Decision Making Frameworks

Decision Making Frameworks

Working in the health care facility employees are faced with having to make tough decisions on how to care for patients. The worst department would probably have to be the cancer treatment center. For this reason many facilities have an ethics committee that you can present situations to help ensure that all decisions are being exhausted. Recently our facility had an Appalachian patient that wanted to stop treatment for his stage 4 bone cancer. His family on the other hand wanted to continue the treatments and has even gone as far as verbally abusing the nursing staff for consenting to stop treatment. Wanting to respect the patient's wants the facility felt that the best thing to do was meet with the ethics committee. The purpose of this paper is to discuss the process from choosing the ethical decision-making frameworks, who will lead the committee, and who should be included in the process.

Hodgson's Framework

In health care the best way to ensure that patient's needs and wants are being addressed is to have a framework in place to help during the process. Facility can use many frameworks but the easiest to comprehend for our facility is the Hodgson's three stage framework that was developed in 1992.

The first step is to examine the situation (SME, n.d.). In this step critical facts are gathered, key stakeholders are identified, and all the options are identified. To get ready for our presentation to the ethics committee we determined that the facts are that the patient does not want to continue treatment for his stage 4 bone cancer. Due to the patient's wishes treatment was halted, but the family of the patient was not on board. They felt that their loved one was giving up and wanted to continue with the treatment. They even went as far as verbally abusing the nursing staff for not proceeding with the treatment. The family, the patient, the nursing staff, and physicians were listed as the key stakeholders. The family wanted to proceed with treatment to see if remission was possible, the patient wanted to stop treatment and die with dignity. The nurse staff and physicians were caught in the middle.

Now that step one has been determined step 2 establishing the dilemma can begin (SME, n.d.). This step asks why each stakeholder wants to proceed a certain way. The family thinks that their loved one can go into remission and that treatment should continue. They are putting their needs over the patient's needs. The patient who wants to die with dignity feels that treatment is prolonging his life-a life that is not the quality he wants in his last years of life. The dilemma for the nurse staff and physicians is who is right and who should they follow.

The final step is identifying the options (SME, n.d.). When identifying the options it is best to identify the principles behind the options. The family thinks that with treatment their loved will go into remission and that life with return to a sense of normalcy. The patient on the flip side of the coin thinks that carrying on with the treatment is slowing down the dying process and is prolonging the pain of having to watch his loved ones go through this process.

Back in 2011 my father-in-law was battling prostate cancer. Even though he lived in St. Louis, Missouri we knew the struggles that he and his wife faced during each round of chemo. The last time we talked to him we could barely understand him as he was preparing for final stage of life; we could tell he was ready. The hospice nurse made him comfortable and on February 2012 he lost his battle. We drove to Missouri to pay our last respects for a man who died as dignified as I remember him in life. Yes he was young, 71, but he knew that his body was failing him and he did not want to see his loved ones having him die a slow death. He decided that if the round of chemo did not work that all treatment should be stopped. The family was torn because the chemo worked once before. The cancer came back aggressive and this time treatment was not working.