Nancy Cruzan's Ethical Dilemma

“An ethical dilemma exists when a choice has to be made in which the consequences may have a potential positive or negative outcome.”("Topic 4: Contemporary Ethical Dilemmas (How do managers evaluate beginning-of-life dilemmas?). ", n.d.) The given scenario presents a patient named Jamilah Shah, who is of Turkish descent, 90 years old and collapsed at the side of her bed in the extended care facility in which she resides. The patient suffers from Chronic Pulmonary disease and diabetes mellitus. The patient was rushed to the ER were the EKG and lab tests revealed she suffered a heart attack and she was started on anticoagulants. The patient has no advance directives and a communication barrier exists, the ER department contacts the emergency contact, one of the patient 's sons Bashir. The patient 's family arrives at the hospital and her son states that he makes the decisions and the wants a do not resuscitate order for his mother and no medical intervention other than comfort care. The social worker handling Jamilahs case is concerned by her family 's lack of support and that the family 's wishes are at odds with the patient 's request for help and her expressed desire to live. Furthermore if the patient does not receive a cardiac catheterization or is considered for a coronary bypass, she will surely die.

Further, relatively few patients have executed an advance directive such as a living will or durable power of attorney for health care.” (Slomka, 2003). So therefore, the doctors in the state that they practice in must become “familiar with state laws and address legal concerns with hospital legal counsel. The US Supreme Court, in its Nancy Cruzan decision,15 reiterated that nutrition and hydration are medical treatments and as such can be legally withheld or withdrawn under appropriate medical and ethical circumstances.” (Slomka,

The first scenario I will like to write about is from the video Advance Care and Planning, the case of Mary, Helen and Steven. According to the notes from PowerPoint slides on “Ethics and Aging,” death is viewed with a negative connotation, even considering it taboo, and some feel speaking about death might trigger a tragic life event (Wong, 5). This might be the reason why Steven, 32, might not have an Advance Care Plan nor a Power of Attorney for Personal Care as indicated by the video. As one of the members of the hospital ethics committee, I would talk to the Helen and Mary first about Steven, and figure out through them what Steven would consider to be a good quality of life. I would then try to convince both women that the quality of

This case is about 55 years old Mrs. Celeste with an end-stage lung disease. Currently, she is unconscious and is under aggressive life support. The health care team feels that she will not be able to be off of the ventilator, and that she had actually, although there is no proof, told the physician that she did not want to be on life support if there were no other choices. Since Mrs. Celeste did not assign anyone to hold her power of attorney, the doctors turn to her four children. Three of the children are religious and believe that a miracle is possible, and that she should not be taken off of life support, and she should be left as she is. One of her children, who is different from the other three, believes that her mother should be taken off of life support and should be left to die comfortably. In this paper, I will first state my stance as to why Mrs. Celeste should be taken off of life support using ethical concepts. I will then debate about possible counterarguments, and explain any sociological concept related to this case. I will conclude with how this case should be handled and, how it could be applied to related cases.

The right of an incompetent patient is one of the greatest issues. If the incompetent patients lose the ability to speak, or make decision, patient’s family usually make the choices for patient’s health care. It becomes difficult, when family’s decision relate to patient’s life. The issues includes withdrawn of hydration, nutrition, and oxygen are parts of the difficulty of making decision. The Nancy Cruzan is the significant case in this issue. This case are called “right to die,” several state courts addressed that issues, but they are still in controversy. Then, the Supreme Court has to clarity the law in this important area, because it relates to many aspects such as religious, moral, and medical decision making. From the Cruzan case, the

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.

