Five Principles Help Resolve Ethical Dilemmas in Care
SEATTLE--Physicians and nurses frequently confront ethical dilemmas in caring for cancer patients, and these must be resolved on an individual basis, through established principles, Tom McCormick, DMin, senior lecturer in medical ethics, University of Washington, told the Association of Pediatric Oncology Nurses. "I don't think we'll ever see the day," he said, "when we can put all of the alternatives into a computer, press a button, and ask the computer to come up with a decision."
SEATTLE--Physicians and nurses frequently confront ethical dilemmasin caring for cancer patients, and these must be resolved on an individualbasis, through established principles, Tom McCormick, DMin, senior lecturerin medical ethics, University of Washington, told the Association of PediatricOncology Nurses. "I don't think we'll ever see the day," he said,"when we can put all of the alternatives into a computer, press abutton, and ask the computer to come up with a decision."
Dr. McCormick outlined five principles to guide the health care providerin making ethical decisions: (1) Respect the autonomy of the patient andthe family; (2) balance the benefits with the burdens of therapy; (3) attemptto do no harm while providing benefit to the patient; (4) seek justicesuch that those who are poorly educated or do not have access to healthcare insurance are not deprived of the resources of the health care community;and (5) maintain integrity and veracity in the professional relationship.
Because even health care professionals are influenced by personal biasesand value judgments, the last principle is especially important, Dr. McCormicksaid. For example, personal bias might drive a health-care provider topush for intensive therapeutic interventions, when considerations of qualityof life or helping the patient to achieve a "good death" mightbe more appropriate.
The nursing staff are often the first to become aware of this shiftin what is truly in the best interest of the patient. "The cure orientationof the medical staff and the care orientation of the nursing staff willsometimes come into conflict," he said. It is therefore importantthat institutions have mechanisms, such as ethics conferences or care plandiscussions, to resolve these conflicts, and that nurses be included inthese discussions.
Ethical dilemmas may arise from a conflict between the health care professional'smoral duty to provide the greatest benefit for the patient (the principleof beneficence), and the need to respect the patient's own informed choiceregarding treatment (patient autonomy).
"The right to consent to treatment also encompasses the right torefuse treatment," Dr. McCormick said. "We often discover thatpatients have goals and values that differ from the traditional goals ofhealth care."
Issues in Pediatric Oncology
In pediatric oncology, decisions regarding the best interest of thepatient are further complicated by the inability of children to make informeddecisions.
At times, the desire of the parents to prolong the life of their childmay be so overwhelming that the quality of the child's life is ignored,even when there is little hope for a cure. Dr. McCormick recommended thedevelopment of age-appropriate consent forms so that children might trulytake an active role in their own care.
Finally, Dr. McCormick outlined a formal framework of questions designedto make the process of resolving ethical dilemmas in patient care an easierone, or to justify one choice over another.
