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Navigating end-of-life decisions in critical care settings

This sample paper presents a nursing discussion broad post on the topic of end-of-life decisions in the critical care setting. The discussion post writer examines the ethical, emotional, and medical issues involved, noting that times have changed and patients, together with their families, have multiple options when it comes to making these decisions. In particular, it is noted in this paper that as time has progressed, healthcare professionals have begun accommodating humane approaches when choosing the different medical interventions present. However, the writer of this discussion broad post also discusses the different ethical dilemmas that may arise due to aspects such as the autonomy of the patients and the shared decision-making involved in this process.

* The sample essays are for browsing purposes only and are not to be submitted as original work to avoid issues with plagiarism.

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Navigating End-of-Life Decisions in Critical Care Settings

End-of-life decisions in the critical care setting are deeply personal and complex, many

times interwoven with serious ethical, medical, and emotional issues. Such a setting presents

healthcare professionals, patients, and families with decisions about the continuation and

withholding of life-sustaining treatments, palliative care options, and quality versus prolongation

of life. These decisions not only test the moral compass of those involved but also underline

patient autonomy, shared decision-making, and ethical standards in medical practice. As

developments in critical care continue to push the frontiers of life prolongation, it is evident that

there needs to be a balance between medical intervention and humanistic approaches when it

comes to navigating these decisions.

One of the key dilemmas with making end-of-life decisions in the critical care setting is

the balancing of life-sustaining interventions with the quality of a patient's life. Medical

technology has significantly improved, especially in the ICU, in such a way that health providers

can sustain life even when a patient is suffering from a grave illness or injury (Akdenis, Yardimci

and Kavukcu 16). This too often begs the question of whether the ability to prolong life is always

in the best interest of the patient. In the case of many critically ill patients, the continued

application of medical intervention is inconsistent with their wishes when the quality of life has

diminished, autonomy is lost, and suffering has been prolonged. The literature has pointed out,

from the perspective of the patients, that the quality of life may override mere survival where

terminal conditions manifest themselves (Spoljar, Curkovic and Gastmans 12). This thus calls for

the need for early and clear discussions of patient preferences and values, and this should ideally

occur through advanced directives or living wills.

Other critical considerations involve patient autonomy, which is usually lost during

critical care due to the fact that a critical care patient is not able to voice his or her preferences.

Decisions may therefore shift to a healthcare proxy or, alternately, family members or legal

representatives of the patient. The problem arises when proxy decision-making may become very

problematic, with distressing consequences especially when family members disagree or are

uncertain about the patient's preferences. In one research, Vogel et al. (2023) showed that family

members of critically ill patients reported significant stress in cases when they had to make

end-of-life decisions, especially when there were no prior discussions regarding the wishes of the

patient. The latter, in particular, underlines the ethical dilemma between respect for patient's

autonomy and the emotional needs and moral beliefs of the family members.

These challenges, in turn, have brought about the need to develop protocols that will

ensure that ethical and informed decisions are made. These include ethics committees, palliative

care teams, and the use of decision aids. Of these, palliative care teams play the central role in

guiding families and patients through the maze of end-of-life care, ensuring that comfort and

pain management, rather than curative measures, are addressed. Studies have demonstrated that

early involvement of palliative care improves patient satisfaction and decreases the length of

ICU stays and use of non-beneficial treatments (Rodin, Swami and Pope 1875). Thus, a more

integrated approach to providing palliative care in the critical care unit would appear to mitigate

some of the ethical tensions that arise in end-of-life decisions.

Decision-making at the end of life within the critical care setting carries profound ethical,

medical, and emotional challenges. A balance between life-sustaining treatments, patient

autonomy, and quality of life thus becomes a complicated process. It is further influenced by the

presence of healthcare proxies, stress that comes with decision-making, and even possible moral

distress among healthcare professionals. The ultimate consideration, however, should be to have

those end-of-life decisions respect the patient's dignity and values while appealing to the

emotional needs of the families and healthcare providers alike.

Works Cited

Akdenis, M., B. Yardimci and E. Kavukcu. "Ethical considerations at the end-of-life care." SAGE

Open Medicine 9.1 (2021): 9-18.

Rodin, Rebecca, et al. "Impact of early palliative care according to baseline symptom severity."

Cancer Medicine 11.8 (2022): 1869-1878.

Spoljar, Diana, Marko Curkovic and Chris Gastmans. "Ethical content of expert

recommendations for end-of-life decision-making in intensive care units." Journal of

Critical Care 58.1 (2020): 10-19.

Vogel, Gisela and Eva Joelsson-Alm. "Shifting focus: A grounded theory of how family

members to critically ill patients manage their situation." Intensive and Critical Care

Nursing 78.1 (2023): 34-48.

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Academic level:

Graduate

Type of paper:

Discussion post

Discipline:

Nursing

Citation:

MLA

Pages:

2 (550 words)