Analysis of the moral aspects/issues found within the scenario.
This case study essay is based on a case study: ‘Matt, a 20-year-old white male, was brought into the emergency department unconscious with a needle protruding from a vein in his left forearm.’ Need help doing a custom case study analysis? Click on order now to hire someone to write a Bioethics essay paper for you.
The prime ethical dilemma faced by the nurse is whether to resuscitate or not. This will be based upon several issues that have been presented. One of the issues was the fact that the nurse is told in explicit terms by the attending physician, not to resuscitate the patient, Mark, as all efforts to keep his brain and heart functioning have been unfruitful. Her supervisor seconds the physician’s recommendation claiming that the nurse should not resuscitate the patient. Thirdly, the nurse herself has a preexisting dislike for resuscitating drug addicts. The family, even after five code blues, still insists that there should be no DNR order declared whereas the patient himself did not leave any orders detailing whether or not to be resuscitated. Compounding the problem even further, the nurse discovers that there isn’t an existing ethical committee or body in the hospital that would guide her in making the decision of whether to try and resuscitate the patient. This means that there lacks a set procedure on how to deal with the issue formally, yet it is of utmost importance that employees be made aware of the steps to follow when faced with similar dilemmas.
Relevant facts that relate to the aspects/issues
The American Nurses Association (ANA) states that no nurse should take part in orchestrating premature death as doing so goes against the tenets of the nurses code, the ethical traditions and objectives of the calling. It also goes against the vow they have with the society which is to provide humane, timely and compassionate transition palliative care. The ANA refers to DNR as assisted or enabled suicide and thus is in direct violation of the nurses’ code (Eckberg,1998).
The question of whether to resuscitate or not, rests with all concerned parties. These includes the patient, who must be informed prior to making the decision of the repercussions involved , the surrogate family as the patient defined them to be and the medical team concerned with his case. Succinct DNR orders need to be drafted before the occurrence of an emergency that might require they be utilized (Callara, 2011).
Ownership of the situation
In Mark’s case, there is no existing express order of DNR between the patient and the hospital giving directive to the cause of action to be taken. In this case therefore, the next of kin or surrogate will be charged with the responsibility to prescribe the way forward, and since they have done so and asked that the patient be kept alive at all costs, the nurse can only respect their orders. This is because she is bound by the ANA code of ethics and the express will of the patient which is manifested through his next of kin. Should the nurse fail to honor these, legal repercussions might befall her and the hospital.
The five essential values that are the core of the nursing profession, as advocated for by the American Association of College Nursing (AACN) are human dignity, integrity, autonomy, social justice, and altruism. These chart the path for nurses and are crucial in the decision making process of an attending nurse. These values are a must have in any worthy professionally practicing nurse (Creasia &Parker, 2001).
Nurses’ main functionality is to advocate for the patients’ wellbeing at whatever cost. The fundamental values as outlined by AACN are mirrored in personal attitudes, actions and behaviors of nurses. In the case of the nurse from the scenario, it`s evident that she is at a loss of what steps to follow because these core values or codes of ethics are not deeply ingrained in her. In as much as nurses are taught these values in their school curriculum, it’s up to the students to internalize them into her profession. If it were up to her, she would affect the DNR order because of her personal opinions on drug addicts. This denotes lack of professionalism and flaunts the core ethical values (Mantley, 2000).
Analyze (suggested length of 1–2 pages) two bioethical issues in the given scenario in terms of a specific ethical theory of your choice. Bioethics theory Discussed
Bioethical issues are part and parcel of a nurse’s daily routine. A nurse however does not operate single-handedly and in coming to conclusions on decisions, he/she seeks the advice the team in which he/she is a member especially when encountered with unfamiliar or complex situations for instance, in the DNR dilemma. It is worth noting that nursing morals and medical morals together constitute part of the larger field of bioethics (Fry Veatch &Taylor, 2011).Nursing is an interdisciplinary are of study and stands out from other disciplines yet it still borrows some concepts from these others (Volker, 2003; Hom: 2006: Wright &Brajtman, 2011).
By 1899 the International Council of nurses had been in operation and was one of the forerunner institutions that developed nurse’s codes of conduct. When the nursing code was first put in place, it was envisioned to be a guideline on how nurses were to serve the physicians` needs the latter being the main trainers of nurses in the Florence Nightingale method of teaching. By 1975 however, the focus of the nurses had effectively shifted from physicians to patients (Callara, 2011).
