Rationalism vs Empiricism in Ability to Predict the Future

This is the case study of Mr. Joseph Weber, a 58 years old gentlemen, who has been diagnosed with stage IV Mesothelioma. Mesothelioma is a tumor of the tissue which lines the lungs, stomach, heart and other organs. He is also suffering from Hepatitis B and at the end stage of cancer as well. Because of his health conditions, he is admitted for palliative care to keep him comfortable with medications and nursing care. Palliative care is specialized medical for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve the quality of life for both the patient and the family. Apart from this Mr. Joseph has communication difficulties as he can’t speak. Also, his behavior was found aggressive in the past as he has hit nursing staff, which results in restraining his hands to prevent the staff from physical harm. He is physically weak and suffering from a pressure ulcer which results in muscle wasting. A pressure ulcer is defined as ‘localized injury to the skin and underlying tissue usually over a bony prominence, as result of pressure, or pressure in combination with shear. And when providing care for pressure ulcers he is complaining of pain. In palliative care he was also given an overdose of medication it might be the staff’s negligence of care. In this case study, we can find three ethical issues which include clients' autonomy, non-maleficence and beneficence. Here, Mr. Joseph has refused all the treatments and as a nursing ethic we can’t force him for the treatments though it is harmful and may lead to risk for him but we should respect his choice. Also, his family got his power of Attorney of health and financial matters. The second ethical issues is Non-maleficence , which means ‘above all, do no harm. Here Mr. Joseph has suggested for restraining and also he has pressure ulcer, he is feeling pain every time when we turn him for position change. It should be considered. The third ethical issue is Beneficence, which means ‘above all. Do good. As Mr. Joseph at the end stage of life, he is psychologically stressed as well as his family members are also worried about his condition, they are in dilemma whether these medications and treatments works on him or not.

Whether our role is that of a nurse or other health care administrator, working in the field of health care is both highly rewarding and challenging. Many medical procedures and treatments have both merits and downsides, and patients have their own input and circumstances to consider. Ethics is a branch of philosophy dealing with values pertaining to human conduct, considering the rightness and wrongness of actions and the goodness or badness of the motives and ends of such actions. There are four principles of health care ethics:

• Autonomy: Autonomy refers to the right of the patient to retain control over his/her body. A health care professional can suggest or advise, but any actions that attempt to persuade or coerce the patient into making a choice are violations of this principle. Patients must be allowed to make his/her own decisions whether or not the medical provider believes these choices are in that patient’s best interests-independently and according to his/her personal values and beliefs.
• Beneficence: This principle states that health care providers must do all they can to benefit the patient in each situation. All procedures and treatments recommended must be with the intention to do the most good for the patient. To ensure beneficence, medical practitioners must develop and maintain a high level of skill and knowledge, make sure they are trained in the most current and best medical practices and must consider their patient’s individual circumstances; what is good for one patient will not necessarily benefit another.
• Non-maleficence: Non-maleficence is probably the best known of the four principles. In short, it means, ‘to do no harm. This principle is intended to be the end goal for all of a practitioner’s decisions and means that medical providers must consider whether other people or society could be harmed by a decision made, even if it is made for the benefit of an individual patient.
• Justice: The principle of justice states that there should be an element of fairness in all medical decisions; fairness in decisions that burden and benefit, as well as equal distribution of scarce resources and new treatments, and for medical practitioners to uphold applicable laws and legislation when making choices.

Mr. Joseph is at the end of life. As a carer, we may be looking after a person who has a terminal illness and may be nearing the end of their life. These final months or even days can be challenging, traumatic, exhausting and confusing. Sadly, the time may come when the person we care for is near the end of their life. When this happens our caring role may change and will become more about making the person we care for feel as comfortable as possible by:

• Controlling pain or symptoms of the disease

Providing emotional, spiritual, cultural and psychological support

• Holding to address unresolved issues in their life

A. For Mr.Joseph the first priority is to treat pressure sores which include:

1. Prevent friction and shearing forces during repositioning and transfers

• Lower bed head prior to repositioning
• Use slide sheets to move the patient
• Apply skin dressing

Observe the patient closely for signs of friction and these techniques are to be used in conjunction with manual handling procedure and safe handling of patients and materials procedures.

