Legal and Ethical Issues in End of Life Care

This article discusses the legal and ethical issues in end of life care, focusing on the importance of holistic care provision and the role of informed consent. It also explores self-care strategies for caregivers and the application of the Gibbs reflective cycle. The case study of a patient with chronic obstructive pulmonary disease and Alzheimer's disease is used to illustrate these concepts.

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Student’s Name
Institutional Affiliation

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Legal and ethical issues in end of life care
Patients with chronic diseases often spend a lot of time in hospitals and healthcare centers
seeking care. Clinicians and nurses interact with these patients for a long time in order to provide
treatment and monitoring of the conditions. They therefore get to better understand the patient
needs and devise a care plan that is all rounded and that seeks to increase patient satisfaction.
End of life care refers to healthcare of people in their final hours of living as determined by their
healthcare providers (Chan et al, 2016). It involves care of terminally ill patients whose condition
has advanced and progressed over time to levels that treatment methods have little or no effect at
all. End of life care like any other form of care provision requires the utmost attention and
dedication of the nursing staff and care providers in order to ensure that the patient needs are
met. There is need to incorporate a holistic care provision plan that values ethics and well-being
of a patient (Bassot, 2016).
In the case study under discussion, Mac is a patient with a history of chronic obstructive
pulmonary disease and Alzheimer’s. These two conditions are chronic in nature and require time
to time monitoring. Due to the nature of his condition, there is need to provide a care plan that
prepares the patient for end of life as well as observes law and ethics. Alzheimer’s disease is a
condition that affects a person memory and causes dementia (Thomas, Lobo & Detering, 2017).
It is a progressive disease that worsens over time. Mac’s is 86 years which suggests that his
Alzheimer’s condition has worsened to alarming levels. His wife states that he is ready to die
indicating that the condition has affected him for quite a long time. She further added that he will
probably die with the next chest pain attack indicating that his chronic obstructive pulmonary
disease had also advanced. Since the patient is considered to be in his last stages of life, there is

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need to respect the patient’s wishes as much as possible during the treatment process (Curtis et
al, 2016).
It is ethical for clinicians and nurses to provide care that values and respects the patient’s
choices and decisions when it comes to deciding on options available for treatment. Informed
consent forms a primary principle when it comes to the care of a patient. Since healthcare should
always be patient-centered, the patient has the right to make decisions on available treatment
forms. Informed consent involves the patient giving permission to receive a certain form of
treatment after clearly understanding what it entails and its side effects (Wright et al, 2016). It
forms an important ethical issue when it comes to health care of any patient. In this case study,
Mac was suffering from Alzheimer’s which is often associated with memory loss. The patient is
therefore not in a position to make sound judgement to the form of treatment and care that they
would prefer. However it is important for the nurse to act in the best interest of the patient at all
times.
The patient in this case should be involved in their care process and advised accordingly
despite the nature of their condition. The final decision in the treatment process should always
come from the patient (Bone et al, 2018). It is always important to maintain respect for all
patients as required by the nursing codes of ethics. The patient in this case seems to use vulgar
language towards the nurse and the wife claims that he could not use search terms if it was not
for his Alzheimer’s condition. As a nurse, it is important to understand the situation of the patient
and comply with their demands in order to maintain respect and dignity of the patient. The
nursing codes of ethics require the nurses to always maintain the highest level of professionalism
and good conduct when attending to patients (Sallnow et al, 2016). It is therefore unethical to use
vulgar language during practice despite insults from the patient.

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Holistic care plan
In order to ensure and establish holistic care that is all round, it would be important to
involve the wife of the patient to provide insights as she had a better understanding of the
progress of her husband’s condition. Dorothy is at a position to give more information about the
patient and therefore involving her would bring influence better end of life care delivery. She is
also the primary care giver at home and therefore interacts with the patient more. In this clinical
case of Mac, there is need to provide care that not only focusses on the physical well-being of the
patient but also his emotional, social and psychological well-being. End of life care aims at
prolonging the life of the patient at all costs. All efforts of nurses and clinicians should aim at
human life preservation and well-being of patients (Halpern, 2015). In order to provide a holistic
care plan, there is need to provide nursing interventions that target memory restoration since the
patient is suffering from Alzheimer’s. In addition to this, preventive measures should be
incorporated in order to prevent exacerbation of the patient’s chronic obstructive pulmonary
disease. Some of the preventive measures include avoiding cigarette smoking by the patient in
case they do. Involving the wife to help the husband remember basic information can be an
effective strategy. Emotional support throughout the disease process is also important in end of
life care. Adequate monitoring of the patient and being present always to assist and attend to the
patient’s needs is important so as to achieve a holistic care provision plan (Aldridge & Kelley,
2015).
Self-care strategies
Patients suffering from Alzheimer often affect the emotional well-being of the immediate
family members and people taking care of them. Dorothy being the wife of Mac is affected by
her husband’s state as she has to cope with his everyday condition of dementia. There is

