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Case Study: Palliative Health Care Provision

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Case Study: Palliative Health Care Provision

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Case Study: Palliative Health Care Provision

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Write about the Case Study for Palliative Health Care Provision.
 
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Introduction
In the case study provided, Harry Nelson is a terminally ill individual suffering from the last stage cancer. He is required to get medical care from the hospital, however, prefers to get it from his home. The condition of the patient is deteriorating, but due to the experience of not receiving care in many facilities, he refuses to go to the hospital and does not apply to advanced care. His daughter is in constant worry that her father has lost value for life, therefore, seeks for help from the palliative care despite the ethical conflict between them. The team analyses his condition and takes him to the hospital about their professional code of conducts, personal morality, principlism theory and the International Prague Charter relating to palliative care.
 
In case study one, Harry Nelson has cancer which is in its last stages but insists on receiving medical care at his family home. The ethical conflict presented in this case scenario is the palliative care. According to his situation, he is reliable to receive further treatment and health care. Therefore, the palliative medical team finds it fit to take him to a medical facility in spite of his constant protestations (Brazil, Kassalainen, Ploeg & Marshall, 2010). His daughter Stacey is always worried about the health of her father therefore and believes if he got increased medical attention, he would have a chance to live longer. Palliative health care is a policy that is used to guide nurses and caregivers in the provision of health care solutions to the critically ill persons. Palliative care aims in providing patients suffering from chronic illness with mental and emotional care support for the family and the patients. Also, the policy is aimed at helping to relieve or manage the pain a paint is experiencing thus relieving them of their suffering. In the case study, when the palliative care team arrives at Harry’s home to find conflicts however as per the rules guiding them, they take him to hospital despite his refusal (Drummond, Sculpher, Claxton, Stoddart & Torrance 2015).
Regarding the case scenario provided, the legally and ethical approach to addressing the conflict presenting itself is the patient choice. In this method, the family members and the nurses disagree with the personal choices of the patient especially in cases where the decisions are aimed at not helping the recovery process. According to the case study, Harry is aware of is inevitable death and therefore refuses to seek proper medical care because he thinks that it would not be of help to him (Naylor, Kurtzman, Olds & Hirchman, 2011). The law of the land expects that every person receives correct and sustainable medical practice despite his or her condition and their perspectives. Legally Harry is entitled to the choices he makes regarding his treatment process however due to his condition, his legal right to personal choice is objected, and as a result, the palliative team takes him to hospital despite his knockback.
Personal choice also is a logical approach regarding the health of a critically ill person. Many people suffering from chronic illnesses such as cancer prefer to receive treatment at home near their family and friends. However, home treatment may not be effective to the patient who needs constant care and observation. In most observed case, the health of a critically ill person receiving treatment from home tends to deteriorate because they are not getting nursing care at home leave alone the general care given by their family members (Smith et al., 2012). The decreasing health conditions of the patients also puts a strain in the mental and emotional status of friends and relatives as they tend to be always worried about the outcome of the disease. According to the case study, Harry prefers home treatment but while at it; his health deteriorates despite receiving care from his daughter thus forming a cause of conflict between the two individuals. Also, he has his daughter always worried when he chokes on his food prompting her to call the ambulance.
 