2. Reducing moisture

• Apply barrier cream
• Keep skin clean and dry
• Investigate and manage incontinence

3. Skin inspection

• Inspect the skin of the patient during each repositioning to identify indications of pressure injury including balancing response, localized heat, oedema, induration and skin breakdown.
• Particular attention should be paid to areas of bony prominence which are at an increased risk for pressure injury due to pressure, friction and shearing forces

4. Positioning and repositioning

• Reposition the patient every 2 hours.
• When repositioning the patient in any position always check the positioning of heels and other bony prominences
• Heels should be suspended off the bed using pillows or gel pads.

5. Nutrition

• Offer frequent fluids and diet to at-risk patients to maintain adequate nutrition and hydration.
• Nutritional support should be designed to prevent or correct nutritional deficits, maintain or achieve positive nitrogen balance, and restore or maintain serum albumin levels. Nutrients that have received primary attention in the prevention and treatment of pressure injuries include protein, vitamin C, vitamin A, and zinc.

B. Try to reduce the use of restraints by assessing the need for change, link the problem, interventions and outcomes.

C. If possible move the patient room to a nearby nurses' station, so that care can be provided shortly and also helpful to check on the client frequently.

Patient choice and autonomy are considered key in palliative care. Autonomy is about a person’s right to make their own decisions. To do this effectively, they need to have enough information. Patients do not always fully understand what they have been told, or they may not have been told. Decisions are best made without undue influence, and the person making the decision should also be deemed capable of doing so. Part of the nurse’s role, wherever possible, is to advocate for a competent patient’s right to decide their own course of action, whether it is something that the nurse feels is appropriate or not. Decision-making is complex and includes cultural and social aspects that are not always acknowledged. It may be difficult to stand by when a patient decides (something against advice) to take a course of action that is not considered ‘acceptable’ or ‘appropriate’. However, if the patient is capable of making such a decision and is well informed of the consequences of their actions, they must be allowed to exercise their autonomy to do so. Palliative care patients are often vulnerable and maybe more easily persuaded to make choices that they would not normally make, such as accepting further treatment that they don’t really want. They may also continue to request treatment that they have been told is futile and may not help. Further examination of their understanding of the situation and their goals is required to help support them in their decision-making.

Nurses are expected to refrain from causing harm, but they also have an obligation to help their patients. Ethicists often distinguish between obligatory and ideal beneficence. Ideal beneficence comprises extreme acts of generosity or attempts to benefit others on all possible occasions. Beneficence also includes protecting and defending the rights of others, rescuing persons who are in danger, and helping individuals with disabilities. For example resuscitating a drowning victim, providing vaccinations for the general population, encouraging a patient to quit smoking and start an exercise program, and talking to the community about STD prevention.

The nurse must not do anything that would purposely harm patients without the action being balanced by proportional benefit. Because many medications, procedures, and interventions cause harm in addition to benefit¸ the principle of non-maleficence provides little concrete guidance in the care of patients. Where this principle is most helpful is when it is balanced against beneficence. Example; Stopping a medication that is shown to be harmful, refusing to provide a treatment that has not been shown to be effective

One of the most common ethical dilemmas arises in the balancing of beneficence and non-malfeasance. This balance is the one between the benefits and risks of treatment and plays a role in nearly every medical decision such as whether to order a particular test, medication, procedure, operation or treatment. By providing informed consent, nurses give patients the information necessary to understand the scope and nature of the potential risks and benefits in order to make a decision. Ultimately it is the patient who assigns weight to the risks and benefits. Nonetheless, the potential benefits of any intervention must outweigh the risks in order for the action to be ethical.