Ethical Dilemmas In Nursing

“A decision made by a person (‘P’) after he has reached 18 and when he has capacity to do so, that if – (a) at a later time and in such circumstances as he may specify, a specified treatment is proposed to be carried out or continued by a person providing health care for him, and (b) at that time he lacks capacity to consent to the carrying out or continuation of the treatment, the specified treatment is not to be carried out or

Though ethics committees have been helpful, scores of physician-patient disagreements end up in the U.S. court system with inconsistent results. The states adopted individual “statutes regulating DNR orders and their provisions vary in analysis throughout the U.S.” (Bishop, Brothers, Perry & Ahmad, 2010). One ethical dilemma that is constant in emergency rooms, the intensive care unit and terminally ill persons is a futility of treatment. In the case of CPR/DNR, New York State wanted to enact a law that describes the decisive responsibilities of the patient, and the family or surrogate, and physician. “In April 2003, the New-York Attorney General asserted that the DNR law would require a physician to obtain a consent of the patient’s health care surrogate before entering a DNR order, even when the physician

of care and changes in the patient’s condition to revise the course of medical treatment if

Secondly, the patient should be capable of making and communicating health care decisions for him or herself. Thirdly, the patient must be diagnosed with a terminal illness that will lead to death within six months.  Interested patients must also provide the request for termination in writing to the physician. In addition, physicians are expected to inform patients to alternative means of care including hospice care and other medications. Only after precautions evaluation, the laws then permit patients to make the ultimate life ending decision.

In this situation, the doctor asked the husband if he could resuscitate his wife despite her having a DNR. The nurse in the room could have interjected and said that the wife has already signed off on a DNR, and the question of resuscitation is off the table. Also, the nurse could have explained the patient's wishes to the husband and the doctor. In this case, the doctor was influenced by the husband's wants, the husband had told the doctor that he wants his wife to live.

The topic of end-of-life care may seem daunting and uncomfortable, and yet most individuals do have unique desires and concerns regarding their provision for the future. Providing the opportunity for that communication, the advance directive and POLST forms allow an individual to explicitly state their wishes before the future. Developed to lessen the apprehensions concerning patients undergoing any extensive and unwanted measures to preserve life at any cost, these medical directives lighten the decision-making burden for physicians and families alike and help comply with the patient’s utmost end-of-life wishes.

Rarely any physician intends to harm patients when he or she provides treatment to them. Patients see physicians and specialists in full faith that they will get help with a condition. What complicates the patient-doctor relationship is that the outcome of each patient’s treatment is different because of individual health conditions and the course of treatment chosen by the doctor. Problems arise when a patient is not satisfied with care provided by the doctor or in extreme cases when a patient dies. Since most of the time it is hard to clearly determine whether the outcome was solely a result of the course of treatment chosen by the doctor or whether other factors played a role too, quite often patients take their

Every patient has a right to decide on their own course of treatment and freely consent to that treatment. In order to make an educated decision they must be provided with the proper information to make an informed choice (Opinion 8.08 - Informed Consent, 2006). It is the physician’s legal and ethical obligation to provide this information when making their recommendation on treatment. The choices given must be in accordance with good medical practice (Opinion 8.08 - Informed Consent, 2006). The informed consent is the legal policy, either written or verbal, that gives full disclosure of all the information including potential risks that is applicable to the patient’s condition and treatment being offered (Kazmier, 2008).

I must be aware, as the patient’s advocate, of the choice of each individual patient regarding his or her medical management or, as in this case, the withholding of treatment.

Do-not-resusciate (DNR), or no code, is a legal order written either in the hospital or on a legal form to withhold cardiopulmanory resusciation (CPR) or advanced cardiac life support (ACLS), in respect of the wishes of a patient in case their heart were to stop beating or they were to stop breathing https://en.wikipedia.org/wiki/Do_not_resuscitate. One reason a patient may not sign a DNR is not wanting to leave or disappoint their family. Even with physical disabilities and mental deterioration, I can empathize with not wanting to leave my kids and family. Death is inevitable to us all and the only certain thing in life, but I can understand not wanting to live as long as you possibly can for your family. I can also see finances being a potential

I believe that the immediate family members should be given the option to be present during resuscitation of the patient. I believe that it is the immediate family members’ right to be present if they

With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient

Ethical dilemma may also arise in cases where a patient may feel their right to DNR should be carried out when giving direct order. The DNR process, however, is required to be documented by a physician. Andrew Putnam (2003) presents a case where an eighty-eight year old patient’s code status was DNR; “However, the patient has never signed formal advance directive statement or assigned durable power of attorney for her health care to anyone.” (Putnam, 2003, 2025) Ethics can be simply stated as doing the right thing (Roberts, 2002, 242); but in this case ethics is questioned because the physician was faced with the decision to carry out the wishes of the patient or to make a decision based on legality. In this case, it may have been morally right to carry out the wishes of the patient who wanted DNR orders carried out, but it may have been the right choice to do the legal thing and not carried out due to lack of signed documentation.

A Do Not Resuscitate (DNR) order is a document written by a physician that expresses the patient’s, or their surrogate decision-maker’s, wishes on what should occur if the patient experiences cardio and/or respiratory arrest (Braddock and Clark, 2014). While often confused with advanced directives, a DNR is traditionally only in effect if and when a patient requires cardiopulmonary resuscitation (CPR). In practice, most hospitals and professional medical organizations have policies in place, along with guidelines established by state law, to determine when establishing a DNR is medically appropriate.

Usually either patients or families have the legal rights to determine what medical course to take with the patient when it comes to the diagnosis of death, in this case the family's conflict needs be considered. The healthcare staff involved in the patient’s care must communicate with the family members during this difficult time. If the patient is determined to be dead, the family will need support from the health care staff that has been involved in the patients care, all available hospital resources, including medical, nursing, social work, ethics, and pastoral care will be a good resource for the family members. Lawyers will usually advise health care staff to work with the family in the most compassionate way possible, the lawyers should be there to help with any conflict between the family members, and this will also help the organization against any future malpractice suits against the health care staff and organization.