Differences of Opinion in End of Life Care

Differences of Opinion in End of Life Care Sample Approach

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Introduction

The case study relates to an expected death of one of the residents who lived in a care home that provides nursing care and support for older people with many various conditions. Mr. X became frail after a couple of months of admission to the settlement. Lastly he was treated by antibiotics for various infections, mainly chest and urine (four times within a short period of time – 8-9 weeks). Regrettably his body appeared not to respond to the treatment used. He was losing the ability to decide about himself gradually. Due to Mr X’s limited mental capacity one of his sons had power of attorney (POA) in order to make complex decisions related to his father care. Adult with incapacity (AWI) certificate was in place. Suddenly Mr X’s condition deteriorated rapidly and actions were required in relation his end of life care. POA holder wished Mr. X to be transferred to the hospital for further, invasive treatments. However staff members were of the opinion that according to Mr X’s wishes he would prefer to be cared for within his present settlement.

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Assessment

The issue in this situation was: differences in family and staff views at what the patient stated he would want to have and by whom he would want to be cared for at the end of his life.

The identified problem was the risk of abuse of the patient’s autonomy. Although the son had good intentions to prolong Mr. X’s life because he was anxious and did not know how to approach the decision making, staff felt that Mr. X was becoming more ‘an object’ and not a person.

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According to Department of Health (DH) abuse can have unintentional complexities stemming from relationships of individuals involved (DH, 2000).

The team lead by myself had to face a difficult and complex task of being ‘the advocate’ (Hurst et al., 2008) of Mr. X and brief the son about his fathers’ wishes.

Under Mental Health (Care and Treatment) (Scotland) Act (2003) Mr X have chosen his son, to have power of attorney (POA) to make decisions about his health on his behalf, but he also specified in advance that he does not want to be transferred to hospital at last stages of his life. The NHS (NHS Choices, 2015) state that one cannot override this decision unless the POA specifies that the acting on behalf has the power to do so which was not the case

We had to find a way to explain in a tactful manner that the approach to care will be palliative with rather sad prognosis trying to remove some of the stress from the difficult situation.

At the same time documentation had to be looked through accurately; checked and analyzed and completed to have new care plans related to Mr. X final life stages in place. This was to ensure accountability and demonstrate how decisions related to Mr.X’s care were made (The Nursing and Midwifery Council, 2010)…..