Lecture #10 - Ethical Challenges in Palliative Care Flashcards
Moral distress def?
Environment/professional requirement impedes on nurses desired action in relation with her own ethical standards. “Nurse cannot do the right thing.”
Moral distress en indicators of environment vs nurse weakness?
envi.
Moral agency def?
A nurse capacity to engage in actions that morally relevant (right). IN both the hospital/caring setting and in a socio-political settings.
Brazil four construct of moral distress?
- negation of nurses role as pt advocate
- Lack of competency in work team
- Disrespect of pt autonomy
- Therapeutic obstinancy
Strategies to address moral distress?
- Listening to nurses
- Teaching articulation/advocacy for resolution of moral distress in universities to nurses.
- Communication channel in workplace to address these challenges
- Orders should provides guidance to there members.
Chan and al. findings?
- Palliative pt not a priority (task-oriented priority), causing distress in nurses.
- Palliative care requests deamed too early/pt too sick/no place on floor
- Its hard to let go when you don’t have a Dx/you don’t understand what is going on.
- Prognostic is hard and thus when to demand pall. care is harder.
- Perception that pal. and acute care don’t happen simultaneously
- Yet no accepted standard of pall. care delivery.
Primary goal of palliative approach?
Ensure pt is comfortable and maintains a level of functioning.
What is suffering (Carnevale)?
Suffering is not pain. Pain refers to nociception (Eg. Giving birth gives pain, but not suffering). Depression results in suffering, not pain.
1. Only properly understood by how it is subjectively experienced by a person. Cannot be correlated with severity of illness (Cassell).
2. The intactness of the person must be threatened (Cassell).
Suffering should be viewed as an emotion.
Can one’s suffering be assessed by another (Carnevale)?
NO, suffering is subjective, not objective except in term of own sympathetic response. Even is it has distinctive features, it cannot be correlated with intensity.
What is the moral significance of suffering (Carnevale)?
Eliminating suffering is a primary obligation of modern medicine. Thus making suffering bad, and its relief, good. This help to justify the limits of life-sustaining therapies (better off dead than alive and suffering).
Principle of double-effect?
- Action must be morally good.
- Bad effect must not be the means by which the good effect is achieved.
- Motive is good effect only.
- Good effect at least equivalent to bad effect.
Fundamental moral dilemma?
High responsibility with low level of control.
Principlism pillars?
Autonomy: Right to self-determination
Beneficence: do good
Nonmalefiscience: Dont do bad
Justice: Fairness
Consent?
- Substituted Judgment Standard
- Pure Autonomy Standard
- Best interest standard
- Self-Determination
- Once-competent, done by family
- Formerly autonomous and then expressed desires toward future situations, now-incompetent (Mandate).
- Pt preference not known. Proportionality (benefits>burden)
- Free/enlightened consent.
Legal vs Factual competence?
you are or arent.
Ability to make decisions (complex, risk involved)
CNA informed decision making standards?
- Provide info
- Respect wishes of capable person
- Respect each person decision-making process
- NUrsing provided with the person informed consent.
- Nurses sensitive to power differentials between HCP and pt
- Advocate for pt
- Assist family in understanding person decision making.
- Respect informed decision-making of capable persons
- Assist person in decision-making
- Respect law on consent