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Analyze the bioethical issues found within the scenario
It has to be noted that Matt’s case presents a controversial ethical and legal situation that has a potential to affect the medical facility, its workers, as well as the family members. There are several bioethical issues involved in the case. First of all, there is a disagreement between the desire of a family to resuscitate their son and the judgment of the physician not to proceed with this procedure due to the low chances that the patient will eventually wake up. Secondly, the nurse finds it morally difficult to take care about the patient with drug-related problem that can affect her judgment of patient’s state. Thirdly, the patient does not have DNR clause, making it difficult to satisfy his needs. Finally, the physician does not want to follow the ethical guidelines by omitting the interests of the family. All these issues present a set of complicated problems that cannot be resolved at once.
Provide relevant facts that relate to the issues
At this point, a physician sees several signs indicating that Matt will not wake up, as EEG shows his brain is dead, there are clots of black blood, and several procedures of resuscitation used earlier. The family members are willing to proceed with the attempts, which may collide with the decision of a doctor not to do so. A nurse, in this case, finds herself in a difficult position, as she is obliged to take care of the patient’s interests as well as to make sure that all procedures and decisions comply with the ethical code of conduct. Also, she does not feel comfortable with taking care of patients dealing with drug problems, which points to the personal ethical values of a nurse. There are also the interests of Matt that have to be considered. As he is not an adult, the family cannot have the right to decide his future. As the physiological signs are showing, he will not survive even with the further attempts to resuscitate.
Discuss how the nurse and the family members have ownership in the given scenario
As there is no signed DNR clause, Matt’s interests are represented by his family members, meaning that they have ownership of his rights in the situation. It will be illegal and unethical to eliminate the family interests from the equation. They have the right to seek the compliance of their interests and if necessary may turn to the legal support. However, the nurse, who is obligated to serve the interests of the patient, has the right of ownership to represent the interest of the patient, which enables her to turn to persuade the physician to follow the desire of the family, turn for the guidance to the ethical committee, and instruct the family members regarding the current situation with their son.
Discuss how the ethical principles of autonomy, beneficence, and non-malfeasance relate to the given scenario
The issues of autonomy, beneficence, and non-malfeasance have to be reviewed in the Matt’s case. The principle of autonomy requires medical professionals to respect a patients’ privacy and the ability to make decisions on their own. In this scenario, physician and a nurse cannot fully consider Matt’s choices, as he is unconscious. Yet, his family has certain rights to represent his interests. Here, the medical professionals are torn between the autonomy and beneficence, as it requires the medical staff to contribute to the welfare of a patient. From a medical point and the principle of beneficence, Matt has not to be resuscitated, but in order to maintain autonomy, it is important to consider the family’s desires. Non-malfeasance points to the same direction, as the attempts to save Matt cause unnecessary suffering to him and his family, which contradicts this principle.
Analyze two bioethical issues in the given scenario in terms of a specific ethical theory of your choice
In the Matt’s case, it is possible to use the principles embedded in the deontological framework. This theory requires individuals to act on the basis of their direct duties and rights (Garbutt & Davies, 2011). First of all, in the Matt’s situation, there are two major bioethical issues, including the choice of resuscitation and the nurse’s attitude to the patients with drug-related problems. First of all, deontological principles require the medical professionals to recognize not only the duty of a professional but also the legal issues in the situation. Therefore, the physician has to consider the interests of the patient as well as his family in terms of the morality of his and their actions and regarding the possible legal conundrums. Secondly, regarding the inability of a nurse to take care of the patient with drug problems, she is obliged to follow her duties by taking care of a patient, despite her personal attitude to the issue with drugs, which is not professional. Also, she is mandated to take into account the desires of the family and patient’s interest. It has to be noted that a nurse has to obey the instructions of the supervisors and follow a physician’s decision.
