ETHICAL DILEMMAS IN CRITICAL CARE: EOL

End of life

refers to the final stage of a person’s life when they are expected to die soon

End of life

it involves providing specialized care and support to individuals and their families during the dying process

End of life

describes the final stage of a person living with a terminal or eventually fatal condition where death is a foreseeable outcome.

Principles of Ethics

1. Autonomy

2. Beneficence

3. Non-maleficence

4. Justice

Autonomy

The patient’s rights to self determination and to make their own healthcare decisions

Beneficence

Acting in the patient’s best interest to do good.

Non-maleficence

the obligation to above all “do no harm”

Justice

Fair distribution of resources and respectful treatment for all patient

1. involve cultural clashes between a strong desire to prolong life and religious beliefs. 

2. challenging open conversations about death

end of life ethical issues for filipino nurses

1. deciding when to withhold or withdraw aggressive treatments 

2. deciding patient autonomy vs family-driven decisions

3. general lack of quality palliative care

4. shortage of trained professionals

Key dilemmas

family centric

decisions are often family-centric and families may want to withhold information from patients.

Autonomy vs Beneficence

matter between science vs spirituality

Autonomy vs Beneficence

Nurses must balance respecting the patient’s autonomy (right to make their own choices) and the principle of beneficence (acting in the patient’s best interest) 

The organ donation act of 1991

Republic Act 7170

Republic act 7170

main law in the Philippines that authorizes the donation of all or part of human body after death for purposes of therapy, research and medical education.

family centric culture, religious and belief systems, public education

Cultural considerations of organ donation in the philippines

Family centric culture

the strong emphasis on family in filipino culture highlights the importance of family involvement and open discussion of donation. 

Religious and belief systems

philippine culture on religious and spiritual beliefs can influence attitudes towards death and organ donation; nurses needs to be sensitive in handling organ donor

Public education 

culturally sensitive public education campaigns are crucial to address specific concerns and promote a better understanding of organ donation within the community. Health professionals need to be familiar with campaigns 

1. donor identification and assessment

2. family support and communication

3. education and advocacy

4. process coordination

5. cultural and religious sensitivity 

roles of nurses in organ donation

donor identification and assessment

nurses are vital in identifying potential donors; by recognizing patients with irreversible brain damage or those likely to meet the criteria for donation

family support and communication

nurses provide emotional and spiritual support to grieving families. 

education and advocacy

nurses can play a significant role in educating the public about organ donation, dispelling myths and promoting a positive attitude towards donation, which influences family decisions. 

process coordination

nurses coordinate care with potential donors and liaise with transplant teams, ensuring the logistical management of the donation process.

cultural and religious sensitivity

nurses must be adept or skillful at facilitating culturally and religiously sensitive care for families, addressing their beliefs and needs during the donation process. 

Legal aspects of organ donation

1. defining and declaring death

2. consent and coercion living donors

3. organ allocation and justice scarcity equity

4. commercialization and trafficking organ markets 

5. balancing principles, justice, utility and autonomy 

EXTRACORPOREAL MEMBRANE OXYGEN

ECMO