The Decision to Withhold Potentially Life-Prolonging Treatments:Scenario Janet and Mrs Jordan - Case Study Example

sе Sсеnаriо: Jаnеt аnd Мrs Jоrdаn [Name] [Professor Name] [Course] [Date] Contents Introduction 4 1. Original Version of the Scenario 4 a) Is Janet’s conduct legally in order? 4 b) Is Janet’s conduct ethically appropriate? 5 2. Alternative Version of the scenario 6 a) Is Janet’s conduct legally in order? 6 b) Is Janet’s conduct ethically appropriate? 7 3. Legality of euthanasia 7 4. Advocacy as an ethically important role for a nurse 8 5. Giving Nurses Authority to write NFR order 9 6. References 10 Abstract: The decision to withhold potentially life-prolonging treatments has been accompanied by several legal and ethical issues since the “do not resuscitate” orders were introduced in 1980s and their subsequent formalization to “not for resuscitation” orders. The debates on why and when such orders should be instigated by nurses, as well as nurses’ moral obligation to their patients are discussed in this paper. Further, the perils and benefits of discussing such discussions with the patients’ families, as well as collaboratively between the doctor and the nurses, are also examined. In addition, the unintended impacts of “do not attempt resuscitation” orders are also reviewed. Lastly, the paper discusses several alternative methods of approaching the decisions to reduce ethical dilemmas that physicians face (Werth and Blevins 2012). Introduction When patients approach intractable burdens or even death, they may wish to restrict medical treatment administered to them, including life-saving treatment. Consequently, they may write a will or reach an agreement with the physicians that particular treatments should not be used on them, such as resuscitation measures after failure of their vital organs such as the heart. Putting these orders into effect can however often be a difficult decision and a source of conflict between doctors and the nurses. For instance, it can at some instances be difficult for the physicians to foretell the exact response of the patient to the medication, thus making it tricky to decide whether the resuscitation attempts should be suspended or whether to follow the patient’s will to withdraw the resuscitation (NSW Health 2012). 1. Original Version of the Scenario a) Is Janet’s conduct legally in order? In the original version of the scenario, Janet’s conduct can be termed as illegal. First, Dr. Johnson had expressed that there was a slim chance that Mrs. Jordan’s life could be prolonged, thus to let her die would be against the principles of his practice. Janet disregarded the doctor’s suggestion. Further, the Australian law states that in the event that a person is terminally ill, the physician or any one for that matter should not kill or actively quicken the death of the patient regardless of how unbearable the patient’s condition is or how he wishes to die. This makes Janet’s conduct to be treated as a case of unlawful homicide (McIlwraith and Madden 2006). Moreover, the principle of “double effect’ suggests that despite the fact that administration of drugs to hasten death (as Janet did) would naturally be unlawful homicide, the common law holds that, the action is justified when the patient shows no signs of recovery. However, the doctor should deem the action as substantially necessary. Again, section 17 of the Consent to Medical Treatment and Palliative Care Act 7995 (SA) stipulates that a medical practitioner in charge of caring or treating a terminally ill patient is under no obligation to continue using life sustenance measures but only after the doctor has examined the patient and decided so (McIlwraith and Madden 2006). b) Is Janet’s conduct ethically appropriate? By disregarding the doctor’s suggestion, it can still be argued that Janet’s conduct was ethical as she had acted to the best interest of the patient, not the doctor. Indeed, this is reflected on the code of ethics contained in the ANMC code of ethics conduct that suggests that nurses have an unmediated and a direct obligation to the patients under their care. Thus, nurses have the power and authority to discharge their duties and obligations to the patients especially when seen to be acting as advocates of her patients (Australian Nursing & Midwifery Council 2013). In addition, Janet’s conduct is ethically appropriate and consistent with the guiding principles in clinical care. First, she sought collaborative approach in the end-of-life care -- before hastening Mrs. Jordan’s death by taking a new bag of IV fluids and hanging it to run continuously. For instance, during Mrs. Jordan’s stay in ICU, Janet had been engaged in several discussions with Mrs. Jordan’s family and they had clearly indicated that the patient had wished that no life sustenance measures be administered in case of terminal illness. In the ethical principle, the health care practitioners and the families of the patients have an obligation to work jointly in making decisions for terminal patients who lack decision-making capacities. 2. Alternative Version of the scenario a) Is Janet’s conduct legally in order? Janet’s conduct can be argued to be legally in order as Mrs. Jordan, the patient, had left instructions not to be resuscitated. The patient’s wishes had to be respected unless there was a reason to substantiate that the circumstances had changed since the patient had issued the directive to have the treatment stalled. Legislation ensures this right. In the case of Mrs. Jordan, her condition had continued to worsen and CPR (Cardio - Pulmonary Resuscitation) was not an option. