Introduction
Palliative care is a particular branch of medicine that deals with terminally ill patients and their families to ensure that their quality of life is not jeopardized. Terminal illness typically provides patients and their families with traumatic moments that reduce the quality of life and lower life expectancy. Multidisciplinary professionals such as doctors, nurses, counselors, and religious leaders generally provide end-of-life care (Social Care Institute for Excellence, 2009). Although various services are offered, the patients and their families can select what best suits them (Acts of the Scottish Parliament2000 asp 4, 2000). Palliative care is essential as it helps manage pain, offers spiritual support, and ensures a patient leads a comfortable and happy life.
This essay is based on a complex case involving Frank, a patient undergoing home care after several chronic obstructive pulmonary disease admissions, jeopardizing his independence. The multidisciplinary team offers specialized care to ensure that the needs of the patients are addressed at the right time (Taylor et al., 2019). Once the case is analyzed and the multiple needs specified, it will focus more on the selected aspect of palliative care and its relevance (NHS Education for Scotland, 2018). The ethical issues arising from the case are analyzed, and a recommendation is given on offering quality palliative care.
Brief Outline of the Complex Case
Frank suffers from a respiratory disease coupled with a previous history of chronic illnesses. The symptoms displayed by the patient include shortness of breath, inability to perform activities of daily living, and fatigue signaling COPD (Currie, 2017). When the present symptoms are combined with the previous history, it amounts to a complex case requiring multifaceted care (Fearon et al., 2018). Other than the COPD treatment, other health needs by the patient include close monitoring of sugar level and cancerous cells. The complex case affects the patient’s emotional and psychological well-being (Newman and AlBooz, 2008). Frank family must work closely with the medical staff to offer him a higher quality of life.
Franks’s complex case requires a multidisciplinary team treat the different ailments from a professional point of view. According to the Acts of the Scottish Parliament 2015 asp 9, (2015), professionalism in healthcare is improved if each ailment is treated by a specialist. A comprehensive care plan is needed to ensure that all the symptoms are treated (Schofield et al., 2023, p. 26). According to the ethical standards in Scotland governing the health domain, terminally ill patients may have personal wishes that need to be addressed in the hospital domain (Bernat and Beresford, 2014, 287). Some of the wishes may include the withdrawal of medication, which may challenge by the families.
Selected Aspects of Care and Rationale
The selected aspect for Frank’s situation is the withdrawal of active medication. Even though the decision by the patient may be unwelcome by the family members, the medical team is obligated to grant the patient’s wish (Cranmer and Nhemachena, 2013). The rationale of withdrawing care is anchored in the basic principles of palliative care which are improving comfort and autonomy (Beauchamp and Childress, 2001, p. 81). Frank may therefore request the medical team to stop the medication to avoid the prolonged suffering. Further, when Frank thinks he has become a burden to his family without any hope of recovery, he may opt to eliminate the medication to speed up the dying process (Acts of the Scottish Parliament 2007 asp 10, 2007). The decision must however be based on the Scottish legal and ethical framework (Cranmer and Nhemachena, 2013). Frank’s decision to increase his death process by withdrawing care is acceptable if the medication’s side effects compound the pain.
Other Aspects of Care to Be Applied In the Decision
Medication withdrawal is an important aspect that may be considered in palliative care. However, other options may be included to ensure that the patients and their families are part of the decision-making process and that the decision serves the patient’s interest (Hunter and Orlovic, 2018). In the process of implementing the patient’s decision, the care team must educate the family members on the documents provided by the patients such as advanced directives to support the decision (Barnes, 2013, p. 196). According to Scottish health standards, every patient has a right to prepare the advanced directives to be used as a decision when the patient cannot make sound decisions (U.K. Public General Acts 2010 c. 15, 2010). Patients enjoy monotony in palliative care and can make personal decisions regarding their medication.
An advanced directive is a wish provided by patients in writing regarding their treatment towards the end of life. Examples include the will and the anticipatory care plan, which explains what should be done to a person in case the sickness persists in the discourse (Parsons and Preece, 2010). The medical team must however advise Frank on the importance of shared decisions such as sharing with family members (General Media Council, 2022). It is, however, imperative to note that all the decisions must be made in line with the patient’s preferences at all times.
Acts Related to the Family, Capacity, and Consent
Frank’s age and complex medical condition may affect his capacity to make sound decisions. The Nursing and Midwifery Act of 2018 provides a good course of action to ensure better palliative care (Department of Health 2008). Since the patient cannot make the critical decision and give informed consent, the family will be engaged to state whether the patient left an advance directive. If there is no directive, Frank’s family will play a massive role in the successful decision-making (Promote Professionalism and Trust, n.d). Another important aspect is the DNACPR, an acronym for not attempting cardiopulmonary resuscitation if the heartbeat stops. It is an example of an advanced directive the patient gives to ensure their wishes are fulfilled (Ministry of Health and Birrell, 2015). Following the orders ensures that the patients get decent end-of-life care where their wishes are granted (Hazelwood and Patterson, 2018). However, Frank can make the decisions after consulting with his family and ensuring that the orders align with the Scottish code of ethics in palliative care.
