Should Nurses Assist in the Withdrawal of Life Support Systems - Research Paper Example

?Should Nurses Assist in the Withdrawal of Life Support Systems 0. Overview: Ethics and Nursing Nursing has an ethical dimension. In the delivery of quality health care, the question of what is right and wrong is always involved in the work of nurses. This is because the work of nurses involves making decisions. Given so many patients to attend and in need of health care services, whom should a nurse prioritize? Relatives and the public may request information on the patient’s health, should information be given? Therapies may be painful or may be associated with pain, to what extend should a nurse accommodate a patient’s request to hold off or postpone an action that is necessary but painful to a patient? These are some of the ethical questions that may confront a nurse and even other health professionals. The ethical goal of a health professional’s practice is to deliver a caring response given an ethical issue or question (Purtilo and Doherty, 2011, p. 25). 2.0. Relevance of the Ethical Issue on the Withdrawal of Life Support System The issue on whether it is ethical for nurses to assist patients or their relatives in the withdrawal of life support systems for patients is highly relevant because the issue is frequently encountered in the setting of terminally ill cancer patients, stroke, heart attacks, and other illnesses where patients can become comatose. In this case, the case for withdrawing the life system can be debated especially if there are no signs that the patient will recover from the situation soon. The ethical issue is also relevant in situations where the patient is terminally ill as determined by a competent medical professional, believed to be without possibility of recovery from the standpoint of medical science, and in extreme and serious pain at the same time. Finally, the ethical issue may also be relevant in situations where nobody is footing the bill for the life support system and, yet, the patient does not show signs of recovering from a condition or illness believed to be terminal as determined by a competent medical professional. 3.0. My Argument My argument is for an affirmative response to withdraw the life support system where any of the following applies. Firstly, in situations where the patient is assessed by a competent health professional that he is or she is terminally ill with no bright hope of recovery and in serious in pain. Secondly, where the patient is in coma and there is no indication of recovery from the illness or situation. Thirdly, when the patient is brain-dead, there is no sign that the patient will recover, and that no one is footing the bill for his or her medical expense. The ethical principle or theory on which I base my perspective is utilitarianism. Utilitarianism “is the creed which accepts as the foundation of morals, the greatest happiness principle” (Mack, 2004, p. 63). Mack (2004, p. 63) continues that “it holds that actions are right in proportion to happiness and wrong as they tend to produce the reverse of happiness.” Allowing a person to suffer extreme pain when dying will highly magnify the grief and sufferings not only of his or her loved ones but also of the patient. A person who is brain dead with no likelihood of waking up and surviving produces grief for his or her loved ones. Most likely, if a patient in coma is asked of his or her opinion on his or her situation (situation of prolonged coma and prolong suffering for her loved ones), he or she would vote for the withdrawal of his or her life support system. If nobody is footing the bill for one’s life support system and dying or not waking up is the likely outcome, then it might also be better if the life support system of the individual is withdrawn. 4.0. Counter-Argument Those who subscribe to the deontological or duty-oriented theories on ethics will probably oppose my position. According to Edge and Groves (2006, p. 38), “deontological ethicists feel that the basic rightness or wrongness of an act depend on its intrinsic nature than on the situation or consequences.” Deontologist may argue that it is the foremost duty of the health professional to save lives. They can argue that saving lives rather than ending them is the appropriate “caring response” to the condition. Further, the counter-argument that can be forwarded against my perspective is that nobody has the right to make judgment for the patient to end his or her life with the withdrawal of the life support system. 