Ethics - page 2

A patient you meet on the ward has had A.I.D.S. for some time and is now seriously ill with pneumocystis carinii and other opportunistic infections. He frequently suffers respiratory failure, and has... Read More

  1. by   renerian
    I would call it. Without the documentation to that effect it would be considered here say.

    renerian
  2. by   Tweety
    I wouldn't have waited a few days. As soon as he told me not to resusitate him, I'd be on the phone with the MD. Any MD worth anything would immediately grant the patients wishes at that time. Be a patient advocate, don't let it go in one ear and out the other when he says he doesn't want to be resuciated, get him to fill out the papers and get the DNR order STAT.
  3. by   leslie :-D
    Quote from P_RN
    This sounds very much like a Junior Project in Ethics 101.

    Is this a true situation or is it hypothetical?

    As long as the patient is alert and oriented, without aids psychosis, he/she will be the one to determine code status. Once the physician is made awary and changes the status then the ethics of the situation fall on him.





    http://home.sprynet.com/~owl1/note100b.htm
    P RN - this link is no longer valid, but once i further study the 'linguistics' of deontological theory, i'll respond accordingly. but if it is indeed guided by a moral duty, then it is up to the nurse/advocate to honor the patients' wishes through a legal channel.
  4. by   EastCoast
    Quote from 3rdShiftGuy
    I wouldn't have waited a few days. As soon as he told me not to resusitate him, I'd be on the phone with the MD. Any MD worth anything would immediately grant the patients wishes at that time. Be a patient advocate, don't let it go in one ear and out the other when he says he doesn't want to be resuciated, get him to fill out the papers and get the DNR order STAT.

    I agree with the above.
    Understanding this an old thread...however, the greatest evil would be the nurse who knew this and failed to institute the necessary measures to honor the wishes. If in fact the patient disclosed this wish to you and you failed to honor it i think that would fall along the lines of assault. If you mentioned it and it was ignored and you didn't pursue that either I think that is unethical. I would be interested in hearing how one would apply the utilitatairian theory to this.
  5. by   Spidey's mom
    Isn't it interesting that you can change your mind at any point about DNR and all it takes is your word. Your heart starts doing dangerous things and you get scared and say, "Wait a minute, I don't want to die yet, go for it". And we rescucitate you. But in the same scenario, if you want to die it takes an act of Congress to let you go . . . .

    I'm definitely with Tweety here . . that first conversation needed to be acted upon. If not, you must act and rescucitate and if there is not a DNR order.

    steph
  6. by   EastCoast
    I was lucky enough to work with doc who would actually say the scariest words 'i am not going to resucitate your relative as he is going to die'. that actually gave opportunity for the family to know and spend time accordingly. understand there was no 'god complex' here. The doc was simply someone with enough sense to not drag the family down the long emotional road to hell that is so often not kind or beneficial. when i address end of life with families i will often take the path of 'this is time you could spend with your mom /dad/sister...'. "I don't feel that we as healthcare workers should take that away from them when we know full well there isn't an outcome.
    sorry for the long post.

    regarding the act of congress thing above: that's so true. Unfortunately if someone is uncomfortable enough that they have pain or suffering and change their mind because of this that i don't think they are getting the proper palliative attention they deserve.
  7. by   Katnip
    Unfortunately, if a family wants the patient to be a full code, then the doc legally has to resus them.

    In the short time I've been a nurse, I've seen these issues come up again and again...sometimes the docs don't want to let go and won't tell just how grave the situation is...very unfair to the patient in my opinion, and if the family asks, I'll tell the truth.

    Families, even in the medical field, who won't let go, or want the patient resused and intubated for a few days so they can gather all the cousins from around the world.

    Families who just don't want to let go and deal with the pain. Have to gently remind them that it's going to happen sooner or later, they're just postponing the inevitable.

    Families who keep their loved ones on machines long after they are gone, hoping God will pull off an 11th hour miracle. Have to gently remind them that if God wants a miracle he can do it quite well on his own.

    Anyway, Tweety is right. The minute the patient asked to be a DNR, the nurse should have notified the doctor and gotten that order. Days is too long to wait. The patient could well feel betrayed by that nurse, and a very precious trust will have been lost.
  8. by   leslie :-D
    Quote from EastCoast
    I agree with the above.
    Understanding this an old thread...however, the greatest evil would be the nurse who knew this and failed to institute the necessary measures to honor the wishes. If in fact the patient disclosed this wish to you and you failed to honor it i think that would fall along the lines of assault. If you mentioned it and it was ignored and you didn't pursue that either I think that is unethical. I would be interested in hearing how one would apply the utilitatairian theory to this.
    well eastcost, let's give this a shot. it seems pretty evident that we all agree, from a deontologist viewpoint, that this pt. is begging for a merciful end to his suffering, and we as nurses, feel and understand his need to end it all. the utilitarian theorist would address a much broader audience and not just the patient's needs. who will benefit the most from letting this patient die, or who will be least affected? let's say that his family and friends want every conceivable intervention applied, to prolong his miserable existence. the utilitarian would consider their requests, as well as other factors, including costs involved to keep this person alive versus reimbursed $ received to facility from medicaid or other insurances. after weighing all intellectual, scientific, monetary and emotional/spiritual perspectives, i would have to guess that even the utilitarian would have to say, in this particular case, let the patient go.

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