Ethical Issues on being both Professional and Human: One Women’s Journey Paper
Introduction
Awareness has been heightened in the recent past over the need to take account of the patients’ experiences during illness. Their friends and relatives have are also affected during this hard times and have stories of heart break from pain inflicted when they see their ill friends and family. The stories from this people provide a good means for the generation of logical ideas about the medical practice, the effects and experiences in good health and illness, and the issues of morality. Often, they are particularistic and highly dynamic. This is so because the readers are engaged at a personal level deeply. This connects the gap between the human conditions and individual experiences thus help us in having an understanding of the unexpected and the ordinary, and finally the unavoidable experiences in good and bad health. (Kerridge et al., 2006). The emphasis on this paper will be based on the deficiencies in the art of communication between patients and the medical practitioners. Also a it will have a close look into the relationship that the doctors have with the relatives and friends of the ill person. The trauma that people undergo in witnessing their ill beloved ones gets reduced from a healthy person of distinctive biography to a clinical problem. (Little, 2006). This paper will therefore be keen on the important ethical issues that are laden upon families, patients and the medical professional teams that are charged with handling matters at the intensive care unit. This will also try to look deeply into the emotional experiences and the perception of relatives towards the health professional and their conduct at work.
The most affected during illness are the closest of friends and relative. The following is an account and reflections of the predicament that a woman had when her husband was admitted in the ICU and in a serious health condition. Her journey was one of pain and optimism however much the future between her and the sick husband was bleak. The late husband underwent a complicated cardiac surgery transplant. After the surgery, he was transferred from the private hospital where he had the surgery to a public tertiary hospital. He was in ICU for close to five month, that is from September 2004 to end of January 2005. During this time he was under close observation and intensive treatment. His wife stayed by his side and had a first hand experience of the excruciating experience he had. She silently and painfully watched how her husband was suffering. She also interacted with all intensive care unit staff members to an extent that she acted as one of staff and participates actively in meeting. At the height of events, the husband’s situation deteriorated and he had intra cerebral haemorrhage. That fateful night her husband passed on as she watched him seated by his bedside. Through this critical time, not even one doctor came offer her condolence. Only the nurses were there to support her. The husband’s death marked the termination of her contract with his beloved husband and lover and therefore no one was there anymore who could give her emotional support during this hard time. This made the widow so depressed and unsatisfied with the medical team although they had provided great and intensive care for her late husband. In this case therefore, there are quite a number of moral issues that need to be addressed and clearly understood (Komesaroff, 2005).
Over time, the care of any ill person is often considered to be outside the professional jurisdiction of the doctors. The medical fraternity rarely consider that they have a responsibility to the family and close relations of the ill person. Sharing of decisions between the medical doctors and the patient’s relatives has never been seen as a necessary and it has been ignored greatly. A majority of the doctors consider the patient’s decisions and expressions more over that of the close relatives, for instance the wife or husband to a sick person. There has been an extremely limited relationship between the patient and the physicians throughout the medical history. This has however made decision making during critical moments very difficult especially during times of severe illness where decisions are required for the reasons of management and treatment for instance amputation. It is unfortunate that as much as this hampers the smooth medication of the patient, miscommunication still prevails. Poor communication has led to low family satisfaction, slow or wrong decision making process, and outcome of the made decisions that family members were not a part of many a times has been seen as a causal issue in key incidents which have resulted in great life loss (Reader et al, 2007). In the ICU work can be divided and often interrupted, express communication may not be the best option, which therefore may lead to communication breakdowns which perhaps could lead to medical mishaps (Hoonakker et al., 2011).
