Writing an essay regarding ethical dilemmas

[JSBCP]

Hi,

I am very new to this website, so please excuse if this topic has been covered before...

I am required to write an essay regarding the ethical dilemmas faced by nurses in a scenario of a Jehovah's witness who has been involved in a car accident, who has internal bleeding and requires surgery, but is also 8 months pregnant and is refusing treatment.

It asks to go through Autonomy, beneficience, non-maleficience, justice and confidentiality relating to the case.

It then goes on to ask to analyze the ethical dilemmas regarding the unborn baby.. the hurt mother and the impact of the decision that the nurse chooses with other members of the hospital team..

I am unsure whether I would have a duty of care to ensure the safety of the baby whilst upholding the wishes of the mother or whether I would only have a duty of care to the mother?

Thanks in Advance

JSBCP

[Flying ICU RN]

the terms, i would have to refresh my memory however; i can easily describe my duties and responsibilities in such a case.

the following is true of any scenario, any diagnoses, and any clinical dilemma.

#1 is that i can do nothing that exceeds the limitations of my clinical privileges. the flip side of this particular coin is that i must also intervene in a timely and appropriate manner to circumvent the limitations of those privileges. (i.e., being the timely involvement of the appropriately privileged personnel).

#2 is that i must follow the laws of the land, which in this case would no doubt be dictated by the intervention of the judicial branch of the state where this would be taking place.

our job, from a clinical perspective is deceptively easy; the moral dilemma is a personal issue.

[llg, PhD, RN]

I am unsure whether I would have a duty of care to ensure the safety of the baby whilst upholding the wishes of the mother or whether I would only have a duty of care to the mother?

Thanks in Advance

JSBCP

That's the question YOU are supposed to discuss in your paper. There is no 1 right clear-cut answer to it. You have 2 conflicting obligations -- 1 to the respect the mom's right to autonomy, the other to protect the life of the baby who has not had the opportunity to express his/her wishes. That conflict is what makes it an ethical dilema. Your job as a student is to discuss "both sides" of the dilema and then weight the different considerations on both sides ... then come to a conclusion about what you would do if the situation and had to make a choice ... and justify your conclusion.

I suggest you start by taking "1 side" and building your case for providing no treatment -- putting the mother's right to refuse treatment first and respecting that. Then take the "other side" and make the argument that the mother's choice should not take precedent and that the baby's right to treatment outweighs the mother's rights.

Go through each separately ... and weigh the merits and weaknesses of both sides of the argument. Then pick one and justify your choice.

An interesting twist to this particular topic (and I have both been around such situations as a health care provider and written on it) ... might be found if you do some research on the actual beliefs of the Jehovah's Witness faith. You might also explore your own beliefs to enrich your exploration.

[nerdtonurse?, BSN, RN]

Autonomy -- the mom has autonomy to make her own decisions AND her minor children unless you can prove she can't give informed consent/refusal of care. Beneficience -- well, obviously the best thing is to help both mom and baby, but if mom refuses, you can't do much legally unless you get the hospital's legal department/social services involved and then try to get a court appointed guardian for the baby, which wouldn't probably happen fast enough to do any good. Non-maleficience -- that's where I'd "live" in the paper -- first do no wrong. If you don't help the baby, you've wronged the chld, if you contact social services, you may have religiously "wronged" the mom in the expression of her religious beliefs, and if you treat her against her will, you've committed assault and battery. You'd also have to be careful about the "confidentially" issue (nice side dish of HIPAA compliance). Justice would be getting the mom to allow a C-section so that the child could be treated separately, and if the mom decided to bleed to death, she didn't take along innocent passengers. In the real world, if she continued to refuse, I'd get a fast psych consult to try to get someone to say blood loss plus trauma would render her incapable of informed refusal.

In reality, the patient would probably end up filing wrongful death charges against you when the baby died, stating the stress you put her under caused the death of the child (as opposed to the untreated injury and blood loss), file a HIPAA complaint because her health care info was released to a judge (even though it's legal in that situation), and while she'd lose in criminal court, she'd win in civil court.

[SlightlyMental_RN]

I know I sound grumpy when I say this, but I really hate it when students ask us to do their homework for them.

[blondy2061h, MSN, RN]

Keep in mind two things:

1. At 8 months gestation the baby is likely viable outside of the womb.

2. Jehovah's witnesses rarely refuse all treatment, usually just blood products. Is she refusing all treatment for purposes of your paper?

[llg, PhD, RN]

I know I sound grumpy when I say this, but I really hate it when students ask us to do their homework for them.

Me too. That's why I gave her a clue as to how to go about writing the paper ... but didn't actually write it for her. I don't want future colleagues who don't have either the ability and/or personal ethics to do their own homework and answer their own test questions. But I will gladly point someone in the right direction to do the work themselves.

[ImThatGuy, BSN, RN]

I don't see how someone could crank an essay out on that. They don't want you touching them so don't. I can't see it being any more clear than that.

[Brilliant Dreams]

If I were writing this paper, I would first focus on the side where the mother has the right to be respected. I would also include that many states do not consider the baby a baby but an unborn fetus and therefore does not have the same rights as a born child. Therefore the mothers wishes should be upheld.

The second aspect is obvious, that many believe the baby is a baby. And that baby has the right to treatment. Who is to say that the baby once grown will also be a J.W. and have the same beliefs of the mom. Who is to say that the baby if an adult would not accept a blood transfussion... Etc, etc

To conlude I would throw in the alternatives for this case which could make both parties happy - that instead of a blood transfusion you could educate the mom on blood expanders or artifcial blood. As well as clearly educating the mom on the risks of refusing treatment for herself and baby.

[Brilliant Dreams]

I dont mean to sound cranky when I say this either but I cant stand it when someone posts for advice and other people post things like - refer to other threads, or this topic has been discussed or my favorite - I dont want to help students because of bla bla bla....

Yea whatever! If you dont want to then dont. Why post anything at all? She wasnt asking for someone to write her paper... Have you ever heard of writers block? Or better yet if she is a student maybe she doesnt understand all the aspects that this assignment is looking for. I commend her for thinking to ask experienced nurses about this topic. That doesnt mean anything more than she wanted someones insight on the topic.

[roser13, ASN, RN]

never mind

[nurse2033, MSN, RN]

The fetus has no legal rights until born. Whatever your person feelings are about this, it is true. It is also not in your role to question the beliefs of the mother (at least publicly). You do have a nursing responsibility to the fetus, but only in the manner the mother allows.