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When Ethical Dilemmas Arise

Provider (08/07) Vol. 33 , No. 8 , P. 35 ; Wickersham, Mary Eleanor
Home care providers sometimes face conflicts of interest between a patient's wishes and the facility's standards of care, and must therefore be ready to solve ethical dilemmas. In one such situation, a schizophrenic nursing facility patient declined to eat and asserted she was ready to die. However, the patient was not terminally ill and her mental illness had been regulated effectively by drugs. The facility employees called on the ethics committee to consider questions, such as whether the patient's independence is more significant than the facility's duty to supply care and whether compelling the patient to eat would violate her civil rights.
The committee also must question whether the patient's actions are putting others in danger and whether the patient is capable of making a serious decision.
Four principles set forth in the "Principals of Biomedical Ethics" by James Childress and Tom Beauchamp--autonomy, beneficence, non-maleficence, and justice--can guide facilities struggling with ethical dilemmas, though the principles cannot always clearly point to the best solution without additional examination of reputational, legal, ethical, and healthcare consequences and outcomes.
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