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by justjill

hi, everyone! i was wondering if any of you wonderful nurses have dealt with any kind of ethical dilemmas during your career. i need to write a research paper for my ethics class and i'm having trouble deciding on a topic. so...do you have any suggestions or ethical dilemmas you have been involved in?

thank you so much for your help!

[whipping girl in 07]

YES!! I won't give too many details on a public forum, but we recently had a patient with a DNR order who was dying (bradying down, cheyne-stokes breathing, doppler BP, anuric) whose family NEVER visited, but who miraculously showed up while she was trying to die and asked for the DNR to be rescinded. It was, she was coded and spent a month in ICU then PCU on a vent and gtts to keep her going. Finally got her off the gtts and vent (after being trached), made her a DNR again (at the wishes of the family, mind you) and she was about to die AGAIN and the family did the same thing! Back on the vent, back to ICU for a few hours and then to PCU because she was on no gtts. She's still in PCU on the vent, and she was coded the first time back before Thanksgiving!

One of the doctors took it to the ethics committee, but he lost because the family would probably sue if we didn't do everything to help this patient to keep living (but what a life!)

Several doctors have told the family to find other doctors because what they are doing is wrong, but they insist that she (the patient) would not want to die, she would want us to do everything (even though before she tried to die the first time, she was refusing meals, meds, treatments, dressing changes, etc and kept saying she wanted to die).

The patient has an extensive mental illness history and some of us wonder if it's "payback" for all the years of grief she gave the family. Truly a shame.

[cactus wren]

Like Konni, i have the same sort of scenerio, and i bet almost every ICU nurse has.....would make an interesting paper....


These type of events tend to help the burnout issue IMHO....they just drive you crazy...

[pattyjo]

Hi JillianRose: We had a patient who developed a massive post op infection, the treatment needed was against the religious beliefs of the family. The patient was a minor, but only a few weeks shy of turning 18. Doctor ended up getting a court order for the treatment. This case still stays with me, and it happened 20 years ago. Save the patient/ignore the family's faith. Well, the patient lived, the family was happy. All's well that ends well? I've never been positive we did the right thing. Suppose the patient hadn't made it; would the family be haunted by the fact that what was done violated their beliefs?
These are always interesting discussions. The answers are never as clear as we would like.
Good luck on your paper.


Patty

[muffie129]

I work in an ICU. Two summers ago, we had a young lady in her twenties, drown in a nearby pool. She was under for ten minutes before the lifeguard could find her for the pool was cloudy. CPR was initiated and a heart beat and airway were established.

The ER was going to extubate and let her go, since she was gone already, but, the family said no.

We had her in ICU for FOUR weeks, rotting from the inside out. We tried with this family, but to no avail.

Of course, the ethics committee and administration and the lawyers all had to get into it and side with the family.

We gave her every antibiotic on earth. We even gave her TPN and lipids. She was coded 6 times.She was tested and was found to be brain dead in the first week. She was in MODS and her body finially just gave up.

Why, why, why???????????????????

[AdelaideChic]

Re: ethical dilemma

Sounds like a shame, imagine the extra upset for family and friends going thru so much for so long. Also a real shame for the potential of organ donation...

[Susan9608]

Re: ethical dilemma

When I worked in the NICU, it seemed like there were constant ethical dilemmas. The worst one I ever participated in was with a 32 week preemie born to a 21 year old mom and 55 year old dad, both of whom were crack addicts. Baby was not born addicted to crack, but something was very off about her, in addition to the normal preemie stuff.

Numerous scans of her body and an exploratory lap showed that that baby had no intestines at all. No one could tell if the intestines never formed or if the tissue some how died off during development. But the fact remained that she had nothing below the stomach.

The doctors called in consults from surgery and GI and everyone concurred - this was a fatal defect. Several doctors presented this information to the parents, who refused to accept this. The insisted on a second opinion, which they got, but when the 2nd opinion agreed with the first, the parents went ballistic.

They insisted that SOMETHING be done; they were not up for allowing the child to die peacefully and with dignity. So someone had the brilliant idea to contact the nearest teaching hospital and ask them about it. The teaching hospital said that they just happened to be doing experimental intestinal gut transplants. Of course, the parents jumped on this bandwagon and ran with it.

In order to qualify for this surgery, the child would either have to be 9 months old or 12 pounds. She had a birth weight of 3 pounds. Since she couldn't eat or digest anything enterally, she would have to exist on TPN/lipids for 9 months or 12 pounds. By that time, she probably would have needed a new liver as well.

Our ethics committee got involved at this point, since the case was hopeless, would cause lots of pain and suffering, and a great deal of medical resources. Their first idea was to attempt to remove the child from the parents' custody. Since she tested positive for illegal drugs at birth, this probably could have been accomplished without too much difficulty. Some how, though, her parents got wind of this, and started threatening to go to all the newspapers, telling them that hospitals and CPS were stealing babies and killing them.

No one wanted that kind of publicity. So she stayed in her parents' custody and remained in the NICU for 2 months, trying to gain weight on TPN/lipids. Then, her parents finally slipped up, and came to the NICU high on crack, picked a fight with the staff and attacked an RT. The child was then removed for her parents' custody, and allowed to die a peaceful, comfortable death.

It was a horrible case all around.

[angel's RN]

Re: ethical dilemma

God bless the little baby. What a sad tale!! I really feel bad for that baby, and OH MY GOD!!! What if they try to procreate another poor thing? I may sound like an ogar, but she needs to have the cradle removed so they can have an unproductive playpen!!
Thanks for hearing me out! 's RN