5.0. Medical Indications, Patient Preference, and Quality of Life Meanwhile, the problem of anchoring the decision to withdraw the life support system on a supposed “brain death” is that what may constitute brain death is not be easy to define and if successfully defined, can be subject to legal debates. For instance, Verheijde et al. (2009, p. 409) has questioned the 1968 Harvard criteria that “equated irreversible coma and apnea (i.e., brain death).” Verheijede et al. (2009, p. 409) questioned the 1968 Harvard criteria for equating brain death with human death on several grounds. First, according to the authors, “brain death does not disrupt somatic integrative unity and coordinated biological functioning of the living organism.” Second, neurological criterion of human death is unreliable. The “criterion of circulatory arrest 75 seconds to five min is too short for irreversible cessation of whole brain function” (Verheije, 2009, p. 409). Third, the brain-based criteria for determining death with a beating heart exclude many factors (Verjeije, 2009, p. 409). Fourth, clinical guidelines defining brain deaths are not consistently validated. (Verjeije, 2009, p. 409). Finally or fifth, the scientific certainty of defining impaired consciousness or brain deaths has not been public disclosed (Verjeije, 2009, p. 409). Thus, given the problems involved in determining what constitute brain death, the appropriate rule to follow is to base decisions on science, particularly medical science, our notion of brain death and even the notion of what constitutes unlikely recovery from a coma. In the case of people who are experiencing severe pain just before dying, withdrawing the life support system may be the best way of raising the patient’s quality of life. For these people, however, it is best that the decision to withdraw the life support system originate from the patients themselves rather than from the medical professional. 6.0. Contexts and Ethics Applying the relevant code of ethics of various health professionals should be the main basis for making ethical decisions. In the 2006 International Code of Ethics of the Nursing Council, the preamble defined that nurses have four fundamental responsibilities: “to promote health, to prevent illnesses, to restore health and to alleviate suffering.” Clearly, withdrawing the life support system in a situation where life has been deemed ended will not likely violate the four fundamental responsibilities of the nurse. When life is not longer there (something which must be defined scientifically and medically), withdrawing the life support system will not lead to a violation of the nursing code of ethics based on the 2006 International Code of Ethics of the International Nursing Council. Another document that can be the basis of ethical decision is the 2001 American Nursing Association’s code of ethics of 2001. One of the highlights of the ANA code of ethics is the emphasis on human dignity. It appears logical to argue that withdrawing the life support system when death is either surely imminent and suffering is only promoted, withdrawing the life support system can be the only way of preserving human dignity. Another document that can be the basis of ethical decision is the document Guidelines Summary NGC-6550. The guidelines identified ethical and legal standards for decision-making. For example, the document pointed out the use of surrogate decision-making, the ethical principles related to the withdrawal of life-sustaining care and the procedure for withdrawing life-sustaining care. Behaving consistent with or following the official and applicable guidelines and code of ethics of the relevant professional healthcare groups constitute correct ethical practice. We have seen that the relevant guidelines we have identified are consistent with ethical behavior related to the withdrawal of life support systems when needed to keep patients safe from prolonged pain and prolonged coma when the prolonged coma will not likely lead to health recovery. 7.0. Six-Steps in Ethical Decision-Making Purtilo and Doherty (2011, p. 102-110) recommended” a six-step process of ethical decision making in arriving at a caring response.” Let us apply the six steps in analyzing the issue of whether nurses should assist patients or their relatives in withdrawing the life support systems. Firstly, gather the relevant information (Purtilo and Doherty, 2011, p. 102). In the issue of whether it is ethical to assist the patient or his/her relatives in withdrawing the life support for a patient, medical health professionals must check first and foremost whether the patient is really terminally ill or whether the pain that the patient feel is merely transitory or impermanent. It must be established first whether the patient’s illness is terminal or whether there is a chance for survival or for overcoming a condition or illness. I believe that in this regard, the patient must be encouraged to seek a second or several medical opinions on whether his or her condition is genuinely terminal. Secondly, identify the ethical problem (Purtilo and Doherty, 2011, p. 105). The ethical problem can be a moral distress, an ethical dilemma, or a locus of authority. In this second step, the appropriate point for reflection on whether the ethical problem involved in the question of whether