I have spent a good deal of time in the past week reflecting on my emergency medicine clerkship experience, specifically in regards to illustrative ethical situations I have encountered. Despite by best efforts, I could not come up with a true “ethical dilemma” I encountered, in the sense that there was never a situation in which there was significant doubt or disagreement between the healthcare team and/or patients and their families about the proper or ethical course of action. In many ways, this is fortunate. Nevertheless, there were several cases that did serve to illustrate some of the core ethical principles in action that would be useful to discuss. One in particular that comes to mind involves the question of advanced directives and …show more content…
Most important to this case was the question of capacity. In this situation, the patient was clearly incapable of making medical decisions. We were fortunate to have an SDM readily available who understood his condition and previously stated wishes and was able and willing to act in the patient’s interests. In any case of formal or informal application of “advanced directives” or previous statements of a patient’s wishes, it is important to consider the intent of the stated wishes [1]. In this case, it was fairly clear that while the patient stated he would not want aggressive resuscitative measures in a terminal situation, this did not mean he would not want basic investigations done which could reveal a potentially treatable cause of his presentation. Pauls et al discuss a case when overly strict adherence to the “letter” of a patient’s advanced directive, without considering the intent behind it, would have tragically resulted in the death of a patient with a stated DNR from a treatable epidural hematoma. Had the daughter refused the CT or bloodwork, a true ethical dilemma could have arisen which may have required us to question whether she was truly acting in accordance with the spirit of the patient’s previously stated
The nurse in the case study is faced with an ethical and professional, dilemma. How can she be an advocate for her patient Mr. E? Dr G. is proceeding on a course of action or plan of care that is directly contrary to the patients advance directive and his verbalized objections to the course of treatment proposed by the physician and that is concerning for her. There are multiple issues to consider. For the nurse, she needs to think about her code of ethics, her scope of practice and the legal issues regarding advance directives and Durable Power Of Attorney (DPOA). She also needs to consider the patients right to privacy and confidentiality. As with most areas and issues in modern healthcare the statues can be
“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.
Nurses advocates for the patient and family, analyzing the culpable and appropriate use of life-sustaining care in accordance with the choices of the patient and family. (Melissa K Slate, 18) Mr. Miles is unconscious in the scenario and according to the code of ethics, I as a nurse would still respect the rights, dignity of the patient. My services of support for Mr. Miles and his family with whatever decision is made for the family member. My conduct of care will remain the same. Meaning that I will still talk to Mr. Miles while given care, making him as comfortable as possible, telling what I as a nurse is doing whether it be giving him his medications or reposition
According to the U.S Department of Health and Human Services, the Affordable care Act from President Obama gives consumers more options and benefits when seeking coverage from insurance company. It offers lowering cost as well as gets more access to high quality of care. This law creates Patient’s Bill of Rights that is very effective to protect consumers from any abuses or fraud from insurance company. Some preventive services are available to many Americans especially Medicare recipients at no cost. Not just that, they also receive a special offer of 50 percent discount for any well-known drugs in the market place under Medicare named “donut hole.” The Affordable Care Act helps other organizations and programs to convince healthcare providers
Nurses are constantly challenged by changes which occur in their practice environment and are under the influence of internal or external factors. Due to the increased complexity of the health system, nowadays nurses are faced with ethical and legal decisions and often come across dilemmas regarding patient care. From this perspective a good question to be raised would be whether or not nurses have the necessary background, knowledge and skills to make appropriate legal and ethical decisions. Even though most nursing programs cover the ethical and moral issues in health care, it is questionable if new nurses have the depth of knowledge and understanding of these issues and apply them in their practice
In the United States, we place great importance in our autonomy and the right to make decisions about our health care. The right to choose or refuse medical treatment: that our wishes will be honored by the medical community as well as our families. Medical treatment decisions that impact the timing and dying process can provoke strong emotions in patients, health care providers and the public at large. These decisions can raise difficult ethical issues for all involved. They can create conflict between providers and the patient’s families, within families and the health care team itself.
