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.
