Pertinent Ethical Issues

llg, PhD, RN · Jan 23, 2003

If you really want to open up Pandora's box, why not go for some issues related to nursing rather than medical decisions? It's the docs that decide when to use extrordinary measures, etc. The nurse rarely is the one making the decision. Why not address some of the issues that nurses control?

That's a harder list to come up with. Here are a couple:

1. Nurses who sleep on night shift (now being discussed on another thread)

2. Nurse-patient relationships that become non-therapeutic. Sometimes nurses get attached to patients (e.g. pediatrics) and start to come between the parents and the child.

3. The morality of refusing an assignment.

4. The ethics of under-staffing.

etc. These are NURSING issues that nurses face every day. In many of the examples listed above, the nurses are dealing with the situations every day, but they are not making the decisions. If you want to explore those issues, you should consider the nursing role in the situation. If not, you may as well be writing a medical ethics paper.

Nursing ethics and medical ethics are not exactly the same.

llg

MishlB · Jan 23, 2003

Originally posted by SmilingBluEyes
how bout the everlasting quest to keep super-preemies alive at all costs, iespecially the emotional ones to the parents? the assault going on daily in the NICU's to save paper-skinned iron-lunged 23-24 weekers is what I am talking about.......often against the wishes of parents who would be willing to let such children pass.

How is this possible?? If the parents say stop, isn't care stopped?? :eek:

llg, PhD, RN · Jan 23, 2003

Originally posted by MishlB
How is this possible?? If the parents say stop, isn't care stopped??

Sometimes. Legally, parents' rights to refuse treatment for a child is limited. For example, if the child has a perfectly treatable condition, but the parents want the child to die, they can not ignore the health problem. The law just doesn't let you "get rid of your kids" that way. In order for treatment to be discontinued, the physicians have to agree that further treatment is not in the best interest of the child. If the physicians disagree it is usually possible for the hospital to obtain a court order to treat the child in spite of the parents' objections. Such an extreme situation doesn't happen often, but it does happen.

Most often, there is an honest disagreement/questioning about what is truly best for the child -- with no one being a "bad guy" or a "good guy." Sometimes, the physicians just feel that the child does not meet the criteria for discontinuing treatment and will feel compelled to over-ride the parents' wishes to stop. More often, the parents "question" the continuation of treatment and the physician tells them that not everything has been done yet, there is still a chance, etc. A court order is not necessary because the parents agree to continue treatment based upon the physician's advice.

The nurse is rarely involved in the decision-making in these cases -- although sometimes nurses are involved in the discussions leading up to the decisions. Most often, the nurse is left carrying out whatever decision has been made by the other parties. That's what makes the nursing position unique.

llg

MishlB · Jan 23, 2003

Originally posted by llg
Sometimes. Legally, parents' rights to refuse treatment for a child is limited. For example, if the child has a perfectly treatable condition, but the parents want the child to die, they can not ignore the health problem. The law just doesn't let you "get rid of your kids" that way.

llg

I understand...but I was referring to the super-preemies in Smilings post. Isn't it often the parents that refuse to accept the situation and not the physician? At 22-23 weeks, and I know there are exceptions, isn't survival almost impossible? Just curious...I don't have experience with this.

llg, PhD, RN · Jan 23, 2003

MishlB: I was referring to micro-preemies, too. Sometimes, it is the parents who can't let go: sometimes it is the professionals.

llg

purplemania, BSN, RN · Jan 23, 2003

the Natl. Institute of Health has an ethics committee with a website

SmilingBluEyes · Jan 23, 2003

exactly llg. it's very complicated.

nursenatalie, ADN, RN · Jan 26, 2003

Well, as a collaborative effort in our group we decided to explore drug diversion among nurses, the way nurses "cover-up" what they take etc. and we are focusing on the co-worker who suspects another nurse of this and what they should do. I printed the post and we discussed all the topics as a group. I appreciate all the input from everyone.

MishlB · Jan 26, 2003

Originally posted by llg
MishlB: I was referring to micro-preemies, too. Sometimes, it is the parents who can't let go: sometimes it is the professionals.

llg

I agree...frustrating isn't it?????

night owl · Apr 10, 2003

Originally posted by nimbex
again, the relatives overriding DNR status, but even worse to keep collecting the social security benefits...

Those that keep "loved ones" alive to receive checks.....

SICK

I agree with you 100% it is more than sick, it's criminal in my book, and there ought to be a law against it. I get so disgusted when our residents are sent out to the hospital because the families want EVERYTHING POSSIBLY done, but never even bother to come visit them. I could cry for them everytime. It makes you want to slow code them just so they don't have to suffer anymore...and the so called families can stop getting rich off of their suffering, so called loved one. How is it that they get away with this???? It just sounds criminal doesn't it? Getting rich off of the pain and suffering of someone else. God, how horrible and what kind of people are these family members? I get so worked up over stuff like this...Pardon me for ranting.......I'm sorry.

suzannasue · Apr 10, 2003

I work in a very small rural hospital which,unfortunately, is under the direction(dictatorship) of an MD who codes everyone, often encourages the pts to override their own living wills or gives the pt families false hope thus, they override the living will and many g-tubes, many intubations, many EGD's, many colonoscopies, many codes are performed on ppl who have made their wishes known before hand...it is useless to appeal to the hospital's medical ethic's committee, he is the chairman...he has no ethics...none...nada...

We nurses are professionally obligated to follow his directions and if he wants to have a 3 hour code, exhaust every drug in the crash cart, we bite back the tears...he is not capable of understanding that he is not GOD... his latest goof ball decision was in allowing a family to direct us to "intubate only"...no connecting to the ventilator, no bagging, no drugs,no shocks...intubate her and then allow her to what? Exist on room air? What good is "intubate only"...????? DUH!!!!!

As a night shifter, I believe it is universal that we are always understaffed and that no one pays attention to acuity levels...no one wants to come in and be an extra pair of hands because of the way we are orphaned at night...we have no problem with staff sleeping on the job, we have a problem with certain members of staff being assigned to the "acute care area" when thay have no idea of what, when to do anything,cannot read the monitors, and most recently had to be reminded how to call a code overhead...I call it the"warm body in a position" syndrome...those of us who have the knowledge and skills to be in this area often find ourselves with a double assignment, having to make sure everything that needs to be done for the patients has been done...management can be called in the middle of the night but we get no response...no call back...

As far as refusing an assignment, I have refused to take anymore admits and have been granted that " luxury" especially when I actually leave the floor and go straight to the shift supervisor and EXPLAIN room by room why I cannot take anymore admissions... BUT have sometimes been told I will admit to every bed that is empty...makes no sense to me...and it is those times when I jot off a letter of protest to the manager...ensuring a phone call from the manager....

Nursing ethics looks good on paper but is rarely followed to any extent...speaking only of my own situation...

Am presently looking for a job where everyone's skills are equal to the area's needs and where management actually listens to the nurses...

To quote an enlightened, wise member of this board "we will get only as much crap as we will take" thank you sjoe....

jadednurse · Apr 21, 2003

Originally posted by nursenatalie
Well, as a collaborative effort in our group we decided to explore drug diversion among nurses, the way nurses "cover-up" what they take etc. and we are focusing on the co-worker who suspects another nurse of this and what they should do. I printed the post and we discussed all the topics as a group. I appreciate all the input from everyone.

Please keep us posted on your project and good luck!