The ethical standards of health practitioners

The clinical team has assessed that it is time to withdraw life support and let nature take its course, yet the dying patient’s family insists that the hospital “do everything possible” to keep the patient alive. You have been asked your advice as to whether the team can discontinue active treatment and maintain the comfort of the patient while nature takes its course.

Health Practitioners all over the world are always under oath, and they are expected to uphold the pledge at all times while maintaining a high level of ethical standards as highlighted in their manuals. However, the practitioners are faced with ethical dilemmas where they are intertwined between discontinuing the life of the patient at the expense of a continuous increase in medical bills or continuing with medication and at the same time imposing substantial medical bills to incapacitated society. Withdrawal of life support system from a patient is unethical from the health practitioner’s point of view, and it should not be carried out at all cost. From a Biblical point of view, withdrawal of support system amount to death which is against the Ten Commandments. It is the duty and obligation of health practitioners to preserve and save lives at all cost. Sometimes, family members go an extra mile of requesting the Doctors to withdrawal life-supporting system from patients, and it usually subjects them to ethical dilemma issues. The American Medical Association code of medical ethics asserts that “the moral obligation to respect patient autonomy and self-determination requires that the physician respect the decision to refuse care.

According to the code, the medical practitioners must decide whether the support in place is futile or not despite being an ethical issue that has gone to logger’s heads with legal stands. The authority has held that it is allowed for a family to request for withdrawal of life support system from the patient. Therefore, practitioners have a discretionary to removal the life support system and let nature to take its course. Sometimes, making the right decision in the wake of severe illness can be complicated, especially when there is uncertainty or disagreement. In the face of such a dispute, the ethical committees can offer some guidance. The Ethics Committee is a group of Alte Bates Summit Medical Center staff that includes; nurses, social workers, chaplain, and members of the community who are available to aid patients, doctors, families, and other healthcare providers when they face difficult ethical decisions. At times ethical dilemmas arise in several areas such as advances directives, surrogate decision making, refusal of treatment, conflict with caregivers, preceding life-sustaining treatment, Do not accept resuscitation and other issues perceived as ethical problems.

The main aim of medical care has always been to preserve life and health. However, the everyday decision has to be made as either to continue with life-sustaining support or withdrawal of life-sustaining support. The arrangements are made after careful consideration of many factors, wishes, goals and values of the patient, the balance of benefit and burden from any treatment that is under review. Other factors to be considered include the probable outcome expected and best interest of the patients. Once the life-sustaining measure of an individual is withdrawn, the medical practitioner must provide comfort and dignity to the deceased. The process requires clinical officers to manage discussions that respect patient autonomy while exploring whether a patient’s life should be artificially preserved.

A Framework for Ethical Decision Making

The above flow chart represents a systematic process question that a health practitioner should consider before while deciding as either to continue with the life-sustaining system or withdraw it to terminate the autonomy of the patient. The process tends to be lengthy and involving several branches; the doctor has to consider the implication, the ethical and legal positions. A further consideration is based upon the close members of the families to arrive at a decision.

Decision Making Process

The decision making is a tedious process that requires a trained sensitivity to ethical issues and a proven method for exploring the moral and ethical aspects of decision making and weighing the aspects that should influence the choice of the action taken. In this context, it is prudent to explore the Markkula Center for Applied Ethics Framework for Ethical Decision Making. According to the centre, ethic is defined as a standard of behaviour that informs how human beings should act in diverse situations.

Recognize an Ethical Issue

The ethical standards of health practitioners do not allow them to terminate the patient’s life. It is their mandate to save a presence in the best way possible. However, they are faced with confusing and stressful situations where they are faced with making critical decisions. In the example above, the health practitioner is intertwined about letting nature take its course or continue with providing a life-supporting system to the client. Discontinuing the active support system of patients will ultimately amount to death which is not the objective of any health practitioners. Legally, there is an exemption to the ethics standard, especially where cost outweighs the benefit. For example, some patient in life support system experience massive pains and the medical bills keep on skyrocketing. At the same time, the health practitioner is solid aware that the patient cannot make it alive. It means that expenses will keep on rising and ultimately will cost the family hefty amounts. At such point, the family might request the hospital to withdraw the life support system and allow nature to take its course.

Get the Facts

As a doctor, one has to consider the facts at hand and determine whether they are sufficient to execute the decision.  Every party pertinent to the continuous living of the patient should be consulted. Some of the parties include dependents, family members, health practitioners, doctors, churches and legal authorities. The parties should provide their thoughts about the actions to make a decision.

Additionally, a health practitioner needs to provide a breakdown of expected outcomes in terms of costs and benefits of euthanasia. The cost and benefit analysis will provide the parties to the issue with adequate facts for decision making. Get the effects stage in the framework of decision making is critical as it evaluates all the facts known to the situation at hand which helps the health practitioner to honour the plea of the family members or not. Other points to consider include: medical treatment options in future and determine its affordability, resuscitation planning and professional advice from a health practitioner. It is the responsibility of the health management to advise the family member as to whether the health condition of the patient might improve or not. Their decisions are informed and tend to take precedent since they evaluate all the options at their disposal before providing conclusive advice to the patients. Sometimes, the family members might disagree with a decision made, which means that they have the right to air out the grounds for their disagreements. This makes the health practitioner seek advice from experts from the same discipline as the disagreeing party. In case the controversies escalate, the health practitioner must provide psychological information to the affected parties.

Evaluate Alternative Actions

At this stage, the health practitioner has to consider the option at hand as informed by different theories of decision making such utilitarian approach, virtue approach, the rights approach, the common good approach and the justice approach. However, all the methods mentioned above cannot be applied at one single time due to their conflicting ideas about ending the life of a patient by withdrawing the life support system or continuing with the order while incurring hefty expenses. For example, the utilitarian approach focuses on the decision that would produce most good and less harm. Considering the dynamics of the situation, death would create more harm than good, and as a result, it would not be applicable in a case between life and death. The rights approach focuses on respecting the right of all parties who have a stake to the situation at hand. For example, the family members and the patient do have the most significant stake in this situation and their rights should be respected at all cost and it proves to be the best approach to adopt in matters of life and death even though it contradicts the virtue approach on the medical practitioner point of view.

Make a Decision

As a health manager, the Right Approach would suffice since it addresses all the needs and rights of people at stake if the patient dies or continues living. Despite displaying a contradiction with medical practitioner ethical standards, it ends up to be the right thing to do since it addresses all the annexures of the underlying situation of life and death. Other approaches are considered, but they tend to override the rights of stakeholders which is held as a legal position. Legally, the health practitioners are tied by the patient’s family members request on continuing with a life support machine or withdrawing it and allow nature to take its course. Therefore, the patient should be removed from the life support system as it is expensive, and it is also the desired rights of people having stake to the life of the patient despite contravening the ethical standards. Therefore, moral standards are not always adhered to but can be bypassed by the legal standards.

Act and Reflect on Outcome

                After the decision has been made, a health practitioner must continue providing moral support to the affected individuals and ensuring they walk the journey together until they heal completely heal up. At some point, therapy will be required to improve the mental condition of the stakeholders and minimize the impacts of stigmatization throughout the period.


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