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The Under Dosing of Pain Medication

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This paper examines the ethical issues surrounding hospice patients and under dosing their pain medication. Ethical considerations that relate to the problem of under dosing of pain medication in hospice care include autonomy, justice, beneficence and non-maleficence. Non-ethical consideration that relate to the problem of under dosing of pain medication in hospice care is legal issues. According to utilitarian thinking, rules about morals should make many people happy (Lo, 2009). Lo (2009) states, deontological thinking operates under the principle of moral law and common sense. The decision about pain medication is for the patient because he is the one experiencing the discomfort thus he should decide whether he want the pain medication. Health care professionals and availability of medications are institutional factors that affect decisions and course of actions (Guido, 2009). In conclusion, ethical issues surrounding hospice patients and under dosing their pain medication require a thorough review because many health care professionals are not familiar with the ethical considerations in case of a dilemma.

Ethical considerations require equilibrium between care and the patient desire. In the provision of hospice care, most of the health care professionals usually neglect the patient needs and follow their own or the family desire. The patient is left in unbearable pain. The purpose of this paper is to identify the ethical issues surrounding hospice patients and under dosing their pain medication.

Problem Identification

Ethical considerations that relate to the problem of under dosing of pain medication in hospice care include autonomy, justice, beneficence and non-maleficence. Guido (2009) states, autonomy recognize the ability of a patient to make decision about his care depending on his values as well as beliefs. The patient can refuse a pain medication because of his beliefs. The principle of beneficence states that health care professionals should provide care that benefit the patient and protect him from harm (Snyder & Gauthire, 2008). For instance, the nurse should effectively manage the patient’s pain by using the right dose of analgesics. According to non-maleficence, the health care professional should not inflict harm to the patient (Guido, 2009). The nurse should avoid giving the wrong medication for pain relief. Finally, justice is fair provision of care ( Lo, 2009). Health care professionals should mange patients according to the medical and legal requirements. Autonomy is the priority ethical consideration. The health care professionals should respect the autonomy of the patient by telling him the truth about the objective of care, outcome and options (Snyder & Gauthire, 2008).

Non-ethical consideration that relate to the problem of under dosing of pain medication in hospice care is legal issues. The law states that every person has freedom of choice (Guido, 2009) thus; a patient can refuse pain management therapy. The relationship between ethical and non-ethical consideration is their ability to affect the quality of care. For instance, a nurse may not do well to the patient if the patient refuses treatment.

Considerations of Possible Actions

According to utilitarian thinking, rules about morals should make many people happy (Lo, 2009). The health care professional should make a decision that make the family members and significant others happy even if it harm the patient. The viable actions are that the doctor can refuse to prescribe a pain medication that the patient request if the family members do not want it because of their beliefs or the patient can be forced to take a medication that he does not want because other people believe it beneficial. The consequences of utilitarian thinking can be negative or positive depending on the majority wishes and happiness (Snyder & Gauthire, 2008). In a case the patient is denied the pain medication because family members are against it, he will experience discomfort while if given the right medication because many health care professionals are for it, he will be happy.

Lo (2009) states, deontological thinking operates under the principle of moral law and common sense. In deontological ethics, a conflict usually occurs between autonomy and beneficence as well as non-maleficence (Guido, 2009). For instance, a nurse can be in a conflict when a patient refuses the full dose of pain medication. The duty of the nurse is to respect the patient’s autonomy, do that which benefit the patient and avoid harm. In this situation, the duty of respecting the patient’s autonomy is in conflict with the provision of beneficial care. The nurse should give the patient the right dose of pain medication and disrespect his autonomy. This is because beneficence will produce the greatest balance of rightness over wrongness compared to autonomy.  

Decision and Selection of Course of Action

The decision about pain medication is for the patient because he is the one experiencing the discomfort thus he should decide whether he want the pain medication. According to Lo (2009), the patient has a right of deciding the kind of management that he wants. Although the patient has a right to make decision, some values and biasness can interfere with his choice. They include mental, physical and economic factors (Snyder & Gauthire, 2008). A mentally disturbed patient cannot make a right choice. A patient who is in severe pain is likely to make a rational decision. Finally, a patient can choose a certain kind of medication because of the affordability and not potency.

Health care professionals and availability of medications are institutional factors that affect decisions and course of actions (Guido, 2009). A doctor can prescribe a certain analgesic but if it is unavailable, then the patient has to take a different kind of pain medication. The right of a patient to refuse treatment is a legal factor that affects decision (Snyder & Gauthire, 2008). If a patient does not want a certain medication, the nurse cannot force him. Social factors that affect decision are the culture, beliefs and religion (Guido, 2009). For example, some people believe that narcotics are not good.

The decision being made is utilitarian thinking. The doctor implements this decision by selecting a course of action that makes the family members happy. The doctor reduces the dose of pain medication because the family members requested yet the patient is in severe pain. The aforementioned decision is not morally justified. The doctor and the family members should respect the patients request for the above decision to be justified because it is unfair to reduce the analgesics yet the patient is in severe pain. The decision made was against ANA Interpretive Statement Code for Nurses. According to the code, the nurse should respect the patient’s dignity and integrity (Guido, 2009).

Reflection on Decision

The selected decision was acted upon and it accomplished its purpose of making the relatives and the doctor happy. I believe that the decision made was not morally upright. This is because it did not respect the patient’s autonomy. In my opinion, deontological thinking could be the best theory because it respects the patient’s autonomy if the resulting action is beneficial.

Conclusion

Ethical issues surrounding hospice patients and under dosing their pain medication require a thorough review. Many health care professionals are not familiar with the ethical considerations in case of a dilemma. They should be educated on what to do when the patient’s life is at risk. 

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