Staff starts to get really excited to have a new manager, after four months without one. The charge nurses on the unit were excited to have a new manager who will provide feedback and not afraid to discipline staff. According to the new manager’s interview, she has experience firing staff who do not follow her guidelines. The charge nurses had a meeting where the interim manager and new manager where they met up and discussed what needed revamping and what difficulties the staff had providing feedback to our colleagues. The charge nurses previously felt unsupported and didn't know how to hold their colleagues responsible for their actions. It was difficult because they would get push back from their colleagues, with no feedback from their
However, as shown later, the interpretation of these principles leads to controversy when they superseded patient autonomy. The American Nurses Association (2010) stated that “patient autonomy should guide all discussion regarding the end of life” (p. 7). By maintaining patient autonomy through advance directives, patient wishes are respected and a clear line of communication is formed. In addition to providing patients with autonomy, healthcare providers must strive to uphold the ethical principle of beneficence. However, practicing beneficence may be limited by advance directives and physiological conditions. In the face of this, healthcare providers must instead provide care by preparing both the patient and family for the dying process and eventually death (American Nurses Association, 2010). While this action does not heal the patient, beneficence occurs though the prevention of potential pain and anguish caused by unsolicited prolongation of life. Lastly, the ethical principle of nonmaleficence when applied to advance directives carries much debate. The ethical dilemma hinges on the interpretation of non-maleficence for patients with advance directives in life or death scenarios. This ethical dilemma was examined in a 2012 survey regarding physician’s adherence with advance directives. The scenario asked physicians if they would honor the advance directives of a patient who under different circumstances wanted to die “peacefully” but now was experiencing unexpected ventricular fibrillation. Results showed that only 41% of physician would comply with the patient’s advance directives. The majority of physicians would ignore the advance directive under the guise that it was not written in anticipation of the presented condition (Burkle, Mueller,
The decision to limit or withdraw life sustaining therapy is made by medical staff in consultation with patients or surrogates. Patient’s families or surrogates often possess intimate knowledge of a patient’s personal values. They believe that this knowledge empowers them, and them alone to dictate what should happen to their relative at end-of-life in ICU. Occasionally they use this belief to persist in requesting aggressive care despite being advised by
The case of Karen Ann Quinlan led to four basic approaches to this ethical problem; advance directives or other clear evidence of the patients wishes while competent, surrogate decision making (power of attorney), and action in the patients best interest. Each solution has deficiencies both in theory and practice, but there can be no debate that their application has changed the landscape of medical ethics.
Medical professionals are frequently confronted to make ethical decisions about life and death matters when giving aid to individuals and families. Ethical decisions need to be considered in a wider context than personal, professional and ethical principles. When making the decision, nurses and other health care providers should try to look from the viewpoint of the patient and the patient’s family by standing in their shoes. The author describes futile treatment as when there is 10% or below success rate for survival. Michael Li believes that the crucial decision of withdrawing or withholding treatment is not only up to the doctors, but should be deliberated with the patient and the family as early as possible so that they are able to contemplate
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.
In this particular case study, many ethical principles were violated especially autonomy. Autonomy is defined as “having the freedom to make choices about issues that affect one’s life” (Burkhart and Nathaniel, 2014, pp. 60). Even though the patient is only 17 and not yet classified as an adult Jessica De Bord states
Healthcare professionals will be faced with ethical dilemmas throughout their career, particularly in the hospital environment. Having an education regarding professional healthcare ethics will provide some direction in how to best address these dilemmas at a time when either the patient or their family is in need of making decisions for themselves or their family member. It can be difficult for healthcare professionals to weigh professional protocol against their own personal beliefs and ethical understandings when determining critical care for their patient.
An ethical dilemma is defined as a mental state when the nurse has to make a choice between the options and choices that he or she has at her disposal. The choice is a crucial task as the opting of the step will subsequently determine the health status of the concerned patient, hence it requires a great deal of wisdom along with proper medical and health training before any such step is opted as it is a matter of life and death. Strong emphasis should therefore be on the acquisition of proper knowledge and skills so that nurses do posses the autonomy to interact with patients regarding ethical issues involved in health care affairs and address them efficiently. It is normally argued that nurses are not provided sufficient