Principle-based ethics
Deontology is principle-based ethics that has strict guidelines according to which individuals have to act (Garbutt & Davies, 2011). This framework emphasizes the importance of the professional duties, legal rules, and moral values. In the case of bioethics, Deontology can apply its principles within the fields of the professional relationship among the medical staff, the responsibilities of the nurses to take care of the patients despite the interests of the other parties, and the strict regulation of the responsibilities of medical professionals before the community. Deontology is usually criticized for its inflexibility and primary focus on rules, but in the Matt’s case, it is essential to apply principle-based theory, as a failure to comply with rules and obligations may lead to the legal ethical consequences for the medial professionals as well as to the facility.
Explain how the chosen theory can relate to the given scenario
Deontology is a correct framework to apply in this case, as it concerns the observation of medical confidentiality, the problem of medical professionals’ responsibilities to the health and wellbeing of the patient, as well as the problems of the relationship between the workers in a medical facility (Glannon, 2005). Specifically, the nurse has to abstract her subjective attitude towards patients with drug-related problems and comply with the ethical code of conduct and the principles of deontology that obligates her to take care of all patients despite the circumstances and the medical issues.
Discuss a state law or nursing statute that can be applied to the scenario
As Matt does not have “do not resuscitate” (DNR) order, yet legally and ethically his family members or the person appointed to make such a decision have the right to resolve this situation. The decision of a physician has to be based on the desire of the family to proceed with the further attempts. Legally, DNR guide claims that if a patient has lost the ability to make medical decisions and has the advance directive not completely filled in, the family members may decide the patient’s right of DNR (AMA, 2004). At the same time, the guideline advises the physicians to consult with another medical professional as well as the ethical committee when there is a complicated case (AMA, 2004). In this case, the nurse has to follow the legal and ethical framework and advice the physician to comply with these principles. It will be illegal in Matt’s case to stop the attempts to resuscitate him. At the same time, in this case, the physician’s medical knowledge and experience show that such attempts are not correct and harmful. Thus, he has to consult both the ethical committee as well as to seek the independent point of view of another medical professional.
Discuss two alternative actions that could affect the patient outcome
Two possible action scenarios can be implemented in the Matt’s case. First of all, the medical professionals involved can follow the desire of the family members and continue to resuscitate the patient. In this scenario, the nurse is obligated to follow the provision 4 of ANA’s principles, as “the nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care” (Winland-Brown, Lachman, & O’Connor Swanson, 2015, p. 270). Therefore, she has to advise the physician to follow the interests of the family and proceed with the resuscitation. If the physician does not comply with this rule, the nurse has to report to her supervisor and to the ethical committee about a serious ethical and legal issue. In this case, the hospital will avoid legal issues and ethical consequences that may damage its reputation and objective judgment.
Apply the ANA Nursing Code of Ethics to guide these actions
Another scenario involves the provision 2 of the ANA guidelines, which states that “the nurse’s primary commitment is to the patient” despite the family members (Winland-Brown, Lachman, & O’Connor Swanson, 2015, p. 270). Therefore, the nurse has to persuade the family to implement DNR clause by explaining the circumstances. It is possible to speculate that the family is guided by emotions when making the medical staff resuscitate their son. Thus, the nurse has to explain the family that the further attempts will be in vain, as Matt’s brain is dead and his condition shows that he will not survive. Even though it will be difficult to the family, the nurse has to make clear the current circumstances emphasizing that the physician will not be able to save the patient. It is possible to involve an independent medical professional to interpret difficult terms to the family members and persuade them to agree with the physician.
References
AMA. (2004). Family Medical Guide. Hoboken, NJ: American Medical Association.
Garbutt, G. & Davies, P. (2011). Should the practice of medicine be a deontological or utilitarian enterprise? Journal of Medical Ethics, 37, 267-270.
Glannon, W. (2005). Biomedical Ethics. New York: Oxford University Press.
Winland-Brown, J., Lachman, V. D. & O’Connor Swanson, E. (2015). The New ‘Code of Ethics for Nurses With Interpretive Statements: Practical Clinical Application, Part I. Ethics, Law, and Policy, 24(4), 268-271.