Communication has been frequently pointed as the most vital factor affecting families who have the beloved ones in the ICU as studies have confirmed. In this, the quality of care has been clearly neglected. The medical staff have often under estimated the need to have the closest family to be informed of their patients well being. It has also been noted that the said medical officers also lack the knowledge to pass on complex information to the patient’s families. Patient’s families have often failed to get a good understanding of information, even the simplest, which leads to high confusion and anxiety among the members of the family. Conflict may arise due to poor or even lack of emotional concern for the affected members of the family. From several researches that have been conducted, it has been noted that, persons who act as surrogates will lead the families members into prolonged emotional burden, with a great rise of doubts about the actions that were taken during medical care and a lot of tress.
Little information which is inadequate communication involving family and Intensive Care Unit staff members is a widespread complaint. Families have consistently rated the lack of constant passing of information between them and the members of ICU medical staff as the highest cause of depression and the anxiety for them. Many times, the care of the patients that are in the ICU are extended to the members of the family and close friends who will to support. During these times, the nurse is often the most informed in terms of support and more so education. They spend quite a lot of time with the patients more than any other member of medical staff. The family should be involved widely in the care of their patient at the intensive care unit as the patient cannot receive enough care in isolation. In this way, the nurse will easily get information of the social structure of the family by the nurse is made possible. Consequently, the family dynamics and the value systems learned aids in assisting the medical team in determining appropriate care to provide. When a patient’s situation is critical, opening information communication between families is crucial for medical staff to be able to pass the message, which will enable the family to move from a curative spotlight, to end of life care. (Chaitin and Arnold, 2007)
Whatever the cause of distress, be it bad communication or even surrogate that emotionally overwhelmed research has confirmed that medical staff can agree on making honest information and cooperation. This confirmation has been shown through a study that was conducted in an ICU that by having many meetings with the family members, medical staff and families reached consensus about the suitable care plan. Ninety six percent of cases observed show cased this. Families should be supported during times of strong emotions to allow them enough to understand the predicament that has befallen them by the patient’s diagnosis may be a vital step in the fight to overcoming conflict. It is more so helpful to use chaplains, the social workers and the family members from the patient who are overwhelmed emotionally. primary care experts can also be of help in the facilitation of conflict resolution, more so if there is not an reputable relationship between the patient and the ICU team of clinicians (Chaitin and Arnold, 2007).
Undeniably, giving the family with a pragmatic understanding of the circumstance that the patients at the ICU are is extremely vital. Most patients admitted to the ICU may not be in a capacity to have a good understanding of the situation that they are in. They cannot also give necessary information to the family and friends since they may be sedated or are incapacitated to talk by their condition. In this case, Therefore, physicians should have a meet with the members of families and their friends in order to provide them with precise and palatable information regarding the patient’s diagnosis, and treatment (Azoulay et al., 2000).
Unfortunately, the insufficiency of just giving information to the family members is more so revealed in this case, medical officers also should try to know how well the information is understood in spite of the possible cultural differences in perceptions and expectations that regard health care. There may be misunderstanding between the families and the medical staff even though they may speak the same language. The role of cultural differences also should be viewed in relation to that of other factors such as finance and unemployment which was connected with poorer conception (Azoulay et al., 2000). Many doctors have however argued that time spent with the patients families will add to the already costly intensive care and that the medical officers that work at the ICU have no time to spend on talking to each member of the family. Moreover, the medical professionals may not be willing to reveal information that is distressing to both them and the families and prefer to protect them by with holding such information (Azoulay et al., 2000). However, it is necessary to set up patient values and care goals that are connected to his life and contribute to views either from family or the close friends.
It is important that medical practitioners make resolute efforts early in the patient’s stay at the ICU. This will help in understanding the patient’s health history and the medical agendas like ensuring the restoration of health, life extension, reducing or even relieving pain and further avoiding the long reliance of life support utilities. Most of the time, the medical officers will be required to have talks with the patients over their health. However, the patients are mostly unable to make decisions. Sometimes, patients have information that may be vital in the medication of the patient and the making of decisions by the clinicians which may not be available depending on the patient’s health. In such cases the surrogates of the patients are depended upon to give information about these issues.(Chaitin and Arnold, 2007).
