Ethical Dilemmas in Performing a Tracheostomy
The ethical issues related to tracheostomy arise due to conflict of ethical understanding of the patient, surrogate care giver or family, and the physician offering medical care. Tracheostomy is a surgical procedure that inserts an artificial airway into the trachea to allow patients who are on the ventilator to be weaned off (Venkat, 2013, p. 135). The ethical dilemmas result when the patient views the surgical procedure as a gateway to artificial healthcare dependence in a rehabilitation center. Many Americans hold on to the perception that having a tracheotomy causes an individual to be dependent on specialized care which is available from in-patient facilities. In one case, the attending physician viewed a tracheotomy as a necessity to facilitate the transfer a patient from ventilator support to long term management. On the other hand, the patient had earlier told his family members that he would not prefer any artificial medical assistance at the point when that might be required.
Another form of dilemma occurs when the patient or family members would want a tracheostomy to be performed but the doctor is opposed to it due to her moral values. The doctor’s opinion was that inserting the airway tube would only extend the patient’s life but not the quality of life since he would be on artificial life support. The family claimed that the most important thing was the sanctity of life and that the patient would value the comfort he offered his family by his life. In this case, the family wanted to preserve the life of their loved one while the doctor viewed it as means to “prolong the dying process of an end-stage patient” (p. 136). The situation caused moral distress to the doctor as well as to the family who did not want their patient to die given the possibility that aggressive medical interventions would preserve his life.
An ethical committee resolves cases presenting ethical dilemmas due to competing views from the physician and the patient or family members. The committee helps to pass the decision on the way forward when the different stakeholders do not agree. The consultants discuss the case and come up with a resolution that will not undermine the concerns of either party. Conclusive evidence has not been brought forth regarding the advantages of a tracheostomy, although it is agreed that it helps patients which acute conditions that are affecting the airway. The consultants give the details of the procedure to the patient and surrogate caregivers and the expected benefits such as the ability to vocal communication for patients with mental reasoning capability (p. 136). However, the use of the tracheostomy placement as a medical intervention also requires expertise care for maintenance. Typically, after the set period of 8-10 days of ventilator use, patients are required to indicate the next measure of medical care.
The legal issue issues associated with tracheostomy include the fact that physicians are obligated to protect patients’ health at all times. Physicians who feel moral distress about performing a tracheostomy on an end stage patient should either refer the patient to another surgeon or seek ethical advice. Patients insisting on remaining on ventilators occur space in the intensive care unit (ICU) whereas they can be moved to the rehabilitation center if they consider the tracheostomy procedure. When conflicts arise, a tracheostomy can be used to resolve the issue when offered as a trial therapy for the acute or chronic disease conditions. The medical facts have to be clearly explained before the operation so that the patient or family members fully understand the implications and the physician can avoid law suits.
The dilemmas involving personal concerns of the patient about tracheostomy can be handled by stating the benefits of the surgical procedure. I will dispel the patient’s fears of being unable to care themselves and being placed under nursing care by giving them the option of a personal care giver at home. There is evidence of patients’ successful recovery and later on having the tube decanted. The patient’s values can be reconciled by involving the ethical consultants. The preoperative expectations of the patient should be well discussed with the physician to straighten out and misunderstandings. The threshold moment when the understanding of the patient and the doctor conflicts is resolved by agreeing postoperative care preferences.
In conclusion, tracheostomy is a crucial medical tool for providing essential care to patients who are critically ill. The American population of persons above 65 years is increasing and with it the need for more artificial life support facilities. Performing the minor procedure possess ethical dilemma which can be overcome by providing adequate details about the procedure to the patients and their family members or surrogate caregivers. Providing evidence of patients who have undergone the procedure successful is a tactic that has been used by ethical consultants to resolve the conflicting cases. Patients should be ready to be transferred to rehabilitation facilities where they can access expert nursing care after surgery. The necessity of tracheostomy is undeniable in the current content in medical research despite the associate dilemmas.
Venkat, Arvind. “The Threshold Moment: Ethical Tensions Surrounding Decision Making on Tracheostomy for Patients in the Intensive Care Unit.” Journal of Clinical Ethics, vol. 24, no. 2, Aug. 2013, pp. 135-143, www.researchgate.net/publication/255705242.