New Issue of The American Journal of Bioethics Now Online
Volume 8 Issue 4 of the American Journal of Bioethics is now online. This month's issue includes target articles on whether ethics education effects nurses and social workers ethical sensibilities, pragmatism in clinical research, and ethical issues in rural health care
contribute a comment
Your contributions to the conversation are very much appreciated. We do have a few simple guidelines, though. Be civil. Stay on topic. We reserve the right to remove comments that violate the aforementioned guidelines. One more thing: comments are moderated, so it may take a little while for your comment to be posted. Thanks.
comments
Should a doctor grant the wish of a terminal cancer patient to undergo TPN even if it will cost her life?
Colleen's cancer is out of control. "There is nothing more we can do," she was gently told. She wants her doctor to start Total Parenteral Nutrition (TPN) by intravenous route so she can try one more round of the research protocol of medication and make it to her son's graduation. Her son is five and a kindergarten. Her doctor agrees the TPN will offer her nutritional support and energy, but the side effects of the treatment are unduly burdensome and could cost her life. Should the treatment be started because she wants it though the doctor disagrees?
She we respect here the Autonomy of Colleen?
- by Sydney on Aug 2, 2008 at 3:50 AM | link
I think the balance here is between autonomy and beneficience. The side effects of TPN would generally be high blood sugars, possible infection at the IV site, and possible complications of inserting the PICC or central line. These all should be managable with normal nursing care. The benefit would be possibly prolonging life with a clear goal in mind. In this case, I would feel very uncomfortable if the physician refused ordering TPN and would advocate for my patient for her to get a line and the TPN.
There are times when patients request or demand treatment that is not medically indicated, and some patients definately do have a "the customer is always right" mentality. I also definately think that giving in to some demands violates professional integrity, and these demands should be set aside.
In this case, the physician should counsel his patient but give wide respect to her autonomy. In my opinion.
Andy Ege RN MSN
- by Andy Ege on Apr 23, 2009 at 7:40 AM | link