Ethical Issues in Palliative Care
Decision-making is vital during palliative care as it determines the trajectory that the healthcare outcome will follow. According to the publication by the UK’s Ministry of Health and Birrell, (2015), the patients’ decisions play a key role in the provision of care and must always be followed when implementing care plans. However, it is essential to ensure that the patients are educated on the ethical and legal issues related to end of life care (Dimond, 2011). In the Scottish context, six main concepts form the decision-making framework that must be followed when deciding the course of action for a patient (Hall and Mitchell, 2016). The aspects include the respect for autonomy, beneficence, no maleficence, communication, shared decision making and justice (Tingle and Cribb, 2014). Respect for autonomy is critical and ensures that all patients have a right to make the final decisions and be provided with the required aspects of care, such as religion and emotional support.
Beneficence is an essential ethical principle in health that ensures that a healthcare provider applies all the knowledge and skills for the betterment of the patient. When a medication is likely to harm the patient in the long run, a doctor who follows the ethical principle will change the medication with a new set that ensures patient safety (U.K. Public General Acts1998 c. 42, 1998). In palliative care, a healthcare practitioner ensures the patient is not in pain. It is, however, essential to note that the doctor does what is best for the patient but also follows the patient’s wishes (Topsfield et al. 2019). The healthcare team must always ensure a balance between the patient’s rights to make decisions and the important health information that may improve the patient’s quality of life.
Nonmaleficence is an essential ethical consideration that ensures the medication team does not harm the patient. The principle ensures that in all the care provisions given to the patients, none inflict pain and cause suffering (Tapsfield et al. 2019). For example, in the withdrawal of medication, the multidisciplinary team has a significant role in ensuring that the withdrawal does not harm the patient in the long run (Parsons and Preece, 2010). The ethical standards provided by the country and the medical team’s role include analysis of the healthcare situation. Each team member offers an expert opinion on the impact of withdrawing the care.
Further, communication with the family and the patient is enhanced to ensure they always speak what is required in the discourse. Continuity of care must always be assured, and monitoring the said symptoms (Akdeniz et al. 2021, p.18). Applying the ethical principle of nonmaleficence ensures that medication withdrawal is conducted in line with the patient’s needs. Justice is an ethical standard that ensures that all people get a fair allocation of resources and treatment regardless of a person’s situation. According to the Department of Health and Richards (2008), justice is given to all patients by ensuring they get the best care services regardless of their family engagement. Since palliative care deals with patients suffering from chronic and terminal conditions, the principal supports the medical team to grant justice and all the resources required to improve better outcomes.
The provision of end-of-life care presents numerous ethical issues that must be addressed. The concept of end-of-life care is a multifaceted area of concern which includes the use of life enhancement treatment, comfort measures, and pain management must be conducted within the dictates of the regulation laws in the medical realm. A policy was formed in 2000 in Scotland to ensure that the needs of the patients were always supposed to be heard and their decisions implemented in delivering quality medication (Long et al. 2008). The incapacity was defined and evaluated by a medical professional. Intervention orders must be documented to ensure that the person suffering from the terminal illness does not make a poor decision based on their health.
The Scotland medical ethics provides for the safeguards, a document representing the incapacitated patient’s interests and rights. The family members have limited powers towards the decision made on a patient who is the primary beneficiary of the care taken to the dying person (Barnes, 2013, p. 201). On the other hand, a power of attorney gives the patient an option to choose a person who will make such decisions in the case of their incapacitation, such as a spouse, a relative, or any other person whom they feel is safe (Jukić, and Puljak, 2018). A power of attorney further allows the patient to represent their interests without being affected by the outcome (Jahn, 2011, p. 225)). Palliative care decision-making follows the ethical trajectory by ensuring everyone makes decisions for the patient’s good or with permission through a power of attorney.
Communication is an essential aspect of the delivery of care. Patients undergoing end-of-life care are prone to hallucinations, which may lead to communication breakdown. Information sharing between doctors, nurses, medical practitioners, and counselors must be guided by the ethical standard of truth, cultural sensitivity, and diversity (Hall and Mitchell, 2016). Since diverse populations have unique communication methods, communication must follow the basic rules for success (Nyatanga, 2021, p. 307). As the patient requests to withdraw care, failure to convey the information correctly may appear to be a ploy by the medical staff to save on their resources. According to the ethical standards guiding communication, the decision will be made after a series of steps and documentation, which helps clarify it.
Ethics is a fundamental concept in the medical profession that allows patients to get better treatment. Ethics control professional behavior and allow the patient’s decisions to triumph (McEwan, 2021). Scottish law provide each profession with a code of ethics which ensures that citizens get higher quality services. In the medical realm, the Scottish government has an inclusive medical ethics to cover all the aspects of care in order to enhance professionalism and accountability (Thompson et al. 2006). Further, the code of ethics improves uniformity in the treatment of patients in the discourse. In palliative care, ethical practices reduce harm and ensure that the patients are always protected from harm.
