When responding to your colleagues’ postings, please reflect upon the following
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When responding to your colleagues’ postings, please reflect upon the following areas:
1}Suggest why you might see things differently,
2)Ask a probing or clarifying question, and
Share an insight from having read the post
3)Share an applicable clinical or work-related experience that is congruent with the ethical issue.
BELOW IS THE POST TO RESPONSE TO
A health ethics issue that I have professionally encountered and experienced was a surgeon performing an esophagectomy on a patient that had Barrett’s esophagus that had not yet progressed to esophageal cancer and the patient had some developmental delays. The patient had a very complicated and complex post-surgical journey and developed some long-term effects that have decreased her overall quality of life. The patient developed pneumonia and an anastomotic leak resulting in septic shock. The complications the patient had developed required several trips back to the operating room and lengthy ventilatory support requiring a tracheostomy. During one of her trips to the operating room I was her anesthesia provider. Many of the people in my department were discussing the ethics regarding this case as this patient did not even have esophageal cancer. The majority of esophagectomies are done for esophageal cancer at 95.6% (Low et al., 2019). In addition, esophagectomies are complex surgeries that have a high incidence of complications of up to 59% (Low et al., 2019). Furthermore, the incidence of pneumonia in these patients is 14.6% and atrial dysrhythmias is 14.5%. (Low et al., 2019). Other potential complications include anastomotic leak, conduit necrosis, chyle leaks, recurrent nerve injury, and sepsis (Low et al., 2019). The 90-day mortality of an esophagectomy is relatively high at 4.5%. If a patient does not have cancer, why would a surgeon recommend such an invasive and complex surgery if it is not completely necessary on a patient with development delays?
This ethical issue here that could impact clinical practice is as people we often trust and place our lives in our healthcare providers; however, if your physician is recommending you have a procedure you would trust they are doing what is in your best interest. However, I believe in this situation the physician did not have the patient’s best interest in mind. The patient’s condition was not life-threatening as she did not have cancer. There could be a high risk of her developing cancer, but the surgery holds a higher risk of complications including long-term effects and a potential for a decreased quality of life. During our interactions with the patient and her family, my colleagues and I were concerned the family and patient did not understand how invasive the surgery was or the high likelihood of complications.
An ethical principle that could be applied to this issue is nonmaleficence. Nonmaleficence is defined as “one should do no harm, including the inflicting of pain and suffering on others” (Guido, 2020, p. 36). In addition, the detriment-benefit analysis could be applied to this situation. Guido (2020) describes this as “using such an analysis, the focus of the projected treatment or procedure rests on the consequences of the benefits to the patient and not on the harm that occurs at the time of the intervention” (p. 36). This extensive surgical procedure with long-term sequelae resulted in pain and suffering for this patient in a case where this surgical procedure was not even necessary at the time. For this particular surgery and case, the consequences of the risks outweigh the consequences of the benefit.
Two other important concepts in this ethical situation include the importance of informed consent and the role of effective communication. The surgical team must have included in their informed consent “a brief but complete explanation of the treatment or procedure to be performed, an explanation of any serious harm that may occur during the procedure, including death if that is a realistic outcome. Pain and discomforting side effects both during and following the procedure should also be discussed. An explanation of alternative therapies to the procedure of treatment, including the risk of doing nothing at all. An explanation that the patient can refuse the therapy or procedure without having alternative care or support discontinued” (Guido, 2020, p. 115-116). I am concerned that these components of informed consent were not met, and the surgeon encouraged the patient to go through with the surgery. I think that effective communication between the surgeon and the patient and her family did not occur either. It was a sad and unfortunate situation for the patient and her family. After many months in the ICU the patient was eventually discharged to a skilled nursing facility with an extensive recovery ahead of her with little hope of ever returning to her baseline. All of this for a surgery that was not absolutely necessary.
Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Pearson.
Low, D. E., Kuppusamy, M. K., Alderson, D., Cecconello, I., Chang, A. C., Darling, G., Davies, A., D’Journo, X. B., Gisbertz, S. S., Griffin, S. M., Hardwick, R., Hoelscher, A., Hofstetter, W., Jobe, B., Kitagawa, Y., Law, S., Mariette, C., Maynard, N., Morse, C. R., … & Wijnhoven, B. P. L. (2019). Benchmarking complications associated with esophagectomy. Annals of Surgery, 269(2), 291-298. doi: 10.1097/SLA.0000000000002611