Ethical Dilemmas on End-Of-Life Issues: Taxing Values and Fait-Care Wo K

Abstract

Background: Occasionally, a patient in critical care can die no matter what we do. Others may have had a good chance of recovery if admitted, but then limited resources impact on admission. Profound ethical questions confront the medical personnel as they watch and wait helplessly. Setting: Critical Care Unit, Moi Teaching and Referral Hospital, Eldoret Objectives: To explore dilemmas on end of life which have a heavy bearing on Doctors and Nurses: legally, morally and ethically. Materials and methods: A case study of ZX derived from the local setting involving a patient who was in the Critical Care Unit for one year sixty five days. This was experiential: a best case scenario.Consent to highlight and publish the case study was sought from a relative of the deceased. The case study consist of a content analysis

of the patient file, ethical issues arising were noted and were cross- checked to ensure they reflect the entries in the patient file. This study

seeks to dissect some ethical issues experienced in management of ZX. Conclusion: Modern health care has given rise to extremely complex and multifaceted ethical dilemmas. More often the health care workers (Physicians/nurses) are unprepared to manage these competently. There is no Law or guidelines in Kenya on end-of-life issues, making ethical dilemmas inevitable. ZX case brings out four topics that pose particularly vexing problems to the health care givers in their practice of medicine: Respect and equal treatment; Communication and consent; Decision making for incompetent patients; and end of life issues. Professional health care providers associations in Kenya should issue pragmatic policy guidelines to safeguard the Kenyan medics.