Carol Cummings, RN, BSN, Expert on Aging Well

Contact Carol
29 September 2020

Caring for a terminally ill patient at the end of life is one of the most difficult and complex challenges families and health care providers will face. It often poses a number of gut-wrenching questions for which there simply aren’t easy answers. When should life-sustaining treatments like breathing machines or feeding tubes be started, continued, or stopped? What should family members and health care professionals do if a patient refuses treatment that promises to be medically helpful? Who should make health care decisions for patients when they are unable to communicate or decide for themselves?

These ethical questions arise when the right thing to do is not clear or when people disagree about what is best for a person who is ill. So how do we best navigate these difficult scenarios? In the October edition of Brookdale’s Optimum Life Continuing Education, Medical Ethics at the End of Life, we’ll discuss a framework for managing through these challenging situations and explain the four principles of medical ethics in end of life situations. Our guest this month is Anna-Gene O’Neal Brookdale’s Division President of Health Care Services, which operates Brookdale’s home health and hospice agencies across the country. Anna-Gene holds a master’s in nursing and an MBA degree from Vanderbilt University and has served in a variety of leadership and performance improvement roles for private healthcare providers. Before joining Brookdale, Anna-Gene served as President and Chief Executive Officer of Alive Hospice, a large non-profit hospice provider in Tennessee and is an expert in hospice and end of life care. Anna-Gene provided her expert insights to help us better understand the four principals of medical ethics in end of life situations:

  1. Autonomy - In medicine, autonomy refers to the right of the patient to retain control over his or her body. A health care professional can suggest or advise, but any actions that attempt to persuade or coerce the patient into making a choice are violations of this principle. In the end, the patient must be allowed to make his or her own decisions – whether or not the medical provider believes these choices are in that patient’s best interests – independently and according to his or her personal values and beliefs.
  2. Beneficence - This principle states that health care providers must do all they can to benefit the patient in each situation. All procedures and treatments recommended must be with the intention to do the most good for the patient. To ensure beneficence, medical practitioners must develop and maintain a high level of skill and knowledge, make sure that they are trained in the most current and best medical practices, and must consider their patients’ individual circumstances.
  3. Non-Maleficence - Non-maleficence is probably the best known of the four principles. In short, it means, “to do no harm.” This principle is intended to be the end goal for all of a practitioner’s decisions, and means that medical providers must consider whether other people or society could be harmed by a decision made, even if it is made for the benefit of an individual patient.
  4. Justice - The principle of justice states that there should be an element of fairness in all medical decisions. This includes decisions that burden and benefit, as well as equal distribution of scarce resources and new treatments. It is also critically important for medical practitioners to always uphold applicable laws when making choices.

Even with an ethical framework to make these hard decisions, there’s never one right answer. These situations are unique and complicated, as are the people involved. It’s an emotional time and most families simply feel overwhelmed.  That’s why it is so important for healthcare providers to lean into these four principles of medical ethics as a sound basis to make principle-centered decisions when navigating care in end of life situations. If you’d like to learn more and listen in on the conversation, you can attend a session of: Medical Ethics at the End of Life, just send a request to register for the session by visiting our Optimum Life Continuing Education page.

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