Grow Brave Through Reflection: Moral Distress in PICU (Part II) - page 2

by NotReady4PrimeTime 5,657 Views | 13 Comments Senior Moderator

We all know nurses who exhibit signs of burnout. Everyone will have different reasons for their behaviour, and moral distress is often on the list. What does burnout look like? It has many faces, and no two individuals will have... Read More


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    May I ask how an ethics committee is able to override the wishes of the family? I've seen it happen with elderly patients who refuse a PEG and are forced. I don't understand how these wishes can be overridden if the patient/patient's guardian is giving direct instructions. Scary!! Do these ethics committees vary from state to state or do they follow federal guidelines? Anyone know? Thanks!
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    Quote from mfranklin08
    May I ask how an ethics committee is able to override the wishes of the family? I've seen it happen with elderly patients who refuse a PEG and are forced. I don't understand how these wishes can be overridden if the patient/patient's guardian is giving direct instructions. Scary!! Do these ethics committees vary from state to state or do they follow federal guidelines? Anyone know? Thanks!
    I know that in the NICU, there is a federal law called "The Baby Doe Laws" from 1984, still in effect today. .it was enacted because of an infant born in Indiana with Downs' Syndrome and other life-threatening issues. The parents opted not to treat the other issues, and the baby died a week or so later. There were pro-life nurses working the case in the NICU, and they reported it to the media, it went viral, so-to-speak, ended up on Reagan's plate, and he was responsible for this law being passed. It essentially says that life support cannot be withheld from an infant based on the infant's potential for disability. There are a couple of exclusions, such as infant was born with a condition incompatible with life. However, this puts extremely premature infants at the mercy of over-zealous treatment - my daughter was one of those victimized by this, and I know of others. If interested, look up the "Sidney Miller" case - a 23 weeker whose parents did not want life support started, hospital ignored them, did it anyway, Sidney is now horrendously disabled as a result of complications in the NICU, and their insurance limit was maxed out prior to her first birthday.

    Another case in Michigan - a Dr. and his wife had a 26 weeker who was born limp and blue, they asked no heroics be done, hospital ignored them and intubated anyway. Once mom recovered enough to get up to a w/c, Dr husband took his wife to the NICU, where he d/c'd ventilation, placed baby in mom's arms and infant quickly passed away. He was charged with manslaughter. Lengthy trial resulted in aquittal.

    There is an excellent book called "Baby at Risk" published in 2006, that discusses this - very interesting read.
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    I have worked in peds critical care my entire career. I can't imagine doing anything else and am so thankful for those who love geriatric patients. I am currently a pediatric CNS and am working on my DNP and plan to continue in the PICU. Many times, physicians, institutions, and many states make it difficult to "do the best" for the patient due to their own personal opinions about saving a life "at all costs". We often do mislead families by using words like "better", "improved", "had a good night". Families interpret these terms as healed. I always try to tell new grads and others new to PICU that, if you get to the point that you cannot cry with a family, you need a new job. By the same token, I also remind them that, if this takes over your life, you also need a new job. I also try to remind them that, even though you are angry at what a family or caregiver has done or allowed to happen (for example, a shaken baby), you are there to care for the child and that has to be first and foremost. There has to be a balance in all things or all the bad will truly bring you to the pit of sadness.
    trixie333 likes this.
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    Quote from mfranklin08
    May I ask how an ethics committee is able to override the wishes of the family? I've seen it happen with elderly patients who refuse a PEG and are forced. I don't understand how these wishes can be overridden if the patient/patient's guardian is giving direct instructions. Scary!! Do these ethics committees vary from state to state or do they follow federal guidelines? Anyone know? Thanks!
    Yes, laws regarding the ability to override a patient's wishes do vary from state to state. For example, until this past year, Missouri allowed a family member or significant other to override advanced directives and organ donation wishes. That is no longer possible


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