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therefore need for establishing self-care strategies to help her cope with the situation. She is
bound to face anxiety and depression as she tries to care for her husband. The fact that her
husband is an important pillar of their family and is sick can affect her and lead to depression. As
a nurse therefore some of the self-care strategies I would recommend to help her cope with the
situation would include encouraging her to engage in some stress relieving activities such as
exercising, setting aside time for meditation and yoga or even taking walks in a park to drift her
mind off. Other self-care strategies include healthy eating and spending some quality sleep time
(Singer et al, 2016). In addition to this activities, I would encourage planning consultations with
therapists to assist her cope with the situation.
Application of Gibbs reflective cycle
The Gibbs reflective cycle is a model described by Graham that encourages people to
think and reflect on experiences they had during a specific situation and help them derive lessons
from those experiences for improvement (Waltz, 2019). As a nurse, there are various patient
situations that are bound to occur in clinical practice. Deaths of patients in hospitals due to an
illness can have an impact on those who were caring for the patient especially the nurses
(Sumalinog et al, 2017). One of the situations I recall in my nursing practice involves a patient
called Daniel. He was a 52 year old man who was presented to the A & E following a heart
attack. After immediate angioplasty to unclog blocked coronary arteries he was then admitted to
the hospital wards for further management since there were still signs of restlessness and
shortness of breath observed in the patient.
The doctors in the emergency room had claimed that a significant part of the patient’s
heart had severely been affected by cut off of oxygen and was ischemic. A day after admission
the patient was diagnosed of diabetes and his glucose levels were to be monitored. As the nurse

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taking care of the patient, I ensured that I provided the correct nursing intervention and a patient-
centered care. His condition however continued to deteriorate despite measures taken to stabilize
the patient and he would complain of severe chest pains from time to time. Five days following
his diagnosis, Daniel passed away at around 5 pm. I was caring for a patient at the next bed when
the family members who had come to visit Daniel informed me. I closed the curtains around him
and reported to the nursing staffing and my team leader of the death, leaving his family members
to grieve. Remaining calm and composed in cases of untimely deaths of patients is an important
virtue for nurses (Tanaka, Okamoto & Koide, 2018)
This was my first experience of death and Daniel and I had developed a good nurse-
patient relationship since his admission to the hospital. I did not know how to react to such a
matter and started to blame myself of the untimely death. So many thoughts were running across
my mind and I was feeling a lot of guilt. Daniel had been one of those patients who would
always put a smile on someone’s face and I still could not fathom the fact that he was no more.
He had a cheerful spirit and always had hope despite his deteriorating condition. Later that
evening when speaking to my colleagues and his family, I experienced phases of sadness, lost
strength and grief. I sort to seek comfort from my family members by explaining to them of the
happenings later that night after my shift was over. They gave me encouraging words and told
me that I should not blame myself as it was not my fault. I tried to avoid the thoughts of the loss
as much as I could but it was not possible. According to Husebø, O'Regan & Nestel (2015), how
a nurse copes with a death of a patient often affects emotions and behavior of future similar
happenings.
During the course of patient admission and diagnosis of Daniel, he received support and
attention of relevant healthcare professionals and nursing staff. He had claimed to have previous

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attacks of myocardial infarction but they were not as severe as the last one that saw him collapse.
He had described of having severe sharp chest pains from time to time but they lasted a short
time. On getting the diagnosis of diabetes, the patient had claimed to be quite shocked as his
family has never had a history of the disease. The patient was significantly obese and this might
have been a risk factor for the contraction of the disease. Prior to his death, the patient had
mentioned of how grateful he was to receive care from the nursing department and how happy he
was knowing he would get to feel better. He always showed hope and was friendly to other
patients admitted in the ward. The ward mates would claim of how he was always listening to
them despite his short stay at the hospital. After the death of the patient reflecting back, I felt like
I had coped well with the situation by allowing his family members to grieve and not showing
outward emotions despite the feeling of remorse and shock. Informing the nurse in charge and
other relevant authorities was also a good step as they would know how to better handle the
situation. Potter, (2015) states it is good to maintain a patient confidentiality even when they die
as their information and right to privacy must be respected at all times.
From writing this reflective essay, the writer has learned valuable skills and lessons that
will help them deal with death of patients and cope better with the situations. The experience of
the whole situation and seeking information and advice from peers and mentors has helped me
understand that death of severely ill patients is normal and that I should remain strong whenever
this happens. It has helped me focus on providing the best care possible that I can offer and to
remain calm and composed even when death of a patient occurs. On reflecting on this
experience, it has helped me develop better coping skills related to death of patients despite their
care and how to deal with emotions that come with it. Emotions and grief are normal phases

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experienced by care givers on death of patients and should not be disregarded as they
significantly help in coping with similar future happenings (Sekarwinahyu et al, 2019).

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