The Impact of Medical Advances

Along with the unquestionably technical aspect of nursing care comes the purely advanced aspect of medical care: that which is presenting patients and caregivers with entirely new ranges of options, hopes, and ethical problems. Because of medical, surgical, and pharmaceutical technology advances (for example, minimally invasive surgery, robotics, and nan-otechnology), we are now able to offer to patients what we could not have imagined two to three decades ago (Porter-O'Grady and Afable, 2002). Transplants from living donors, in vitro fertilization, surgery in utero, reconstructive options, and costly medications that may retard but not cure a condition are only a few examples of the doors opened to us by medical research and technology. As technology and knowledge rapidly expand, we are presented with multitudes of additional possibilities that are new and that have varying success rates. Patients are faced daily with the question of whether to try something that may sap their resources, cause a degree of suffering, and in the end fail to work as intended or hoped.

This type of decision making can be both emotion-intensive and laborintensive. One study (Byrne, 2002) examined feelings associated with a looming bioethical decision. Common themes for patients included guilt, anger, knowledge sufficiency, power, and frustration. Common themes for nurses included sadness, confidence, colleague support, ability to advocate, and satisfaction with the outcome. What are the consequences of a wrong decision? What if the rejected new treatment option would have made the patient better or at best, left her condition unchanged? What if the surgery is chosen and the patient loses function as a result, rather than gaining ground?

Life-or-death decisions can be especially cumbersome. We have the profound ability to sustain life through mechanical ventilation and cardiac support, but patients, families, and caregivers have individual views on the point at which life should or should not be sustained, views that may vary from moment to moment as a patient's condition or prognosis changes. There are cancer therapies that are potentially curative but not necessarily opted for in all cases; palliative treatment plans are sometimes chosen in lieu of these potentially disease-modifying regimens. Such decisions, which are not made lightly, can be fraught with uneasiness, resolve, peace, fear, guilt, anger, hope, disappointment, or overwhelming sadness and despair. In the middle is the nurse, who, knowing that the patient and family ultimately must decide, can only offer information, support, and respect. Through all of this, the patient's rights must be considered (Otto, 1999).

Cybersurgery, which may sound like something out of a twenty-fourth-century medical fantasy, is also expected to expand much like telemedicine has, following trends inherent in the technological aspect of health care. In cybersurgery, a physician would use computer-assisted robotic technology and telemedicine to perform surgery on remote patients (McLean, 2002). In addition, biotechnology is expanding rapidly, escalating the need for sharing of benefits with patient groups and the obligation to determine to whom the new technology—such as stem-cell technology and life-saving, expensive medications that most cannot afford—will be available. Recent advances in technology have also made it conceivable to manipulate genes, form vast databases of patient information, and even create "neo-organs" for later use (Gold and Caulfield, 2002; Flower, 2000). Such technological advances raise many ethical issues in health care.

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