Ethical End of Life Decisions and Different Considerations - Essay Example

? Ethical End of Life Decisions and Different Considerations: A case of Systemic Lupus Erythematous (SLE) Patient College) This paper will try to discuss and justify my position to support the continuity of life of patients with Systemic Lupus Erythematous (SLE) in reference to various end of life decisions by looking into the different aspects of medical care as well as the ethical, social, and financial considerations that should be taken relative to the patient’s medical care.It consulted several academic materials in order to support and understand the above considerations to support the authors claim. Keywords: Systemic Lupus Erythematous, end of life decisions, ethical, financial, social, legal considerations. Ethical End of Life Decisions and Different Considerations: A case of Systemic Lupus Erythematous (SLE) Patient Systemic Lupus Erythematous (SLE) is an autoimmune disease which presents with antibodies that attacked nuclear antigens can affect multi organ system in the body and is prevalent to female sex with 9:1 female to male incidence ratio (Rahman and Isenberg, 2008). Various studies (Lee et al, 2010; Petri and Lazaro, 2009; Edworthy, 2005; and Ticaniet. Al, 2006) suggest that signs and symptoms commonly identified were butterfly rash over cheeks, photosensitivity, erythematous rash to areas exposed to sun, fatigue, malaise, early bruising, sudden weight gain or loss, hair loss, Raynaud’s phenomenon, joint pain and swelling, ulcers of the mouth and nose, plueritis, pericarditis, low grade fever, diarrhea and nausea and vomiting, hence identified as having multisystem effects. By this, SLE is considered to be one of the most serious rheumatic diseases however; the cause of death may not be directly attributed to the condition but to one or another of its many complications especially for severe cases (“Systemic Lupus Erythematosus Prognosis”, undated). Death is the inevitable part of living, it may come of old age and serious illness or may come violently and sudden in case of accidents. To date, with the advancement in technology and medical facilities, life can be prolonged through life support systems resulting to a stable increase in the number of elderly people worldwide. These events resulted to some serious and various discussions on the ethical and other issues regarding the end of life decisions (“End of Life Care”, 2005). On this paper I will try to discuss and justify my position to support the continuity of life of patients with SLE, looking into the various aspects of medical care as well as the ethical, social, and financial considerations that should be taken relative to the patient’s medical care. A hypothetical scenario on the case of a 38 year- old woman was also presented earlier. The woman complains of fatigue, weight loss, oral ulcers, and malar rash around her cheeks, some hair loss for the past month and a bilateral color changes in her extremities which is induced by stress or variants in temperature. She was also seen in the emergency room two (2) weeks ago complaining of nausea, vomiting, diarrhea, rash on her legs which was attributed to her travel to Brazil three (3) week ago, after the diagnosis the symptoms have resolved. Currently, she is not on any prescriptions or over the counter medications. Her past history is consistent of appendectomy at the age of 16 years and three (3) caesarian deliveries. Her family history is positive for hyperthyroidism in her mother and HTN in her father. Based on this scenario, the expected prognostic outcome of this patient is that she has a Widespread SLE. This chronic, lifelong disease was evident in her diagnosis and in the signs and symptoms she is experiencing. The disease may have started at her digestive system given by the various digestive related signs that she indicated during her medical consultation. She is already experiencing symptom relapses or flares from time to time but she can still do her normal activities 90% of the time as she was able to work and travel. Tests and treatments for other organ involvements must be regularly done to decrease the chances further disease improvement and avoid the major cause of death related to SLE. With the advent of sophisticated medical interventions and early disease diagnosis there is a very good chance (85-95%) that she will live ten years or more. It can be noted that since her SLE were diagnosed later in her life (after 38 years), it was considered less serious than those patients with SLE during their childhood teenage (“Systemic Lupus Erythematosus Prognosis”, undated). By this prognosis, there are several ethical decisions that the patient and her family will have to consider to enable the patient to live as normally as possible. Some of the considerations to be considered are the ethical, social, financial, and the medical treatments to use on the patient relative to its care. SLE as provided for by evidences stated earlier in the paper may pose danger to the life of the patient given improper and insufficient medication. There may come a time where the patient or the family shall be faced with the question on whether or not to extend the life of the patient, the dreaded end-of-life decisions. SLE as a rare and multifactorial autoimmune disease entails a costly medical attention.In 2009, Li et al., observed that the mean annual medical cost consumed by SLE patients is $16, 089 which was significantly greater by $6,831 than those consumed by non SLE patients. They also provided evidences that the cost of medication is increasing by 16% annually with even higher cost incurred by severe SLE patients. Their study suggested that the high cost of medical treatments can be attributed to frequent disease activity and the need for medical attention. It was provided that the outpatient care (dialysis, laboratories) can be accounted for the largest share in the cost (49-56%) followed by in patient (transplants, other operations) with 16-17% annual cost and the rest of the share is filled for by prescription drugs. Similarly, Kan et al. (2013), the cost of healthcare utilization is significantly higher for SLE patients with an annual cost of $9,238 higher than for non SLE patients and $49,754 for SLE patients with severe flares. In this case the patient and the family are faced with the financial aspect of treating the patient. In this aspect, there are several ways to resolve this, in her case where she can still function normally and work this may not be a problem. However, when time comes that she can no longer do her normal chores, she can opt to undergo hospice care and the expenses be augmented by the Medicare or by friends and relatives. According to “End of Life Care” article, there are about 3,000 hospice programs operating in the United States. With the changes in the government policies patients can be somewhat assured that they can receive the just and right medical care even under hospice program. One of the ethical considerations on the end of life case is on pain and psychological disturbances management wherein the importance of treating the symptoms and addiction issues are being evaluated. SLE patients may experience intensified pains, as well as anxiety and depression. These manifestations