Ms. D.: Patient & Interdisciplinary Team Disagree on Treatment
Sample Solution
Ethical Principles at Issue
Several ethical principles are at play in this complex case:
- Autonomy: The patient's right to self-determination and the freedom to make her own healthcare decisions.
- Beneficence: The ethical obligation to do good and promote the well-being of the patient.
- Non-maleficence: The duty to avoid causing harm.
- Justice: The principle of fairness and equitable treatment.
Ethics Consultation
Given the complex ethical issues involved, an ethics consultation would be highly beneficial. An ethics committee can provide guidance and support in balancing the patient's autonomy with the healthcare team's duty to provide life-saving treatment.
Advocacy Roles of the Oncology Nurse
As an oncology nurse, you have a crucial role in advocating for Ms. D.'s best interests. This includes:
- Open Communication: Maintain open and honest communication with Ms. D., addressing her concerns and fears.
- Empathy and Compassion: Show empathy and compassion, and validate her feelings.
- Education: Provide clear and concise information about her condition, treatment options, and potential outcomes.
- Advocacy: Advocate for her autonomy and right to make informed decisions, even if those decisions differ from the recommendations of the healthcare team.
- Collaboration with the Healthcare Team: Work with the healthcare team to develop a treatment plan that respects Ms. D.'s wishes and addresses her concerns.
- Involvement of Mental Health Professionals: Collaborate with mental health professionals to assess Ms. D.'s mental capacity and to provide appropriate support.
Decision-Making Capacity
Determining Ms. D.'s capacity to make decisions can be challenging, especially given her mental health condition. Factors to consider include:
- Understanding the Information: Can she understand the diagnosis, treatment options, and potential risks and benefits?
- Appreciation of the Situation: Does she appreciate the seriousness of her condition and the potential consequences of her decision?
- Reasoning: Can she reason logically about the information and weigh the pros and cons of different options?
- Expressing a Choice: Can she communicate her choices clearly and consistently?
If it is determined that Ms. D. lacks capacity, the hospital's social work department can assist in identifying a suitable surrogate decision-maker. This may involve appointing a durable power of attorney or a guardian.
It's important to balance respecting Ms. D.'s autonomy with the ethical obligation to provide life-saving treatment. Open and honest communication, empathy, and a collaborative approach can help navigate this complex situation