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Essay Available:
Pages:
4 pages/≈1100 words
Sources:
2 Sources
Style:
APA
Subject:
Health, Medicine, Nursing
Type:
Case Study
Language:
English (U.S.)
Document:
MS Word
Date:
Total cost:
$ 17.28
Topic:

Ethical Considerations in Dialysis

Case Study Instructions:

Case Study: “John”
About John
John is a 70-year-old patient with end-stage kidney disease secondary to hypertension, who has been on CAPD therapy at home for the past year. His past medical history also includes abdominal aortic aneurysm repair in 1999 and prostate cancer that has been in remission since 2014. Recent labs at his family physician’s office revealed a significantly elevated PSA count. He has also been complaining of left shoulder and lower back pain. A recent scan confirmed metastasis to the bone for which he underwent radiation. At a recent home visit, John’s son reported that the patient’s appetite and functional capacity have diminished significantly in the previous three weeks. On examination, the patient’s blood pressure was 90/50. He appeared visibly weak. John was admitted to hospital last night with weakness and failure to thrive. At his last clinic visit, John stated that his goals of care include attending his granddaughter’s wedding in six months. He also stated that he preferred “no heroic measures” be undertaken should he suffer cardiac or respiratory arrest.
What ethical principles could be at play in this situation in terms of John’s current status? Based on the concept of shared decision-making, how would you approach care and management of this patient (and his family)? How would you advocate for this patient? What treatment options are there for John?
Thoughts to Ponder
• Is John’s current condition his new baseline or is there potential for some improvement, if so, how?
• The Renal Physicians Association (RPA) guideline also “recommended other patients for whom strong consideration should be given to not providing dialysis, that is, those who have a terminal illness from a non-kidney-related cause. For example, a patient who is dying from a metastatic cancer for which no further chemotherapy or radiation therapy is being offered because of a low likelihood of benefit should, in most circumstances, not be started on dialysis.” (Moss, 2017, p. 838)
• “The potentially longer survival time that dialysis might afford is likely to be at the expense of a greatly diminished quality of life with significant pain and suffering as the cancer spreads.” (Moss, 2017, p. 838)
• Prognosis on dialysis
 Seldom communicated to patients receiving RRT
 Worse in CKD than in most cancers
 Annual mortality rate of patients on dialysis exceeds 20% (Molzahn & Schick-Makaroff, 2017)
1) Review the case study (“John”).
2)Write a report which covers the following aspects of John’s case. Use the associated rubric to better prepare your response.
3) Determine and discuss all ethical principles that are at play in the case study situation.
4) Discuss appropriate care and treatment options based on the concept of shared decision-making.
Submit your assignment to the Assignment folder
This should be written in essay style, between 1000 and 1500 words, double spaced
See rubric for guidance

Case Study Sample Content Preview:

Ethical Considerations in Dialysis
Student’s Name
Institutional Affiliation
Course Code and Name
Instructor’s Name
Due Date
Introduction
John, a seventy-year-old patient, is battling three chronic illnesses. These are hypertension, cancer, and end-stage-kidney disease. He has a history of abdominal aortic aneurysm that was treated in 1999 and prostate cancer that seems to have metastasized following the recent diagnosis of metastasis to the bone. His health has continued to deteriorate, and he is now admitted. He is visibly weak, has low blood pressure, and fails to thrive. He insists that no extra life-saving measures should be taken should he suffer a cardiac or respiratory arrest. Ethical considerations are at play as appropriate care, and treatment approaches are applied following shared decision-making.
Ethical Considerations
The ethical principles in the case are autonomy, beneficence, nonmaleficence, and justice. Autonomy is the ability of the patient to make their own decisions regarding treatment after being informed of all possible risks and benefits of the treatment (Rao, 2020). Patients have a right to reject treatment, even if it is intended to benefit them. For instance, John rejects attempts to save his life and accords the necessary treatment should he suffer a cardiac or respiratory arrest. The autonomy principle would make all goodwill to accord him the necessary treatment go unfulfilled.
Beneficence refers to kindness and goodwill. In beneficence, all the health professional’s attempts should be geared towards promoting the health of the patient and bearing positive outcomes (Rao, 2020). In John's case, the health professionals attending to him are required to accord him the necessary treatment, aiming to improve his condition and save his life. However, all treatment approaches must be carefully considered in a state of comorbidities. One approach to managing one illness can counteract the other condition’s prognosis.
Non-maleficence refers to causing no harm to the patient. Harm may result from either the health professional’s omission or commission. Omission means that an action that could have saved the patient from harm was not done. Commission, on the other hand, means that an action that caused harm to the patient was done (Rao, 2020). In John's case, the commission could cause harm, such as continuing dialysis, which could cause a diminished quality of life with extreme pain in the face of cancer.
Justice refers to being fair and just in offering treatment. Comparative and distributive justice should always be observed in the healthcare environment. Comparative justice is where all patients are treated fairly at an individual level, with reference to their age, ethnicity, gender, and religion (Rao, 2020). Distributive justice is where healthcare services are offered equitably throughout the entire society. In John’s case, treatment is being accorded fairly and justly, without consideration of age, gender, religion, or ethnicity.
Care and Treatment Approaches
Care and treatment should be accorded in consideration of the patient's decisions. One key detail is that the patient does not support or agree to aggressive treatment. His prost...
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