nurses should assist the patient or his/her relatives in withdrawing the patient’s life support system is something that the nurse should decide in the first place. In particular, it should be asked whether it should be the relatives or the loved ones of the patients who should be removing the life support system or whether it should be the doctor’s call or decision. It may be that the decision should be made by the relatives of the patients in consultation with the attending physician and that the decision on whether the life support should be removed is a decision that the relatives or the patient should be making in consultation with their doctor. The nurse in this case is not the decision-maker but only the patient and/or his relatives in consultation with their doctor. Yet, at the same time, nurses may be asked to assist in implementing the decision of relatives or the patient in consultation with the attending physician or physicians. Third: Apply ethical theories or approaches in the ethical problem (Purtilo and Doherty, 2011, p. 107). Some of the ethical theories and approaches covered by Purtillo and Doherty (2011, p. 65-93) include the virtue theory, principle-based approach, and the deontologic and teleologic theories. The ethical theories relevant for health care identified by Edge and Groves (2006, p. 30-55) include the teleological theories, deontological theories, virtue ethics, and divine command ethics. Fourth: Explore Practical Alternatives (Purtilo and Doherty, 2011, p. 108). The practical alternatives for withdrawing the life support systems include assigning the responsibility to significant others or patient relatives the responsibility of actually withdrawing the life support systems. This is perhaps the most practical and correct alternative rather than for the nurse or the health professionals to be the one to implement the withdrawal of the life support system. Another practical alternative is for the health professional to facilitate the preparation of documents that would authorize the health professionals to withdraw the life support system of the patient after confirmation that withdrawing the life support system will be consistent with the patient’s interests. Fifth: Complete the action (Purtilo and Doherty, 2011, p. 109). This involves implementing the appropriate ethical decision on the subject. For example, this may apply when it has been confirmed that it is more appropriate to mobilize the patient’s relatives for the withdrawal of the life support system rather than for the nurses themselves or another health professional. Sixth: Evaluate the Process and Outcomes (Purtilo and Doherty, 2011, p. 110). In the context of the problem that is being addressed by this work, evaluating the process and outcomes involves making several checks on whether our actions have been done consistent with the ethical rules. Evaluation must be done to improve nursing or professional health practice, particularly with regard to the adoption of correct ethical behavior related to the withdrawal of a patient’s life support system. 8.0. Conclusion In my opinion, the appropriate conclusion to make in this work is that nurses must constantly refer to the applicable nursing code of ethics in their work. Nurses have adopted a code of ethics at the international and international levels. While nurses may differ on their opinion on what ethical rules or theories to follow, it is necessary for the nursing profession to have a set of reference that is served by a code of ethics in assessing what action has been right or wrong. References Armstrong, A. (2007). Nursing ethics: A virtue-based approach. New York: Palgrave MacMillan. American Academy of Critical Care. (2008). Guideline Summary on Recommendation for end-of-life in the intensive care unit: A consensus statement by the American Academy of Critical Care Medicine. Guideline Summary NGC-6550. American Nursing Association. (2001). Code of ethics for nurses with interpretative statements. Easley, C. and Allen, C. (2007). A critical intersection: Human rights, public health nursing, and nursing ethics. Advances in Nursing Science, 30 (4), 367-382. Edge, R. and Groves, J. (2006). Ethics of health care. Thomson Delmar Learning. International Council of Nurses. (2006). The ICN code of ethics for nurses. Geneva: International Council of Nurses. Mack, P. (2004). Utilitarian ethics in healthcare. International Journal of the Computer, the Internet and Management, 12 (3), 63-72. Purtillo, R. and Doherty, R. (2011). Ethical dimensions in the health profession. 5th ed. St. Louis, Missouri: Elsevier Saunders. Verheije, J., Rady, M., and McGregor, J. (2009). Brain death, states of impaired consciousness, and physician-assisted death for end-of-life organ donation and transplantation. Medical Health Care and Philosophy, 12, 409-421. Wilson-Barnett, J. (1986). Ethical dilemmas in nursing. Journal of Medical Ethics, 12, 123-126. Read More