Several ethical issues arise when planning, and implementing, advance directives, many of which can be grouped into three general categories: the perspective of the physician, that of the family, and the economic costs associated with advance directives. Physicians are intimately involved in the end-of-care process, and may disapprove with the proxy's end-of -life decisions. A physician may not agree with a proxy's decision to withdraw feeding tubes or medications that may aid in their patient's recovery. On the other hand, a physician's refusal to carry out a patient's wishes may lead to increased pain, suffering, and additional financial hardship. Most hospitals have ethical committees, which help patients, families, and healthcare providers

“Ethical principles are basic and obvious moral truths that guide deliberation and action” (Burkhardt and Nathaniel, 2007, pg. 74). As a professional nurse, the guide of deliberation and action goes back to autonomy, which is respecting the wishes of the patient. Before Mrs. Ann health began to decline, she discussed her wishes with her husband if there was anything happen to them. Mrs. Ann told Mr. Frank, if there was no chance of survival, she did not want to be hooked to a breathing machine. Her health started to decline and she had to be placed in a nursing home. Mrs. Ann stopped talking and eating and the doctor has called Mr. Frank about insertion of a feeding tube. Mr. Frank consults with his daughter about what to do with his wife. As previously stated, before Mrs. Ann health began to decline, she did not want to be hooked to a breathing machine. This means that Mrs. Ann does not want any life prolonging measures to be put in place in order to keep her alive. “For patients with advanced dementia, observational studies have shown no survival benefit when comparing those who do or do not receive tube feeding” (Hanson, et.al., 2008, pg. 1130). Insertion of a feeding tube would not benefit Mrs. Ann, if that is what Mr. Frank and the daughter are concerned about. The primary concern should be respecting the original wishes of Mrs.

Moral distress develops when a person identifies the ethically correct action but that action cannot be put into effect (Delgado & Epstein, 2010) Per the American Nurses Association the nurse is required to protect the patient’s right to make their own decision but in case the patient is unable to do so the provider and the nurse is responsible to look after the patient’s wellbeing especially when the patient is unable to (ANA, 2001). What happens to the patient when they are unable to make their own decisions and the family is not making medically appropriate decisions for the patient? What is the responsibility of the nurse and the health care provider? Up to 63.9% respondents reported frequently or daily encountering issues related to protecting

It might be useful to view the moral principles that apply to this case. First, patients have the right to made a decision on whether or not to receive medical treatment. This follows

In the first case study, Laura’s condition left her unresponsive. Her family is confronted with making medical decisions for her that could impact her quality of life. The code of ethics supports the nurse in this situation though the application of the first three provisions. First, it requires compassion and respect for the individual, whether it is to the patient or her family. It places the nurse’s primary obligation to the patient and requires that the nurse advocate for the patient’s best interest. According to Gingell (2010), “ providing end of life care is expressed in terms of six obligations: providing options,

This scenario is an ethical dilemma because it has two choices that the nursing staff can choose. The first option is to follow the physician’s orders disregarding John’s advance directive. The second option is to follow the advance directive

When researching this case study, the relevant ethical principles that apply to this case study are autonomy, beneficence, nonmaleficence, and justice apply. Autonomy, according to Oxford Dictionary, “Is the right or condition of self-government, especially in a particular sphere.” The medical team respected the patient’s and her husband’s decisions based on their values and beliefs. The principle of benefice, “which centers on promoting the well-being of others,” was used to determine the fate of the patient and her child. The well-being of the woman and her child, was spiritually in this case. Another ethical principle that was involved in this case was the principle of nonmalefiencene, which is “not intentionally inflicting harm on the patient

Ethical and moral dilemmas are an ineluctably ineluctable issue health care provider’s will face, this often leaves the provider torn in making the right decision. When providers are faced with an ethical or moral issue, the right answer is not always clear; and the process of resolving an issues requires the practitioner to examine the situation and make a decision predicated on what will be the best outcome. The purport of this paper to examine an ethical issue, describe the circumventing issues, and compare with Ohio state laws and regulations. Supplementally, the process of addressing the ethical issue with be outlined.

The case study on Ann has many ethical and legal issues at hand, even though she may have discussed not being hooked to a breathing machine, she did not fill out the legal paperwork. Ann has been admitted to a nursing home and after a three weeks develops pneumonia which is now being treated with antibiotics at the hospital. Ann is now improving from the pneumonia but, has stopped talking and is refusing to eat. The physician wants to put in a tube for tube feeding and the husband is having a hard time making a decision. It is often the families that have to make the hard decisions in caring for family members.