Applying Decision-Making Models In Health Care

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Applying Decision-Making Models in Healthcare

Ethical behavior is being the product of moral sensitivity, judgment, character and also motivation. Kidder Ethical checkpoints are important, and also they are applicable in case of the patients who are suffering from end-stage diseases. Firstly, this model addresses that there is a problem, it helps the doctors or the healthcare specialists to acknowledge, that there is a problem which exists. Then, enough amount of facts is gathered to make an effective decision on that issue. Patients who are suffering from terminal diseases and want to choose euthanasia then this model is often used for them in order to better understand the situation. Since one of my patients was suffering from cancer, and she had no hopes for survival and was in pain as well. On her last visit, she told me that she is going to Holland to end her life via euthanasia since his practice is only allowed in that country. That time I didn't know what to say, but later I wrote the following letter to her:

Dear Catherine,

I know that you are going through a lot. It is very bold of you that you are facing this disease with so much dignity, which is quite rare. When you told me that you are going to Holland to end your life, I was shocked because I thought that you would never consider this option because of your strong personality. Do you have no other option other than this? Do you know that it is not necessary that the process is painless, there are many cases where the process turned out to be quite painful for the ones who wanted to do it? Later it was also reported that they regretted their decision. I would recommend that you don't consider this option because this is also against the sanctity of like and you are giving the right to end your life to a doctor, do you really think that your life is so worthless? Life is all about miracles and science is making so many wonders even regarding end-stage diseases, so who knows that some good happen to you too. Also by choosing this option you are setting an example for other patients to end their life, this way more patients will be willingly or forcefully consider this option and that way the scientific research regarding ending such diseases will also stop because most patients will go for this, which is apparently easy.

My dear Cathrine, I know that the pain is real but don't do that, if today only some countries have legalized it, after your decision, if the number of patients choosing euthanasia will increase, more countries will legalize it and that way, it will also be like playing with God.

I hope you will consider what I suggested and think about it again.

