Legal and Ethical Decision Making in End-of-Life Care

This assignment discusses the legal and ethical issues and decision-making involved in end-of-life care, focusing on a case study of a patient with COPD and Alzheimer's. It explores the principles of autonomy, beneficence, non-maleficence, justice, and fidelity. The assignment also covers the creation of a holistic care plan for the patient and self-care strategies for the patient's wife. Overall, it emphasizes the importance of understanding and incorporating ethical and legal considerations in end-of-life care.

Running head: HEALTHY AGEING 1
Healthy ageing
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Introduction
Often, individuals suffering from terminal illnesses or chronic conditions like COPD
and cancer desire quality lives and death. In this particular case study, James an 86 year old
white man is admitted and has a history of COPD with Alzheimer’s. As I was doing rounds, I
realized that he was bitter and the wife Lou is full of regrets that Alzheimer’s is driving her
husband crazy and her wish is that her husband could just die. Appropriate ethical and legal
decision making process, implementation of holistic care and self-care strategies improves
the quality of life and death among patients with terminal or chronic conditions like COPD
(Braswell, 2019). Within the framework of this assignment, there will be an analysis of legal
and ethical decision making, creation pf holistic care plan and self-care strategies for both
James the patient and Lou his wife.
Discuss the legal and ethical issues and decision-making for James end-of-life
care.
Autonomy
Autonomy is a word that has its roots in Latin and it means self-rule. What this
basically implies is that an adult is at liberty to decide whatever he/she feels comfortable
with. During end of life care, patients are expected to make certain decisions. The decisions
might be controversial at times (Chan & Webster, 2013). This is where the ethical principle
comes into play. This principle allows any patient to decide whatever is comfortable or good
with them. In this case study for example, James feels that the nurses should not come back
since the sight of a nurse irritates him. The nurse is expected to adhere to his request. In such
cases however, a nurse is allowed to empower the patient so that he/she is aware of the
consequences of any decision. The nurse in this case can therefore educate James the
importance of being around.

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Beneficence
Beneficence is another ethical consideration in end of life care. Beneficence according
to studies, directs all healthcare providers that whatever is provided to the patient should lead
to maximum benefits (Curtis et al., 2016). What this implies in the case of James is that
whatever the healthcare providers do should be in James’ best interests. However, studies
further recommend that whatever is done should not conflict with the patient’s right to self-
determination.
Non-maleficence
The other significant ethical and legal consideration in the case of James during end
of life care is non-maleficence. Studies have reported inflicted harm to patients in end of life
care. The aim of this ethical principle is to avoid intentional harm to the patient (LoPresti,
Dement, & Gold, 2014). This basically means that whatever intervention is carried out on
James and his wife should not harm them in any manner. This is often controversial if a
patient is in need of assisted suicide since it looks harmful overall.
Justice
Often, physicians discriminate their patients based on age, gender and state of the
patient. In end of life care, it is always apparent that the patient would eventually die
(Myburgh et al., 2016). In the case of James therefore, the physician or rather the nurse
should ensure that they are fair in delivering of healthcare to James. James should not be
discriminated just because he is almost dying.
Fidelity
There have reported cases of physicians telling lies or providing false hopes to end of
life care patients and their families (Wright et al., 2016). The ethical and legal principle of

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fidelity discourage such acts. It advocates for truthfulness and faithfulness in delivering
healthcare. The physicians In the case of James should tell James and his wife the truth.
Furthermore, they should advocate for their patients wishes and bolster their decision making
capacities (Sumalinog, Harrington, Dosani, & Hwang, 2016). Ethical and legal considerations
in end of life care is associated with better health outcomes and improves the quality of
dying. It is therefore important that all physicians understand the skills or concepts of ethics
and legal consideration.
The means of creating a holistic care plan for James in collaboration with his
wife Lou.
Patients and their family members or carers have unique preferences, values and
needs in their lives. If healthcare adheres or dwells to this preferences and values of the
patients, the outcome is likely to be positive. The type of healthcare or approach that adheres
to the abovementioned factors is known as holistic approach to healthcare. Several studies
have proposed the need of holistic approach in end of life care as a physician, I would employ
the same in the case of James (Ullrich et al., 2016). The best means to create the holistic
approach is through communication with the patient and his care giver or family who is Lou
the wife. I would communicate with her to find out what are the preferences, values and
needs of the patient. I would therefore employ effective communication skills like active
listening during the entire process. Fromm the feedback obtained, I can then proceed to
implement the holistic approach to James
Self-care strategies I would recommend for Lou
Chronic conditions are associated with a lot of stress to the patients. Studies therefore
propose different self-care strategies to keep the stress at bay. In this case, I would
recommend maximum hydration to the patient. I would also advise Lou to assist her husband

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take enough restroom breaks (Wachterman et al., 2016) .Furthermore, I would encourage her
to prepare favourite meals to James. Regular exercise is also necessary. I would also advise
Lou to create a health sleeping environment for James (Weissman et al., 2016). Keeping in
touch with the family is also important and I would therefore encourage Lou to come along
with close relatives to visit James.
Conclusion
It is the desire of each patient to experience a quality life and quality death. This is
only possible if the physicians or healthcare providers understand the different ethical and
legal considerations during end of life care such as autonomy, justice, beneficence and non-
maleficence. Furthermore, they should formulate care plans depending on the needs or
desires of the patient such as culture and holistic approaches. Other studies acknowledge the
importance of self-care strategies during end of life care. Further research should be
conducted to come up with better ways of handling end of life patients. Furthermore, it is
necessary for all healthcare providers to understand the importance of end of life care and
incorporate it in their routine practice.

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