Having families congregating will facilitate the communication between the medical practitioners and affected families. Family satisfaction is improved by the effective communication between the stake holders. The patients in this manner will be able to receive the kind of medical treatment that they deserve and therefore not subjected to treatments that will be burdensome to them. It is important to have conversations with the patients surrogate during the early stages of admission of the patient to the intensive care unit. This kind of indulgence is important before decisions such as saving life or even withdrawing are made. This will also allow the families to try and cope on the emotional issues that they will pass through. Having meetings with family members within first forty eight hours of admission into the ICU is important is very vital as it’s more effective. This will achieve gaols such as; giving explanation of the situation medically, to make known the patients preferences, to give emotional support to the family and finally to create a relationship trust between themselves. When this has been achieved, there is a possibility of having an effective work in partnership in the intricate, psychologically charged decisions.
Poor communication has led to emotional conflict. These conflicts may be witnessed between family members, the staff at the hospital, or even between the family members and the medical practitioners. A clear example of conflicts can be seen in cases where the patient’s relations ask the doctor for treatment that the doctor deems to be contrary to the patients wishes. Each family should have information on the situation at hand regardless of the outcomes. It is overwhelming that levels of communication satisfaction between the families of the patients who got well and those that passed on were the same at the ICU. This was more evident on the relatives of the patients that were not going to make it through. Interview conducted on the patients of the dying persons which were done months after the discharge, more than half of the respondents reported that the information that they were given was inadequate and that focus should have been on the situation of the patient, the real reason for the death and the treatment that they received especially for pain and anxiety reduction.
The effectiveness of the information that was given to the families was among the top ten most vital needs that was pin pointed at of the families of the dying patients at the intensive care unit. Every medical practitioner should be privy to information that dying patients families need to have this information. The reason for not giving this information should be clearly outlined. Decisions should be shared without victimization of the medical doctor who was involved w\in making of decisions. The members of the ICU should be informed that the families are not only interested in their own self but those of their ill patient. A desirable care level should be upheld during clinical evaluations. Decisions making should be regular and shift to palliative from the curative view. This should also focus on the preferences of the patients as was discussed.
When decision making is shared, with the use of communication that is highly effective, family members will be reassured and feel helpful to the patient. This will essentially lead to the reduction of possible conflicts. Therefore it is important for the families to have correct information passed to them by the ICU members. The ICU members should give information to the families and offer to take part in decision making but not impose a view on them (Azoulay and Sprung, 2004).
The ICU team need to make decision on whether the treatment a patient is receiving is right. This is done by weighing the prognosis, the burdens and the benefits. The care given to the patients and family should be given more weight and value than just the quest for the preservation of life. The wishes of a patient regarding treatment should be respected and must be followed. Some clinician and the public laws may not give a clear line between withholding and withdrawing therapy which has no moral difference. All the stake holders including the incompetent relatives are to be consulted. The patient must be respected by all means and a good communication channel between the families and the doctors must be kept open. Also all the discussions made must be recorded.
Conclusion
Improved, clear and regular information channels should be maintained on the crucial matter. The family needs should be catered for in all aspects if the patient is incapacitated regarding the decision that touches on their well being. Care provided by the family is very important at the end of life crisis. Information alone may not be entirely sufficient, but the use of decision making models need early and accurate information. The surrogates who are willing to help should be given adequate information so that they can aid in the patient’s care. Conferences that the family members have should provide valuable information and an opportunity to give compassion and interest, and therefore provide the confidence that the family is making the right decisions (Azoulay and Sprung, 2004).
Generally, family and friends are not interested in having long relationships with the medical officers who are treating of their loved ones. They are only interested in the support that this people prove along side their sympathy. They require the recognition of the effects of the illness that it has had on them and will forever be in their lives and relationships. When the patient dies, the surrogates require time and a medical officer who can give a chronology of what really went wrong and be able to identify with their problems.
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