ETHICAL-LEGAL ISSUES

Ethical-legal issues in End-stage-lung Disease



Ethical-legal issues in End-stage-lung Disease

Introduction

Patients suffering from moderate to severe chronic obstructive lung disease (COPD) often exhibit acute exacerbations of the condition, each of which can result in respiratory failure, with a possible need of ventilator support. This is also seen in the case-study provided. Hospitalizations due to acute respiratory failure form a subgroup of COPD patients. Approximately 89% of these patients survive till discharge from the hospital. However, the survival to discharges decreases significantly to about 76% if intubation with mechanical ventilation is necessary. Out of those, only about 59 percent survives for more than one year after discharge from hospital. Furthermore, the quality of life is often poor due to unresolving respiratory symptoms (American Thoracic Society, 2009).

The guarded prognosis creates several ethical dilemmas due to inadequate benefits to patients of intubation and mechanical ventilation, in case they have a well-developed disease, as well as, low possibility of being weaned off from the ventilator support. Hence, the withdrawal from the life supportive care may be considered for the patients dependent on the ventilator support, which have not showed any improvement despite given aggressive respiratory care (American Thoracic Society, 2009).

Unfortunately, there are no clinical factors, which can accurately identify, at the time of hospital admissions, who will fail to benefit from the life supportive care. Without the accurate predictors of clinical outcomes, the health care providers must recognize and try to address the associated ethical dilemma arising from providing care to patients with advanced COPD. At the end, the health care providers needs to consider the benefits and burdens in deciding whether to initiate the life supportive care (American Thoracic Society, 2009).

Discussion

In the clinical practice, the health care providers have to make moral or value judgments daily; though, clinicians in the field of respiratory medicine have to make the most difficult ethical dilemma in decisions relating to patients suffering from end stage lung disease. The ethic legal issues are several that surround the patients of severe chronic obstructive pulmonary disease (COPD) that involves using mechanical ventilation in, withholding or withdrawing treatments, in addition the end of life decision making. Before implementing an intervention, it is essential that health care providers determine its beneficence and malfeasance, which require a thorough knowledge of the outcomes of intervention, as well as, the burdens it will impose. It is necessary the physician and patient have good communication to reach a mutual agreement on the treatment (Simonds, 2003, pp. 272-277).

Outcomes of Mechanical Ventilation in COPD

The overall perception regarding the outcomes of mechanical ventilation on patients suffering from advance COPD is poor. However, the belief is modified by the mortality rates in ICU of 11 and 35%. In addition, an Australian retro-respective study demonstrated that about 79.7 percent COPD patients suffering from acute exacerbation, resulting in ICU admission, were able to survive till discharge, having a mortality rate of 48.6 percent in 1 year. On the contrary, theory suggests worst prognosis in patients of ...