How the chosen theories relate to the given scenario
Two bio ethical issues in the scenario are as recognized in the revised code of ethics of the year 2001 which states that nurses shall strive to be alive and true to every need of a patient under their responsibility. The nurse in our scenario therefore is bound by this ethic, to uphold the sanctity of the life of ‘Mark’ as it’s demanded of her by the code. The act also states that, should a nurse feel they have a conflict of interest like the nurse in the scenario does, (she despises drug addicts), and she should distance herself from caring for the patient as it would be difficult to take care for the patient as effectively as the code requires them to. A Nurse`s self-respect and respect for the patient is also a crucial element advocated for by ANA (American Nursing Association) as it’s only through this way that the nurse will be able to take care of her/his charges (Callara,2011).
Applicable law or agency policy related to this scenario
Had there been an IEC (Institutional Ethics Committee) in existence, it would have been far much easier for the nurse to seek out the way forward in the matter of her patient. It would also ease the decision making process for the hospital because the decision taken would be limited to the confines of the law. The IEC is a multidisciplinary body and therefore the opinion of just one member or the whole team of health providers tasked with taking care of the patient, does not matter as much as that of the patient does. If the multidisciplinary body is working as it should, the patients’ wellbeing cannot be compromised for anything. The IEC would therefore support the family of Mark in their order to not declare a DNR. (Butt, Karen, Rich. 2012)
Discussion on how alternative actions might affect the patient`s outcome.
If the nurse and the rest of the health care team at the hospital were to follow the nine tenets of the American Nurses Association, whose main focus is on the patients wellbeing , they would find other ways of dealing with Mark’s case that do not necessarily have to do with ending his life by refusing to resuscitate him. As the first code states, the nurse`s primary responsibility is to the patient alone and nobody else therefore in the case of this scenario. The physician`s orders should come second fiddle to the rights or the wishes of the patient and since Mark, the patient in question, did not leave explicit DNR orders, it might be assumed he would have wanted to be saved. It could also be viewed that his family members’ opinion represented his as they are the people closest to him (Creasia & Parker, B. 2001).
The nurse in this scenario looks down upon Mark because of his drug problem. The second code of ethics of the ANA states that “the nurse in all professional relationships, practices both compassion and respect for the inherent dignity worth and uniqueness of every individual unrestricted by consideration of social or economic status ,personal attribute or the nature of health problems”(Butts;Kare;Rich,2012). The nurse should therefore practice compassion, put aside her opinion and act like a professional in an effort to save the patient.
When she was asked to pull the plug on the patient, the nurse shouldn’t have asked for a second opinion from her supervisor even with the absence of an ethics committee. She should instead have applied the third tenet of the ANA which says that “the nurse should advocate for and strive to protect the health safety and right of the sick” (Basanthahappa, 2008).
Code nine is yet another relevant clause of the ANA code of ethics that needs to be used for this case. It states that the profession of nursing, as represented by the association and their members, is responsible for articulating nursing values for maintaining the integrity of the profession and for shopping (Callara, 2011).
The hospital should provide technical advice for the family on how to care for the young man. The nurse could also undergo retraining on some core values contained within the ANA code of ethics as this would help her learn how to draw the line between her personal convictions and her duty as a health care provider (Callara, 2011).
The entrenchment of values of the nursing profession within the institution would give Mark a chance at life since as Creasia and Parker put it” nursing involves having respect for human dignity, service to society, accountability and recognition of the client as an individual and being empathetic towards ones charge”(Creasia& Parker 2001).
Butts J. B., Karen R.,Rich k. (2012) Nursing Ethics, ones & Bartlett Publishers,
Creasia, J.L., & Parker, B. (2001). Conceptual foundations: The bridge to professional nursing practice3rd ed.. St. Louis: Mosby.
Callara L.E (2011) Nursing Education challenges in the 21st century .Nova Science Publishers
Eckberg, E. (1998). “The continuing ethical dilemma of the do-not-resuscitate order”. AORN Journal.
Basanthahappa (2008) Community Health Nursing, Jaypee Brothers Publishers,