- Discuss the ethical role of a manager in a long-term care facility when faced with a family decision to withhold nutrition and fluids to a terminal and semi-comatose patient.
- Refer to Hodgson’s ethical decision-making framework or other ethical decision-making frameworks of your choice.
In long-term care facilities, managers are often confronted with ethically complex decisions, especially concerning end-of-life care. When a family decides to withhold nutrition and fluids from a terminal and semi-comatose patient, the ethical role of the manager becomes critically important. Using Hodgson’s ethical decision-making framework, we can explore how a manager might navigate this challenging situation.
1. Recognizing the Moral Issue
The first step involves recognizing that the decision to withhold nutrition and hydration involves significant ethical considerations, such as the patient’s right to life and dignity, the family’s wishes, and the potential for suffering.
2. Making Moral Judgement
After recognizing the moral issues, the manager must make a judgement. This involves considering the moral principles of autonomy, beneficence, non-maleficence, and justice:
- Autonomy: Respecting the patient’s previously expressed wishes if available (e.g., through advanced directives) or the surrogate decision-makers’ understanding of the patient’s wishes.
- Beneficence: Acting in what is believed to be the patient’s best interest, which in some cases might mean agreeing to palliative care that includes withholding nutrition and hydration to prevent suffering.
- Non-maleficence: Ensuring that the decision does not harm the patient. This is complex because withholding nutrition and hydration will hasten death, though it may relieve suffering in a terminal condition.
- Justice: Considering the fair allocation of resources and treatment, ensuring that the patient’s care decisions are in line with what would be offered to any other patient in a similar condition.
3. Establishing Moral Intent
The manager must establish the intent behind the decision. The primary intent should be to honor the patient’s wishes and well-being, not simply to comply with family requests or to alleviate the discomfort of the care team or to manage resources.
4. Engaging in Moral Behavior
Action is required to implement the decision ethically. This involves:
- Consulting with the care team, including doctors, nurses, and possibly an ethics committee, to review the patient’s medical condition, prognosis, and the ethical implications of the decision.
- Communicating transparently and compassionately with the family to understand their perspective, ensure they comprehend the situation, and explain the ethical framework guiding the decision.
- Ensuring that all legal requirements are met, such as verifying the legality of the advance directives or the legitimacy of the surrogate decision-makers.
5. Reflecting on the Outcome
After the decision is implemented, it’s important to reflect on the outcome. This reflection can help assess the quality of the decision-making process and its adherence to ethical standards. It also serves as a learning opportunity for future ethical dilemmas.
Alternative Frameworks
Other frameworks, such as the Four Quadrant Approach or the Principle of Double Effect, might also be utilized depending on the specifics of the situation and the philosophical leanings of the healthcare facility’s policy.
In all cases, the manager’s role is to ensure that the decision-making process is thorough, ethical, and transparent, prioritizing the patient’s dignity and rights while carefully considering the input and circumstances of the family.