on patients can be relieved by surrounding the patient with love and care among family members and regarding them as normal and not as fragile and vulnerable persons in the middle of a very serious illness. If those cited above is still not enough, use of narcotics and other pain relieving drugs can be advised by giving it to the patient with consent from the deciding authority (if the patient herself cannot) and through proper admiration with accordance to law (“End of Life Care”, 2005) Another of the ethical considerations is the withdrawing or withholding a certain medical treatment say, dialysis. In the case of SLE patient undergoing dialysis, the ethical decision to continue or discontinue the process. Since it is a time consuming and rigorous process the patient may evaluate it as obsolete and they may decide to stop the treatment. Some physicians may not advise for the patient to stop it for her own good but in this case, the decision to stop is on the patient herself along with some guideline to follow. Among the guidelines identified are for the patient to either becapable of making decisions and decided to forgo the treatment and the physician himself consider the treatment no longer beneficial in the course of medication, however, communication is important and both parties must understand the consequences of these action. Ethical treatment decisions must be a shared responsibility of the patient and the physician. The need for the physician to inform the patient of the progress or any improvements related to the disease as well as their obligation to provide the patient with the outmost care and most sophisticated and beneficial treatments must be on a mutual understanding basis. However, when there is conflicting ideas on the course of medication, it is the right of the patient or its deciding authority to decide, not discounting the fact the physician had done what he can to communicate and relay the consequences of such decision (Walker, undated). In most cases, ethical treatment decisions should be shared between physician and patient. The physician has an obligation to inform the patient of established treatment options and then to recommend the treatment he or she believes is in the patient’s best medical interest.5 The patient then accepts the physician’s recommendation and consents to treatment, chooses an option other than the recommended one, or chooses to forgo the treatments altogether. In each case, the physician fulfils the ethical obligation to benefit the patient while minimizing harm. The patient, in turn, exercises his or her autonomy in either choosing treatment or refusing it. Even though this shared decisional process may result in conflict, in most cases of treatment refusal the patient’s autonomy should prevail. This does not mean that the physician should not attempt to persuade the patient to act in what the physician believes to be the patient’s best medical interest, but it does mean that the physician should not attempt to coerce the patient’s decision. The quality of life of patients with SLE can also be considered as one factor affecting the end of life decisions of patients and their families. Among the SLE patients diagnosed relative to the age of the woman in the case studies, they have a chance to do their 80% of their normal chores in between medication and symptom relapse. Though some may experience anxiety and depression, the support of family members can be beneficial to them. According to some of the SLE patients in the Lupus Foundation, they can still undergo their education, some have a happy married life, and others even started their own business and do some volunteer works. They did not live the life as a patient but rather live their lives accepting their disease and understanding its complications and adapt to it in the process (“Lupus Stories”, undated). SLE patients and their families may have to wait until to prognosis take effect to be able to understand the concept of medical futility. However, if the case arises, the patient or the deciding authority in behalf of the patient may forgo the any medical treatment that he deemed futile and may not benefit her condition any further. The role of the physician to inform the patient and their families in the futility of a certain medical treatment or life sustaining devices is part of his or her moral obligation to the client, in case disagreements arise, both of them must be informed of the decision of the patient or its deciding authority and the consequences of the decision to be able to uphold both their moral values (Walker, undated). It is of outmost important to note that any medical treatment given to any patient regardless of the disease to be beneficial for the patient and doing no further harm in the process. These can only be done through the appropriate use of any medical intervention and good communication both on the side of the physician and the patient with their families. If these were the case, patients with SLE or with any other illness can be assured of a proper medication and better quality of life even in their disease beds. SLE is a rare and autoimmune disease effecting multi organ system. This disease given proper medication and considering the various ethical decisions regarding end of life can still render the patient to function as normal as possible. The financial aspect, though the disease implied a huge medical cost, it won’t be a problem given that the patient can still expect to function normally and work, other methods to augment the medical cost can be hospice care and to use Medicare, family members and relatives cannot be also discounted to help with the costs and even friends that is into the medical field. The most important is not to overwhelm the patient with the expenses but to surround her with moral and spiritual support during the ordeal. The pain and psychological management can be relieved by surrounding the patient with love and care among family members or through the proper and legal administration of pain relieving drugs. It is also important to note that the both the physician and the patient can withdraw or withhold the use of life sustaining interventions with the proper communication and shared responsibility on the basis of medical futility or benefit. Given the experiences of other SLE patients, it can be summed up that though they have this rare and multi organ system disease, they can still do the things they wanted to do and live the quality of life they adhere if they started to understand the disease and adapt to it. References Cecil, R. L., Goldman, L., & Schafer, A. I. (2012).Systemic Lupus Erythematosus. Goldman'sCecil medicine (24th ed., pp. 1697-1705). Philadelphia: Elsevier/Saunders/. Edworthy SM. Clinical Manifestations of Systemic Lupus Erythematosus. In: Harris ED, et al, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: WB Saunders; 2005:1201-24. End of Life Care: An Ethical Overview. (2005). Center for Bioethics. University of Minnesota. Retrieved from http://www.ahc.umn.edu/img/assets/26104/End_of_Life.pdf Kan, H. J., Song, X., Johnson, B. H., Bechtel, B., O’Sullivan, D., &Molta, C. T. (2013). Healthcare utilization and costs of systemic lupus erythematosus in Medicaid. 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