The Kidder ethical checkpoints are significant for patients who are suffering from any kind of terminal diseases. This model is designed in such a way that it recognizes all the possible factors of any problem. This model is helpful in applying the ethical principles that are most relevant and useful to the specific issue. Once the problem is identified then proper solution is also proposed, like in this case if the patient wants to go for euthanasia then after identifying all the factors the patient will be guided accordingly ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"8vbcLoGH","properties":{"formattedCitation":"(Lo & Parham, 2009)","plainCitation":"(Lo & Parham, 2009)","noteIndex":0},"citationItems":[{"id":543,"uris":["http://zotero.org/users/local/4C6u8dIT/items/MLNK3GR6"],"uri":["http://zotero.org/users/local/4C6u8dIT/items/MLNK3GR6"],"itemData":{"id":543,"type":"article-journal","title":"Ethical Issues in Stem Cell Research","container-title":"Endocrine Reviews","page":"204-213","volume":"30","issue":"3","source":"PubMed Central","abstract":"Stem cell research offers great promise for understanding basic mechanisms of human development and differentiation, as well as the hope for new treatments for diseases such as diabetes, spinal cord injury, Parkinson’s disease, and myocardial infarction. However, human stem cell (hSC) research also raises sharp ethical and political controversies. The derivation of pluripotent stem cell lines from oocytes and embryos is fraught with disputes about the onset of human personhood. The reprogramming of somatic cells to produce induced pluripotent stem cells avoids the ethical problems specific to embryonic stem cell research. In any hSC research, however, difficult dilemmas arise regarding sensitive downstream research, consent to donate materials for hSC research, early clinical trials of hSC therapies, and oversight of hSC research. These ethical and policy issues need to be discussed along with scientific challenges to ensure that stem cell research is carried out in an ethically appropriate manner. This article provides a critical analysis of these issues and how they are addressed in current policies.","DOI":"10.1210/er.2008-0031","ISSN":"0163-769X","note":"PMID: 19366754\nPMCID: PMC2726839","journalAbbreviation":"Endocr Rev","author":[{"family":"Lo","given":"Bernard"},{"family":"Parham","given":"Lindsay"}],"issued":{"date-parts":[["2009",5]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Lo & Parham, 2009). A doctor is someone who should cure the disease, not someone to kill a patient even if he/she is dying. No man should have the right to kill another person, in this way the sanctity of life will be disturbed and there are chances that other people will use this method for their personal interests. In today’s time technology has complicated the dying process ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"593rG6y3","properties":{"formattedCitation":"(Thienpont et al., 2015)","plainCitation":"(Thienpont et al., 2015)","noteIndex":0},"citationItems":[{"id":597,"uris":["http://zotero.org/users/local/4C6u8dIT/items/5RBIZRY5"],"uri":["http://zotero.org/users/local/4C6u8dIT/items/5RBIZRY5"],"itemData":{"id":597,"type":"article-journal","title":"Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study","container-title":"BMJ Open","volume":"5","issue":"7","source":"PubMed Central","abstract":"Objectives\nTo identify patterns in euthanasia requests and practices relating to psychiatric patients; to generate recommendations for future research.\n\nDesign\nRetrospective analysis of data obtained through medical file review.\n\nSetting\nOutpatient psychiatric clinical setting in the Dutch-speaking region of Belgium, between October 2007 and December 2011; follow-up at the end of December 2012.\n\nParticipants\n100 consecutive psychiatric patients requesting euthanasia based on psychological suffering associated with psychiatric disorders (77 women, 23 men; mean age 47 years; age range 21–80 years).\n\nMain outcome measures\nPatient sociodemographic characteristics; diagnoses; decisions on euthanasia requests; circumstances of euthanasia procedures; patient outcomes at follow-up.\n\nResults\nMost patients had been referred for psychiatric counselling by their physician (n=55) or by LEIF (Life End Information Forum) (n=36). 90 patients had >1 disorder; the most frequent diagnoses were depression (n=58) and personality disorder (n=50). 38 patients required further testing and/or treatment, including 13 specifically tested for autism spectrum disorder (ASD); 12 received an ASD diagnosis (all Asperger syndrome). In total, 48 of the euthanasia requests were accepted and 35 were carried out. Of the 13 remaining patients whose requests were accepted, 8 postponed or cancelled the procedure, because simply having this option gave them enough peace of mind to continue living. In December 2012, 43 patients had died, including 35 by euthanasia; others died by suicide (6), palliative sedation (1) and anorexia nervosa (1).\n\nConclusions\nDepression and personality disorders are the most common diagnoses in psychiatric patients requesting euthanasia, with Asperger syndrome representing a neglected disease burden. Further research is needed, especially prospective quantitative and qualitative studies, to obtain a better understanding of patients with psychiatric disorders who request euthanasia due to unbearable psychological suffering.","URL":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530448/","DOI":"10.1136/bmjopen-2014-007454","ISSN":"2044-6055","note":"PMID: 26216150\nPMCID: PMC4530448","shortTitle":"Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders","journalAbbreviation":"BMJ Open","author":[{"family":"Thienpont","given":"Lieve"},{"family":"Verhofstadt","given":"Monica"},{"family":"Van Loon","given":"Tony"},{"family":"Distelmans","given":"Wim"},{"family":"Audenaert","given":"Kurt"},{"family":"De Deyn","given":"Peter P"}],"issued":{"date-parts":[["2015",6,23]]},"accessed":{"date-parts":[["2019",1,31]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Thienpont et al., 2015). Although many aspects of medical interventions are widely welcomed, for example, now people can recover from heart attacks, and they can live for many years. But at the same time, it also has created a new phenomenon that the extension of life in a hospital under constant medical care has also reduced the consciousness and lower the quality of life. Some people who see their friends and family under such conditions choose euthanasia as an alternative and a dignified way of achieving death ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hN8mGg7P","properties":{"formattedCitation":"(Gordon, 2015)","plainCitation":"(Gordon, 2015)","noteIndex":0},"citationItems":[{"id":594,"uris":["http://zotero.org/users/local/4C6u8dIT/items/DR7SPZSF"],"uri":["http://zotero.org/users/local/4C6u8dIT/items/DR7SPZSF"],"itemData":{"id":594,"type":"article-journal","title":"Rituals in Death and Dying: Modern Medical Technologies Enter the Fray","container-title":"Rambam Maimonides Medical Journal","volume":"6","issue":"1","source":"PubMed Central","abstract":"In the absence of immortality, the human species has over the millennia developed rites and rituals to help in the passing of life to honor the person who is dying or has died or in some way demonstrate their “courage” and perseverance as well as duty even in the face of almost certain death. The centuries-old traditions of the gathering of loved ones, the chanting of prayers, the ritual religious blessings are in the process of being replaced by the “miracles” of modern medical technology.","URL":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327323/","DOI":"10.5041/RMMJ.10182","ISSN":"2076-9172","note":"PMID: 25717389\nPMCID: PMC4327323","shortTitle":"Rituals in Death and Dying","journalAbbreviation":"Rambam Maimonides Med J","author":[{"family":"Gordon","given":"Michael"}],"issued":{"date-parts":[["2015",1,29]]},"accessed":{"date-parts":[["2019",1,31]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Gordon, 2015). So medical facilities have also complicated the concept of death.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Gordon, M. (2015). Rituals in Death and Dying: Modern Medical Technologies Enter the Fray. Rambam Maimonides Medical Journal, 6(1).

Lo, B., & Parham, L. (2009). Ethical Issues in Stem Cell Research. Endocrine Reviews, 30(3), 204–213.

Thienpont, L., Verhofstadt, M., Van Loon, T., Distelmans, W., Audenaert, K., & De Deyn, P. P. (2015). Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study. BMJ Open, 5(7).