Chapter 10 Text Outline - 1 2 Chapter 10 Ethical Issues in...

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Unformatted text preview: 8/5/14 1 2 Chapter 10 Ethical Issues in the Use of Fluids and Nutrition: When Can They Be Withdrawn 3 4 Withholding Artificial Nutrition •  Recent cases have highlighted the contentious nature of these decisions. •  When patients have a chance for recovery, these substances are a great assist. •  When patients have no hope of recovery, they can be inappropriate. 5 Ethical Decisions are Complex •  Withdrawing treatments when they are no longer effective is viewed as acceptable practice. •  Fluids and nutrition are not viewed in the same way. •  They are the clinical scaffold. •  From the family view, they constitute hope. 6 Definitions are Needed to: •  Determine how to define fluids and nutrition. •  Determine when providing them serves no medical purpose for the patient. 7 Definitions are Needed to: •  Define artificial hydration and nutrition. •  Decide if artificial nutrition and hydration are not needed to sustain life. 8 Ethics and Artificial Hydration/Nutrition must: •  Differentiate between hunger and thirst and artificial hydration/nutrition. •  Consider care versus therapeutic goals. •  Respect the patient’s integrity and autonomy. •  Consider the medical condition. 9 Ethics and Artificial Hydration/Nutrition •  Ethical analysis must consider the patient’s claim to integrity. •  The strength of claim of integrity and informed consent must be considered. 1 8 Ethics and Artificial Hydration/Nutrition must: •  Differentiate between hunger and thirst and artificial hydration/nutrition. •  Consider care versus therapeutic goals. •  Respect the patient’s integrity and autonomy. •  Consider the medical condition. 9 Ethics and Artificial Hydration/Nutrition •  Ethical analysis must consider the patient’s claim to integrity. •  The strength of claim of integrity and informed consent must be considered. •  One must consider the function of rights in making clinical decisions. •  Some rights require collective responsibility. 10 Ethics and Artificial Hydration/Nutrition •  The manner of death can become a moral enterprise. •  The decision to withhold artificial hydration/nutrition can be a patient’s most important moral need. •  This right can conflict with society’s right to preserve life. •  The patient’s claim must not be a threat to society’s claim. 11 Ethics and Artificial Hydration/Nutrition •  The Quinlan Case provided a formula for addressing conflicting claims. •  The futile nature of the medical treatment must be considered. •  What if withholding these elements leads to death? What is the patient’s right? 12 Benefits and Burdens •  There is a need to balance the benefit of providing the intervention against the burdens. •  When the benefit does not exceed the burden, a decision not to have the treatment is ethical. •  The right to bodily integrity is the core issue. 13 Benefits and Burdens •  The physician can decide that the burden is not worth the benefit independent of the patient. •  This would not be ethically acceptable without considering the patient’s right to integrity. •  Patient consent or refusal is essential. 14 Tensions •  There is a tension between the rights of the patient and the rights of the treating physician. 8/5/14 2 •  The right to bodily integrity is the core issue. 13 Benefits and Burdens •  The physician can decide that the burden is not worth the benefit independent of the patient. •  This would not be ethically acceptable without considering the patient’s right to integrity. •  Patient consent or refusal is essential. 14 Tensions •  There is a tension between the rights of the patient and the rights of the treating physician. •  What is the patient-physician relationship with respect to this decision? •  How can the physician withdraw artificial nutrition/hydration and still do no harm? 15 What Happens at End of Life? •  Dehydration eases the discomfort of terminal illness. •  Artificial hydration can add to the discomfort in the long run. •  Tube feeding adds to the discomfort of the dying. •  Food and fluids are often decreased in end stages without thirst or hunger. 16 Research Shows… •  That there is no clinical benefit to nutritional support at the end of life for cancer patients. •  Inserting feeding tubes does not improve survival. •  In one study, nursing home residents with feeding tubes died sooner than those without. 17 During the Dying Process •  Adaptation to starvation prevents discomfort due to the lack of food. •  Dehydration usually occurs before starvation and its changes produces a sedative effect on the brain. •  Terminally ill patients experience dehydration differently so giving fluids may prove futile. 18 Can the Preservation of Life be Unethical? •  Can favoring life actually be unethical? •  Should life be prolonged when there is no hope of recovery? •  Is continuing treatment an impossible burden on the patient? •  If this is true, then it is no longer ethical to prolong life. 19 Does the Argument Fit? •  This argument alone is not enough. •  Consider the consequences of the action. •  Quality of life must be a consideration. 8/5/14 3 giving fluids may prove futile. 18 Can the Preservation of Life be Unethical? •  Can favoring life actually be unethical? •  Should life be prolonged when there is no hope of recovery? •  Is continuing treatment an impossible burden on the patient? •  If this is true, then it is no longer ethical to prolong life. 19 Does the Argument Fit? •  This argument alone is not enough. •  Consider the consequences of the action. •  Quality of life must be a consideration. •  The patient’s preferences must be considered in the decision. •  We cannot hold the patient hostage. 20 In Summary… 8/5/14 4 ...
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