Autonomy and Terminal Illness
The attending physician should not write a DNR order without informing the patient. It is the right of the patient to know the treatment administered to her (Kilpi, 2000). Sally is in denial that she is terminally ill (Crigger, 1998). The cancer is so advanced that its reversal is impossible. Her husband is aware of this and has agreed with the doctors on the treatment to be offered. Sally on her part believes that the doctors are not doing enough to save her life (Crigger, 1998).
She points out to the case that the doctors are unable to successfully carry out thoracentesis as incompetence on their part (Crigger, 1998). The doctors believe that the reason for the gravity of her sickness is her denial. From this, it is obvious Sally will reject a DNR order as well if informed (Crigger, 1998). The physician can opt to give a DNR order. However this will be against the patients’ rights (Kilpi, 2000). The physician has to inform Sally of the decision even if she has to refuse it.
He has to explain to Sally the reason for the decision (Crigger, 1998). It is evident that her body is weak and liable to reaction to some treatments. Medical records show that her bone marrow cannot sustain the full course of chemotherapy. He should try to convince her to accept her fate and collaborate with them in administering the required treatment.
The oncologist should give all the information about Sally to the physician (Crigger, 1998). This will help in administering the proper treatment which is required. It is the right of a patient to have her medical records kept private (Kilpi, 2000). The oncologist while revealing Sally’s medical condition should be guided by this principle (Crigger, 1998). He should make sure that the information is not disclosed other than for the purposes of treatment. This should be done with the patient’s consent. The oncologist should also be informed of the DNR order (Kilpi, 2000). In turn, he should assess the consequences of the order to the patient’s health. Then he should explain to the patient the implications of this order.
Sally’s husband should also be informed of the DNR order (Crigger, 1998). The patient being his wife, the outcome of the process directly affects him. He has already admitted that his wife sickness is terminal. However, he should not arrange his wife’s treatment without informing her. He should also seek consent from his wife, while revealing details about her sickness to the attendant (Kilpi, 2000). If in any case the physician informs him about a DNR order, he should make a point of informing her wife. He should act within the principle of confidentiality in his wife’s health matters (Kilpi, 2000).
The attendant should carefully examine the patient’s health records. Despite the terminal illness, the patients’ rights should be observed (Crigger, 1998). The rights of the patient should guide any treatment decision undertaken. He should keep the patient’s medical records confidential (Kilpi, 2000). However, medical rules supersede patients’ right or wishes. The attendant should take control, if the patient seems to overrule medical decisions.
He should carefully examine the case and the medical records. He should examine the patient’s behavior throughout the process. After this he should decide on the proper approach to the case. Sally has refused to accept her condition (Crigger, 1998). She continues demanding treatment, which her body cannot cope with. These treatments might result in premature death. Others will be futile and a waste of resources.
The attendant should try and make Sally feel taken care of (Crigger, 1998). He should try to convince to accept a DNR order. He should try to explain its benefit towards her recovery. Should Sally fail to agree with DNR order, medical ethics should be the key (Crigger, 1998). The attendant should continue with the DNR order despite Sally’s resistance to the order. This is because in such a situation, medical ethics take preference over the patient’s rights (Kilpi, 2000).
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