Ethical Dilemmas and Its Effects on Patients, Families, and Caregivers
“Palliative care aims to control pain and manage symptoms” (Palliative care, n.d.) for patients with a terminal illness. During the end of an individual’s life, there are a number of ethical dilemmas that may arise. According to the Hospice Foundation of America, most Americans would prefer to die at home rather than in a hospital (Advance directives, n.d.), however most do not. Most often, this is because the patient has not expressed his or her wishes for end-of-life care and does not have a living will and/or healthcare proxy and is unable to communicate his or her wishes for treatment. End-of-life decisions affect not only the patient, but the families and caregivers as well. In such cases, it may be up to the family or caregiver to decide the patient’s care including curative and palliative measures for treatment. This is when many ethical dilemmas arise.
There are a number of considerations when determining end-of-life treatment for a patient. Even when the patient has outlined his or her wishes, it may ultimately be up to the medical professionals and caregivers to make the final decisions about care. The most significant ethical dilemma may be determining when to end curative treatment in favor of palliative care. Medical professionals are trained to treat a patient with all means available to sustain life. However, many patients choose to end curative treatment in favor of palliative care when they feel that the physical and emotional pain of their illness is no longer bearable. They may also choose to see aggressive treatment that others believe to be futile (Caregiver’s guide, n.d.).
Many times the wishes of the patient conflict with the wishes of the family, but in such cases, the decision is up to the patient, for so long as he or she can communicate. Some patients may express wishes to end treatment when they can no longer live, breathe, speak, or move without medical assistance. They may also choose not to be resuscitated, use a feeding tube, or rely on mechanical ventilation (Caregiver’s guide, n.d.).
The effects of a terminal illness on a patient are not only physical but also emotional and psychological. The patient may experience pain as well as the loss of control over bodily functions. He or she may become frail, nauseous, or constipated, experience anxiety and fear, and have visual or auditory hallucinations. Sometimes patients believe they are stronger or more powerful than they are and try to accomplish things that are no longer possible. They may also believe that those who are caring for them are trying to harm them (Caregiver’s guide, n.d.).
Facing one’s own mortality can lead to a variety of emotions for the patient. He or she may wish to tell someone the stories of their lives. They may wish to be surrounded by family, or left alone. They may feel alone and isolated or fear that they have unfinished business they wish to resolve. It is important for patients to feel they are being heard and supported by their loved ones, and that their wishes will be carried out. “The decision to forego life support is very personal one,” (Caregiver’s guide, n.d.). Often, the patient’s decision is influenced by spiritual and religious beliefs.
Family members of a terminally ill patient also face numerous effects. They are often unprepared for the patient’s death physically, emotionally, or financially. They may feel anger, anxiety, guilt, or helplessness. They may lack knowledge about the patient’s illness and treatment. They may also feel conflicted between honoring the patient’s wishes and their own preferences for end-of-life care. They may also be thrust into the position of caregiver, which can create an additional assortment of effects.
Caregivers may feel a sense of duty to care for their dying loved one, but caregiving can have significant physical, emotional, and financial effects. They may neglect self-care in favor of caring for the patient, which can result in burnout and illness. The substantial demand placed on the caregiver’s time and energy can result in job loss and social isolation as well. Caregivers may experience loneliness, depression, grief, and mourning. They must take care to seek out support, manage stress, and take time for themselves (Caregiving, n.d.). It is important for caregivers to accept help from others, and not take on all responsibilities of caregiving for themselves. After the death of a loved one, caregivers may also “feel an acute sense of loss over the role that caregiving has played in (their) life, or even relief that intense caregiving duties are over,” (Grief and caregiving, n.d.).
End-of-life decisions are not easy and have significant effects on everyone in the patient’s life. It is natural for the patient, family and caregivers to experience grief and fear, but it is important to remember that everyone will experience emotions differently. Ultimately, palliative care is designed to maintain comfort and quality of life for the patient, and support as much physical functioning as possible (Caregiver’s guide, n.d.).
References
A caregiver’s guide to the dying process. (n.d.). Retrieved February 25, 2016, from http://hospicefoundation.org/hfa/media/Files/Hospice_TheDyingProcess_Docutech- READERSPREADS.pdf
Advance directives. (n.d.). Retrieved February 25, 2016, from http://hospicefoundation.org/End- of-Life-Support-and-Resources/Coping-with-Terminal-Illness/Advance-Directives
Caregiving. (n.d.). Retrieved February 25, 2016, from http://hospicefoundation.org/End-of-Life- Support-and-Resources/Coping-with-Terminal-Illness/Caregiving
Grief and caregiving. (n.d.). Retrieved February 25, 2016, from http://hospicefoundation.org/End-of-Life-Support-and-Resources/Grief- Support/Caregiving
Palliative care defined. (n.d.). Retrieved February 25, 2016, from http://hospicefoundation.org/End-of-Life-Support-and-Resources/Coping-with-Terminal- Illness/Palliative-Care-Defined
