Nursing Ethics in Palliative Care: A Case Study on Impaired Decision-Making

Running Head: NURSING ETHICS 1
NURSING ETHICS
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Introduction
A terminal illness has major impacts to the patient and their carers. Once diagnosed, the
patient experiences distressing and painful periods with adverse limitations in the lifestyle
brought about by the illness (Bosslet, et al, 2015). Coping strategies at times can also cause
friction between primary carer and other family members (Haughey& Watson, 2015). Ewing’s
case is already taking that direction. Health professionals can help in ethical issues when they
arise (Wallace, 2015).The person can continue to receive treatment to help manage the
symptoms but not cure their illness (Haughey& Watson, 2015). End of life care helps everyone
affected by the diagnosis have the best quality of life (Goodwin, et al, 2014). It also includes
additional support and help with legal matters.
Values relevant to the case
Eric being Ewing’s carer for the longest time now has a role in supporting Ewing as his
health and ability to care ofhimself diminishes. Being the principal carer he has to help Ewing in
all his activities of daily living which is a more intensive care. As a carer he has a duty to help
the patient to be healthy and well the best way possible (Goodwin, et al, 2014). Ewing’s health
has shifted from curative treatment to palliative care which shows an increase in need for more
support and physical care. This requires an informal carer who will provide physical and
emotional support to a patient with a life limiting illness (Horrell, Stephens &Breheny, 2015).
As a carer, Eric has values of commitment and care. Caring for a sick person is demanding and
exhausting and difficult and requires more patience(Horrell, Stephens &Breheny, 2015). As a
result, commitment needs to be built to improve patient’s care and experience while taking the
necessary actions to handle the challenges ahead. Eric is committed to care for Ewing with the

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assistance from Debbie, Ewing’s daughter.Care as a value is at the center when delivering help
to any sick person. It is a feeling of concern or interest towards them. It helps improve their
health and wellbeing. The type of care depends with the individual needs, choices and wishes in
every stage of their life (Goodwin, et al, 2014). Eric is committed in giving Ewing the best care
even as he nears his death. For this reason, together with Debbie they opt to buy a wheelchair
and a mechanical lifter to help the patient in easy movements around home. He wants the best
care for him and prefers him to be at home for the best palliative care rather than hospital where
the patient may feel lonely, not loved and less catered for. Being a carer to Ewing for nine years,
Eric has altered his own lifestyle to meet Ewing’s needs. It also means accepting the situations
and making adjustments in one’s own life(Horrell, Stephens &Breheny, 2015). Commitment to
care is about giving priority to other things other than oneself(Goodwin, et al, 2014).
Values and their influence in decision-making
Decision-making is about choosing a good choice from the options available through
weighing the positives and negatives of each option available and the outcome of each when
applied to the situation at hand(Holroyd-Leduc, et al, 2016). Based on this the best option is
determined. In relation to the case study, Eric’s decision-making is about what was beneficial to
Ewing at the moment. Ewing’s condition had no known treatment or any form of medication that
would alter the trajectory of the disease. All he needed was palliative care until his time came
(Bükki, et al, 2014). Eric and Debbie had already made a decision to care for him at home. There
was no need for him to be kept under hospital care when there was no proper attention required
at the healthcare. Eric had made a commitment about Ewing’s care and together with Debbie’s
assistance they went ahead and bought the necessary equipment they thought were the best for

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the patient. Out of commitment and care that Eric had created a long-lasting relationship with the
patient. Commitment is not a value for the weak(Holroyd-Leduc, et al, 2016). It requires
persistence, self-discipline and resilience. Eric having made a decision of taking care of Ewing
until his death, he had to stay committed to it. Commitment is about sacrifice. It binds one to a
promise, course of action, a firm agreement and a pledge (Holroyd-Leduc, et al, 2016). He had
made a sincere and a serious decision about the care and was determined to see to its completion.
He is happy when Ewing is discharged for home. He is concerned and more attached to the
patient and looking after him and providing for his needs is his priority (Sizoo,
Grisold&Taphoorn, 2014).
Healthcare professionals and ethical problem solving
The disagreement between the family members on Ewing’s treatment needs to be looked
into on both sides to enable proper understanding that can bring a consensus. The degenerative
neurological condition has already caused severe damages on him and no medication to cure or
improve the problem. Owing to this he can only continue to receive palliative care. The disease
is progressive and death can be reasonably expected.Treatment to Ewing through parenteral
hydration and artificial nutrition was a non-beneficial treatment (Houben, et al, 2014). This is
because the intensity of treatment and the expected degree of improvement in quality of life was
minimal (Haughey& Watson, 2015). The patient was also aware of his condition and felt no need
of going to the hospital though proper monitoring was essential. End of life treatment to him was
ineffective, costly and not in line with his wishes (Bosslet, et al, 2015). This limits medical care.
Veracity in healthcare is important to enable patients and families make informed
consent(Houben, et al, 2014). Patients and families rely on health professionals for information