The personal choice approach towards palliative care is relevant to the principle guiding medical ethics of selection of medical attention. Many patients who are terminally ill prefer to be treated at the comfort of their homes. In the case scenario, Harry opted to remain at home and receive treatment while at home. However, the home treatment is not effective because his condition is slowly worsening. As part of the patient’s choice site of care, many of them prefer to be treated at home near their loved ones (Snyder, 2012). The home care treatment procedure is a primary therapy for the recovery of the patient because it hastens the process. However, despite the selection made by the patient, it is legally and morally right not to honor the choice if the health of the individual is continually worsening. The scenario provided a clear indication for this when the daughter of the patient called the ambulance that took her father to seek more medical attention.
The personal choice approach is also relevant to the professional code of ethics that govern the nursing health care provision of whole person care. Whole person care is a procedure applied to the patient when treatment therapy seems not to be working or ceases to be effective. Overall care person strategy is aimed at dealing with all life aspects of living of a person. It is designed to improve healing and living rather than dying or pain evasion (Quill & Abernethy, 2013). Whole person care is a procedure that cares for the emotional, mental and physical well-being of the patient. According to the study, a conflict exists between a daughter and her father regarding further treatment for the illness. The patient feels that he is too weak and sickly to gain from any medication; therefore, he refuses to go to the hospital and take heed in preparing for health care that is advanced. Legally and ethically the palliative care unit comes and moves him to a hospital setting.
There is a conflict existing between the daughter and the father because Stacey believes if her father agrees on seeking advanced medical care his health would be improved and elevated towards recovery. However, the father who is a patient in this case scenario is not interested in more health care provisions due to his past experiences whereby he has exhausted all medical care services (Wool, 2013). Harry now does not believe that advanced care would be of help because of the current situation. Currently, his health is weakening further but is ignorant as he believes he cannot be saved and is apparently aware of his pending demise. To avert this mindset patients like Harry should be assisted in seeking attention that aims at reducing physical and psychosomatic problems. In the full care of a person, the dignity and self-worth of an individual are raised hence promotes quality living of the patient.
 
The personal choice approach is a legal and ethical defensible approach addressing palliative care and holds quite a great relevance in the medical code of professional conduct which is reflectivity and ethics. Doctors are supposed to practice reflection of their patient’s condition in an ethical way maintaining high levels of privacy. According to the case study provided, Harry Nelson is a cancer patient requiring palliative care from a hospitalized setting however he chooses to remain at his family home for the same. However, home care does not do favor his health as it is worsening hence his daughter decides to call in the palliative care for support (Cassel & Rich 2010). On arrival, the team realizes that there is a conflict between the two about an attempt to seek advanced medical. Despite the current issues the team examines the condition of the patient and reflects on the best way forward. With the help of Harry’s daughter, they make a joined decision to take him to hospital despite his denial as a step relating to their expected code of conduct of ethics.
The Prague Charter is an international charter whose aim is to urge governments of nations to make sure that palliative care is a right. Working together with individual national bodies such as “European Association Palliative Care,” the charter insists that palliative care provision is a legal right for the affected individuals. The charter provides that all the terminally ill people receive care even though treatment to them has ceased to be of importance or lack meaning. According to the study, the team applies the requirements of the charter and aims to heed to them despite the current existing conflict between Harry and his daughter, Stacey (Spring et al., 2014). When they arrive at the patient’s family home, they assess the condition of Harry and determine that he passes the requirements needed for transport and hospitalization. Despite the constant objections from the patient, they carry him for further medical care regarding the Prague Charter.
According to the charter, the health care personnel should receive adequate knowledge and skills to ease their time when dealing with patients suffering from chronic diseases. When the medical care fraternity can work efficiently with patients needing palliative care, then they are in a position to give advice to family and the patients of the importance of registering for further treatment. About the case study, Harry stopped seeking medical attention and also has not registered for advanced medical care program (Ellershaw, 2011). The act may be out of ignorance or may be out of lack of knowledge of the importance surrounding the program. The palliative care team should have been in a position to follow up if the patient had applied for the program and offer advice accordingly. Harry is aware of his worsening condition is probably not seeking medical care because of the awareness of his near death. About this, the team should be in a position to advise him accordingly so that he can regain his sense of self-worth and value for living.
The theory of principlism is a framework used in the medical field so as to deal with conflicts revolving the health care of a patient with a terminal disease. It also deals in defining the moral ethics that should be followed by practitioners during medical provision for the critically sick. In this theory, four main ideas are used during the delivery of palliative care they include justice, beneficence, non-maleficence and patient anatomy respect. Justice is a principle that promotes same health delivery for the patients needing palliative care (Schmidin & Oliver, 2015). About the case study, the health care team practice of justice when they receive a call from Stacey and respond immediately. Also, they do not give up on their efforts to provide care despite the objections offered by the patient hence promoting justice in their performance. Beneficence and non-maleficence are closely related principles. Beneficence principle seeks to find the benefits that are reaped to seek medical care and the relative cost of the provision while non-maleficence wants to reduce the likeliness of harm. In many instances, nurses and practitioners are forced to respect these principles even though their requirements tend not to comply with the human anatomy or their choices (Duke & Bennett, 2010).
 
