Beneficence is the duty to act in a way that would best benefit the patient
Non-maleficence is the duty to do no harm
Justice is fairness for all
The HITECH Act’s modification to the HIPPA Privacy Rule, effective January 2018, grants access to a patient’s personal health information (PHI) 50 years after a patient has died.
A patient with ALS is on hospice care and has now reach an end point in their disease process. Non-invasive approaches are no longer sustaining their symptoms of dyspnea. The family and patient are now asking for tracheotomy palcement with mechanical ventilation. As a hospice nurse, your responsible to: Explain that mechanical ventilation will not stop the disease process, and the patient would then have an increased chance of becoming “locked-in”. Discuss the issue further in a team meeting involving the patient and family. Inform the patient and family if they decide to pursue this change in the patient’s plan of care, the patient can no longer be on hospice. Support the patient’s autonomy and family’s request, but make sure they understand what the procedure entails, as well as the patient’s inability to communicate. Discuss the effects on the patient’s quality of life and the potential consequences of their decision.
A hospice patient with a history of substance abuse has tested positive for marijuana. The provider tells the patient that you will no longer write them prescriptions for their opioids because of this. The provider may be at risk for withholding of medical care or treatment, not adhering to the ANA’s goal of hospice and palliative nursing care, and breaking the ethical principle of non-maleficence (do no harm) secondary to withholding the patient’s pain medications.
In a pain clinic or other area of medicine, a provider is well within their rights not to continue to give opioids to patients that have broken their opioid contracts, or the providers feel they are abusing or misusing their prescriptions. In the areana of hospice care, where a patient should have less than 6 months to live due to a terminal illness, addressing pain and end-of-life issues are imperative. The provider should gather more information such as if the patient’s pain not being controlled with current opioid regimen. It is also worth remembering that care is provided by a team approach, and the provider is not acting alone as in the primary care setting. In hospice, many people are involved in the decisions regarding the patient’s plan of care. The ANA states the goal of hospice and palliative care nursing is to promote and improve the patient’s quality of life through relief of suffering along the course of the illness. If a provider feels their license is at risk, or is having ethical concerns regarding a patient’s issues, they should present their concerns in a professional manner to the team or escalate the issues to a higher authority.
The National Coalition for Hospice and Palliative Care developed the National Consensus Project for Quality Palliative Care. A tast force was assembled for achieving quality initiatives and guidelines for practice.
The National Consensus Project is composed of four large end-of -life organizations: HPNA, AAHPM, NHPCO, and CAPC.
The National Consensus Project for Quality Palliative Care defines primary palliative care as being inclusive to all medical professionals and should focus on allevitating suffering, promoting quality of life, and using an interdisciplinary approach to care, as well as basic symptoms management, open communication, and advance directives.
