Posted: March 24th, 2023
Issue Identification and Position
The case involves the use of left ventricular assist devices (LVADs), which are mechanical circulatory support gadgets used for end-stage heart failure. The case relates to the ethics of life support and the right of the patient to refuse the treatment regardless of the risk involved, including death. RM is a 71-year-old man who was treated using the LVAD through his spouse’s consent but declined the therapy when he regained his ability to make decisions (Allen, 2019). My ethical position in the case supports the respect for the patient’s autonomy and informed consent. The patient has the right to refuse the treatment that lengthens his life but faces other risks, such as infection, bleeding, and other complications.
The implication of the Issue for an NP
As a nurse practitioner, I will have a responsibility to work directly with patients, examining them, prescribing medications, diagnosing illnesses, and providing treatment. Therefore, the outcome of the case involving the use of LVADs will affect my work directly. I have to make an important decision as to whether to respect the patient’s wish to discontinue the treatment or continue with it to protect life. It is a major ethical dilemma for nurse practitioners who are torn between the need to preserve life and to respect the right of a competent patient to refuse treatment.
Legal, Ethical, and Professional Evidence
Regardless of the commitment and the need to protect life by providing effective treatment, I have to respect the patient’s autonomy and the right to refuse treatment. The right to refuse treatment is entrenched in the law under the decision, such as Cruzan v Director, Missouri Department of Health. The Patient Self-Determination Act is another legal code that protects the right of the patient to accept or refuse treatment (Allen, 2019). Ethically, the patient has the right to make an independent decision under the ethical principle of autonomy. From legal and ethical standpoints, health care professionals cannot coerce or force patients to agree with their points of view regarding their care and treatment.
Strategies and Solutions for Addressing the Issue
The issue can be addressed through communication strategies by convincing the patient to agree to the treatment. Since the healthcare professionals have no legal or ethical authority to force the patient to accept the procedure, they can try to persuade him about the importance of LVAD use to prolong life (Allen, 2019). The health care provider will try to convince the patient that the treatment benefits outweigh the risks. Besides, the doctor will monitor the treatment modality to control the adverse effects. Relaying information to the patient is a critical role of healthcare providers, but they cannot force the patient to agree with their perspective.
Other Ethical Issues
Another ethical issue that emerges in the case entails whether the doctor has the responsibility of offering the most effective care to the patient. In this case, the doctor believes that the use of LVAD is necessary to prolong the patient’s life. Failure to provide the treatment is the same as allowing the patient to die, and the doctor may feel responsible for the imminent death. Nonmaleficence, the principle that requires doctors to avoid “doing harm,” applies to the situation. The doctor may feel that he or she is harming the patient by refusing to offer the necessary treatment that would save or prolong his life.
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