of kin or family members, and other stakeholders are involving in the case. It is also important to access how the decision will affect those individuals too. The informed consent from the patient is mandatory when it comes to making the ethical decision. The three elements of informed consent namely; information, voluntariness, and competency must be followed properly (Kleespies 2004).
However, if the patient is in the state of mental instability or loss of control, the power of giving consent will be done by proxies. In addition, advance directives or living will of the patient plays a huge impact on the ethical decision. Sometimes advance directives and proxy legislation may differ from one state or territory to another. For example; Powers of Attorney Act 1998 of Queensland allows advance directives proxies, however, proxies are not allowed to give consent in ending the measures of life-sustaining. On the other hand, Western Australia and Tasmania have no current proxy legislation.
(Cartwright 2000).The next important basic principle of ethics we must take note is the “Beneficence”. We should look carefully into the alternatives and choose the best for the patient. The decision should be based on medical and nursing dimensions in which the latter sometimes may be different from the former one.
The view of patient and social aspects are the key factors need to consider when it comes to making of the ethical decision (Ebunoluwa 2012). Generally, the term “Beneficence” may be considered to promote good. Sometimes, it might get confused with the closely related term “Least Harm or Non-malfeasance”. When it comes to Least harm, it is important to take note that not to harm the patient rather than doing good. Therefore, shared decision making will be the best option when it comes to the end of life dilemmas. The varieties and options of different treatment plans should be properly explained to the patient and his/her family members.
Furthermore, shared decision making will serve as a bridge which will connect the expert knowledge of the medical experts and awareness of the patient and his/her family members to make the best decision (Fink-Samnick 2016). In addition, all the underlying medical conditions, treatments; including the prognosis of the disease needs to be reassessed repeatedly throughout the whole process. The professional expert care and opinion of a qualified palliative medical specialist might be necessary for the process of making the decision (Consales, Zamidei et al. 2014) To my way of thinking, Pain Management plays a crucial role in this case of a dying patient. Generally, most of the healthcare professionals would give increased dose of pain medication to control the pain even it will cause the death of the patient (Steinberg 1996).
This concept is often known as the “doctrine of double effect” which is to ease the pain even if the death of the patient is a foreseeable unwanted outcome. The concept that the right of choosing to reduce the suffering by the informed patients at the expense of shortening life unintentionally is supported by the Supreme Court of the United States (Milligan 1998). Moreover, it is important to take note carefully not to be mixed up with the risk of criminal prosecution when the healthcare professionals decide to undergo for euthanasia or physician-assisted suicide(Cartwright 2000). The main purpose of the doctrine of double effect is to ease the pain to get the comfortable symptomatic relief for the patient. Therefore, many individuals from the religious, ethical, medical and legal generally accept the “doctrine of double effect”. However, if the suffering of the patient is other than pain, the respective health care professionals must consider on all possible means to comfort and ease the suffering.
In conclusion, as a health services manager, the team of my colleagues and I would approve the administration of the additional medications in increasing dose to control the pain according to the “doctrine of double effect” as well as the best effort to maintain the “quality of life” for the patient. In general, the quality of life is the primary goal of medicine to maintain the best for individuals. For the dying patient, in this case, the quality of life may be more sophisticated. However, every step of making the decision will be frequently and carefully check against with 5 sources of ethical standards namely; Utilitarian, Rights, Fairness/Justice, Common good, and Virtue.