On Best Interests: A Case for Clinical Ethics Consultation

Area of Science:

• Medical Ethics
• Health Care Decision Making
• Nursing Advocacy

Background:

• Surrogate health care decision making presents challenges for patients, families, and health care teams when patients lack decisional capacity.
• Clinical ethics consultation offers an objective perspective to guide complex treatment decisions for incapacitated patients.
• Nurses play a crucial role in advocating for patients and families, and can initiate ethics consultations.

Purpose of the Study:

• To analyze a case of surrogate health care decision making for an incapacitated patient with end-stage liver cirrhosis.
• To demonstrate how nurses can facilitate best interest outcomes through ethical consultation and patient advocacy.
• To apply the Stakeholder, Facts, Norms, and Options (SFNO) Framework in a clinical ethics case analysis.

Main Methods:

• Case analysis of Mr. K., a patient with end-stage liver cirrhosis lacking decisional capacity.
• Application of the Stakeholder, Facts, Norms, and Options (SFNO) Framework to evaluate treatment options.
• Review of the role of nurses in initiating and participating in clinical ethics consultations.

Main Results:

• The SFNO Framework provided a structured approach to analyzing Mr. K.'s best interest.
• Nursing interventions, including information provision and facilitated discussion, were key to supporting the patient and family.
• Effective collaboration between the ethics consultant, nursing staff, and family led to a supported decision.

Conclusions:

• Clinical ethics consultation is a valuable resource for complex surrogate decision-making scenarios.
• Nurses are pivotal in advocating for patients and facilitating ethical decision-making processes.
• Utilizing frameworks like SFNO enhances the ability to determine and achieve best interest outcomes in challenging clinical situations.