To conclude, the Harry is a cancer patient needing health care in a hospital setting, but he opts to stay at home where he raised his family. Due to this reason, an ethical conflict arises between him and his daughter. His daughter believes if he took some time to seek further medical care his illness would be more manageable. However, on the contrary, Harry Nelson does not believe in more medical advice as he has exhausted all the systems and as a result, he does not apply for advanced medical care. His daughter is always worried due to his deteriorating health condition hence calls for help from the palliative care team who arrives to find a conflict between the two individuals. About the conflict, a personal choice approach is used to contact the dispute however in relevance to the principles of health care ethics he is ferried to hospital despite him refusing. The professional code of ethics of importance and ethics is used to deal with the conflict between the daughter of the patient and the patient. The Prague Charter is one of the international charters that guide the palliative care of the terminally ill hence it provides it as a human right to be assimilated by governments. The ethical theory surrounding this conflict is the theory of principlism that suggests that the actions of an individual are guided by their moral and ethical background. The theory is supported by four directives which are non-maleficence, beneficence, the anatomy of human body respect and justice all of which are used by medical personnel to provide palliative care.
 
References
Brazil, K., Kassalainen, S., Ploeg, J., & Marshall, D. (2010). Moral distress experienced by health care professionals who provide home-based palliative care. Social science & medicine, 71(9), 1687-1691.
Cassell, E. J., & Rich, B. A. (2010). Intractable End?of?Life Suffering and the Ethics of Palliative Sedation. Pain Medicine, 11(3), 435-438.
Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes. Oxford university press.
Duke, S., & Bennett, H. (2010). Review: a narrative review of the published ethical debates in palliative care research and an assessment of their adequacy to inform research governance. Palliative Medicine, 24(2), 111-126.
Ellershaw, J. (2011). Care of the dying: a pathway to excellence. Oxford University Press, USA.
Mansfield, S. J., Morrison, S. G., Stephens, H. O., Bonning, M. A., Wang, S. H., Withers, A. H., … & Perry, A. W. (2011). Social media and the medical profession. Med J Aust, 194(12), 642-4.
Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The importance of transitional care in achieving health reform. Health affairs, 30(4), 746-754.
Padeletti, L., Arnar, D. O., Boncinelli, L., Brachman, J., Camm, J. A., Daubert, J. C., … & Israel, C. (2010). EHRA Expert Consensus Statement on the management of cardiovascular implantable electronic devices in patients nearing end of life or requesting withdrawal of therapy. Europace, euq275.
Quill, T. E., & Abernethy, A. P. (2013). Generalist plus specialist palliative care—creating a more sustainable model. New England Journal of Medicine, 368(13), 1173-1175.
Radbruch, L., de Lima, L., Lohmann, D., Gwyther, E., & Payne, S. (2013). The Prague Charter: urging governments to relieve suffering and ensure the right to palliative care. Palliative Medicine, 27(2), 101-102.
Schmidlin, E., & Oliver, D. (2015). Palliative care as a human right: What has the Prague charter achieved. Eur J Palliat Care, 22(3), 141-143.
Smith, T. J., Temin, S., Alesi, E. R., Abernethy, A. P., Balboni, T. A., Basch, E. M., … & Peppercorn, J. M. (2012). American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. Journal of clinical oncology, 30(8), 880-887.
Snyder, L. (2012). American College of Physicians Ethics ManualSixth EditionACP Ethics Manual. Annals of Internal Medicine, 156(1_Part_2), 73-104.
Sprung, C. L., Truog, R. D., Curtis, J. R., Joynt, G. M., Baras, M., Michalsen, A., … & Bulpa, P. (2014). Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study. American journal of respiratory and critical care medicine, 190(8), 855-866.
Wicclair, M. R. (2011). Conscientious objection in health care: an ethical analysis. Cambridge University Press.
Wool, C. (2013). State of the science on perinatal palliative care. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42(3), 372-382.

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