After reading Chapter 14 and reviewing the lecture powerpoint (located in lectures tab), please answer the following questions. Each question must have at least and you must use at 1. What signs might alert you to a potential professional boundary violation or crossing? 2. Contrast the terms terminal sedation , rational suicide, and physician-assisted suicide. 3. Identify at least 3 moral dilemmas that occur during end-of life care and decision making.
1. Signs that might alert one to a potential professional boundary violation or crossing in the context of end-of-life care can vary based on the specific situation and individuals involved. However, there are several common signs that professionals should be aware of. These signs include:
a) Excessive personal involvement: When a healthcare provider becomes overly emotionally invested in a patient’s well-being or develops personal relationships that go beyond the professional scope, it may indicate a boundary violation. This can include sharing personal information, excessive gift-giving, or engaging in inappropriate physical contact.
b) Poor boundaries with confidentiality: If a healthcare professional reveals sensitive patient information that should be kept confidential, it suggests a boundary crossing. This could occur through gossiping with colleagues, discussing patient cases in public spaces, or sharing confidential information without the patient’s consent.
c) Dual relationships: When a healthcare professional starts to have multiple roles with a patient, such as becoming their friend outside of the professional setting, it can lead to boundary violations. This blurring of boundaries can compromise the objectivity and professional judgment necessary for providing appropriate care.
d) Overstepping professional responsibilities: If a healthcare professional begins to take on tasks or responsibilities that fall outside of their role or professional competence, it may indicate a boundary violation. This can include providing financial assistance, participating in decision-making on behalf of the patient without proper consent, or engaging in non-clinical tasks that are better suited to others.
2. The terms “terminal sedation,” “rational suicide,” and “physician-assisted suicide” are distinct concepts related to end-of-life care:
a) Terminal sedation: Terminal sedation is a medical practice that involves administering medication to a terminally ill patient to relieve intractable suffering by inducing a state of sedation or unconsciousness. The primary intention is to alleviate suffering, even though it may hasten the process of dying. This practice is ethically permissible in situations where the patient’s suffering cannot be effectively alleviated through other means.
b) Rational suicide: Rational suicide refers to an individual’s decision to end their own life in a situation deemed to be rational and based on informed consent. This concept is highly controversial and raises significant ethical, moral, and legal debates. Supporters argue that individuals should have the right to determine the timing and manner of their death when facing an incurable illness or unbearable suffering. Critics argue that it challenges the sanctity of life and raises concerns about the potential for coercion or the devaluation of vulnerable populations.
c) Physician-assisted suicide: Physician-assisted suicide involves a medical professional providing the means (such as medication) and guidance to a terminally ill patient to voluntarily end their own life. This practice is typically regulated and requires the patient’s informed consent and adherence to specific legal and procedural safeguards. Physician-assisted suicide is currently legally permitted in a few jurisdictions worldwide, and its acceptance varies within different cultural, legal, and ethical frameworks.
3. Moral dilemmas frequently arise in end-of-life care and decision-making, reflecting complex ethical and moral considerations. Three such dilemmas include:
a) Autonomy versus beneficence: One common moral dilemma arises when patients express a desire for certain interventions or treatment options that may be at odds with healthcare professionals’ judgment of what is in the patient’s best interest. Balancing respect for patient autonomy with the duty of healthcare professionals to promote the patient’s well-being presents a challenge. For example, a patient may request aggressive and potentially harmful treatments even though the medical team believes palliative care would offer a better quality of life.
b) The role of family and surrogate decision-making: In situations where patients are unable to make decisions for themselves, such as when they are incapacitated or lack decision-making capacity, determining who should make decisions on their behalf can be ethically complex. Conflicts may arise when family members have divergent opinions or when the patient’s wishes are unclear. Healthcare professionals must navigate these conflicts, respecting the principle of autonomy while considering the best interests of the patient.
c) The allocation of limited resources: End-of-life care often involves decisions about the allocation of limited medical resources, such as intensive care unit beds, organs for transplantation, or expensive medications. Balancing the equitable distribution of resources with individual patient needs can create ethical dilemmas. Decisions may involve considering the efficacy and cost-effectiveness of treatments, predicting patient outcomes, and addressing concerns of distributive justice.
In conclusion, professional boundary violations or crossings can be identified through signs such as excessive personal involvement, poor boundaries with confidentiality, dual relationships, and overstepping professional responsibilities. Terminal sedation, rational suicide, and physician-assisted suicide are distinct concepts in end-of-life care, each with its ethical implications. Moral dilemmas in end-of-life care commonly revolve around autonomy versus beneficence, the role of family and surrogate decision-making, and the allocation of limited resources. These dilemmas require thoughtful analysis and consideration of ethical principles to make appropriate decisions.