Helping Elders Adhere to a Drug Regimen

Devise a strategy for the six types of non-adherence to help an elder adhere to a drug regime. Hesitance to initiate therapy (You have prescribed a drug and discover the elder has not started taking it)

Skipped doses (The elder forgets or is not home to take the drug)

Medication discontinuation (The elder perceives that the medication is not working and stops taking it)

Dose self-adjustment (The elder adjusts the dose to save money)

Over-adherence (The elder takes more of the drug because symptoms worsen)

Inappropriate administration (The elder misuses or abuses of the drug)

 

A significant number of countries have legalized medical assistance dying (MAID), known as physician-assisted death in the last decade. As of the year 2018, medical assistance dying had been legalized in Netherlands, Canada, Switzerland, Colombia, Luxembourg, and several states in the USA (Spence, Blanke, Keating & Taylor, 2017). In Canada, medical assistance dying was legalized in the year 2016, following the amendment of the Criminal Code Act that prohibited physicians from engaging in assisted suicide (Beuthin, Bruce & Scaia, 2018). The changes made on the act stipulated that nursing practitioners and physicians are allowed to provide MAID though they are bound by the laws of the land, codes of ethics, and professional standards of practice (Li et al., 2017). The issues of eligibility for MAID and ethical concerns has remained debatable overtime with different views being presented on the role of medical practitioners in MAID to assure adherence to the set code of ethics. This paper presents a discussion on the ethical issue of concern in MAID, focusing specifically on autonomy. Analysis of the ethical issue based on the utilitarianism theory of ethics, scholarly literature and media is also presented. The paper also explores the nursing role in MAID and the suitable ethical actions that need to be undertaken to resolve the issue of autonomy.

Ethical Concern: Autonomy

The major ethical issue of concern in medical assistance in dying is patient autonomy and respect for persons. Under the principle of autonomy, a patient is seen as a lone person capable of making a valid decision concerning his/her health (Spence, Blanke, Keating & Taylor, 2017). Patients have the ability to understand, discern and make a decision about the general course of their life and health without being coerced or bowing to undue pressures from others. These decisions can be made in accordance with the moral laws or individual values and preferences (Nuhn et al., 2018). Supporters of autonomy believe that patients have the right to make decisions concerning their health or life. On the contrary, detractors of autonomy see it as a claim used to avoid consideration of relevant health values or lower the clinical responsibility of health care practitioners.

Newer theories of autonomy, relational autonomy, have expanded the individualistic notion and the assertion that a person has the right to her health to include his/her relationships and social contexts. According to relational autonomy, individuals are likely to make decisions in the context of their families, society and other societal values, norms and religion (Beuthin, Bruce & Scaia, 2018). The society has no moral obligation of making a decision concerning the life or health of an individual, including the decision for MAID. Rather, it is conceptualized that the autonomous person has a proper understanding of the available options and makes a choice in accordance with his/her values and preference. According to the ethics of autonomy, the eligibility or decision for MAID is personal and cannot be influenced by society or any other external party.

The right to autonomy has some limitations hence faces significant ethical dilemmas. While autonomy dictates that a patient has a right to put forward their end of life treatment, detractors have asserted that such decisions may be due to the pain and suffering exhibited by an individual leading to a serious ethical dilemma (Karnik & Kanekar 2016). The relationship between the patient and the family may also impede the decision on MAID further causing a dilemma (Nuhn et al., 2018). Health care practitioners face a serious dilemma in deciding the patient’s eligibility for MAID. As much as the patient enjoys the right to autonomy and should be given the opportunity to make decisions concerning his/her life, the limitations identified above makes the decision on eligibility difficult (Beuthin, Bruce & Scaia 2018). Irrespective of the limitations, health care practitioners should adhere to the ethical principle of autonomy and ensure the decisions made by patients on their health and life are protected.