Identification of the Multidisciplinary Team
A multidisciplinary team is required in complex cases because the patient suffers from diseases that require different specialties. In the hospital setting, there is specialization and division of labor to ensure that every person works in areas where they are highly skilled (Hall and Mitchell, 2016). A multidisciplinary team is, therefore, a team of medical and social professionals drawn from different hospital departments to ensure that a patient receives the best care to be provided (Marriott‐Statham et al., 2023, p.28). Each of Frank’s ailment must be diagnosed and treated by a specialist for high quality care. Counselors must also be present to ensure that they offer guidance and improve the relationship with others.
Team Collaboration
Once the multidisciplinary team is formed, a working procedure and framework must be developed to ensure a smooth flow of work and that transition is effectively managed. The team develops a framework that makes them work together to deliver better services to the patient. The first step is an assessment, where professionals assess the patient differently and offer recommendations and care plans (Finucane et al., 2018, p.14). The tea has to meet to brainstorm the side effect of the medication for each condition and offers an opportunity to deliver better services. The team then ensures that they subdivide the time the patient has to improve their well-being, such as spiritual, emotional, and other reasons for well-being.
Benefits of the Multidisciplinary Team
The benefits of the diverse team of professionals working together to provide better palliative care, as indicated in the Scotland palliative care act developed in 2015, underscored the quality of medication to the patient as a critical issue in care delivery. The team containing different professionals is vital because it promotes holistic care by ensuring that all the medical issues are understood and addressed on time (Bolt et al., 2021, p.104). Further, the team’s work promotes accountability as the different professionals will perform their tasks with integrity. As the team works together, it becomes easier to make referrals and speed up the care process.
Working together ensures continuity of care and enhances pain management. Failure to collaborate may lead to a professional treating an area not under their jurisdiction. Consequently, the patient will likely suffer more in the discourse. Effective collaboration within the team helps provide better decisions in the long run (Healthcare Improvement Scotland, n.d). Since palliative care requires accurate decisions, the multidisciplinary team must work together to make practical and feasible decisions for the patient’s benefit.
Demonstration of Clinical Reasoning and Decision Making Skills for Effective Patient Care
Managing patients and making decisions in the palliative care unit requires practical experience, critical thinking, and knowledge. The best way to demonstrate clinical reasoning is the ability to create a structured approach to making decisions. Further, the treatment accorded to Frank is linked to the evidence given in care for COPD patients (Turner et al., 2011). Further, effective patient care is attained when a medical practitioner can collaborate, think critically, communicate effectively, and offer feedback whenever needed.
Recommendations for Practice
The Scottish palliative framework focuses on making all the decisions based on the patient’s needs. Further, the framework requires that hospitals generate a palliative care team that is well-trained and equipped to handle the situations in the care settings without fail. The main recommendation to improve the service delivery at the palliative care unit dealing with Frank’s case is developing an efficient, holistic assessment procedure that will likely reduce pain as the medical team conducts the various tests (Marriott‐Statham et al., 2023, p.31). The main reason for the formation of the holistic assessment procedure is to ensure all the tests are done in one sitting so that the patient does not give up on the feeling that he is suffering from multiple diseases. Subjecting the patient to different tests may affect their mental health because their life is jeopardized (Mason et al. 2015). The holistic procedure gives the patient hope that there is only one ailment that the doctors and the team are working together to resolve.
The recommendation for practice may be implemented through technology and training. A hospital or a care home opening a palliative care center must dedicate some staff to training to ensure they know the testing procedure for multiple sicknesses (Leadership Alliance for the Care of Dying People 2014). Therefore, the specially trained nurse will make all the necessary arrangements to ensure all the tests are done (Louis, 2020, p. 12). Constant training is also crucial to ensure that the medical staff has the knowledge to deliver better outcomes. The importance of the holistic assessment procedure makes it necessary to train nurses and equip them with the correct technological tools to deal with clients.
Conclusion
Palliative care units are essential in hospital settings as they ensure that people with terminal illnesses experience a higher quality of life through treatment. One of the palliative care unit’s main aspects is ensuring that the patient can make all the final decisions that affect their situation. Since the patient’s decisions are always considered, it is, therefore, the role of the care setting to exercise all the ethical standards and ensure that the patient’s decisions are implemented. An advanced directive is an important document that gives patients a chance to express their wishes. Frank may for example use the document to order the medical team to withdraw treatment if he thinks it is slowing the dying process or if the medication is no longer effective.
Ethical issues are paramount because they support professionalism and ensure that the patients get the proper medication and enhanced quality of care in the discourse. Since a multidisciplinary team is needed for effective service delivery, ethical standards ensure that the team collaborates effectively with each other. The palliative care setting can be improved if the assessment procedure is holistic instead of the independent assessments conducted by various professionals. When a holistic assessment approach is employed, it will positively impact the people.
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