The paper "Ethical Issues of the Fundamental Differences in Values between Clinicians and Families" describes that one of the problems in Ayeesa’s case is the language barrier, she is unable to communicate her wishes autonomously. However, an earlier offer to admit her to the local hospice for the control of her symptoms was declined…
One of the problems in Ayeesa’s case is the language barrier, as a result, she is unable to communicate her wishes autonomously. However, an earlier offer to admit her to the local hospice for the control of her symptoms was declined. Similarly, she has also seemed reluctant to see the Macmillan nurse, as well as to undertake chemotherapy. This appears to indicate that the patient is reluctant to continue treatment, since the first surgery and chemotherapy, albeit successful has resulted in a relapse and second-line chemotherapy has also provided only temporary relief. However, her daughter is insistent that chemotherapy is continued for her mother, using a new drug.
This raises ethical issues of the fundamental differences in values between clinicians and families. Trough (2007) points out the clinicians may justify withdrawal of treatment despite the requests of family members on the basis of (a) the inevitability of a prolonged death with unnecessary suffering for the patient and (b) the concern about excessive expense and (c) the moral distress associated with provision of futile care. These reasons may supersede the requests by the family to continue treatment in Ayeesa’s case as well, especially since she appears to show a reluctance to receive further treatment.
Another aspect to consider is Ayeesa’s apparent refusal of treatment as opposed to her daughter’s request for it to continue. Winter and Cohen (1999) point out that advance refusal of treatment is becoming less effective in modern situations because they are required to be precisely worded and have not kept pace with the advances in medical technology. Therefore, an alternative approach that is being developed is valued history, wherein the patient’s values are recorded as the basis for making decisions on medical treatment, because they enable an identification of the patient’s core values and beliefs which are important to the patient, in so far as terminal care is concerned. ...
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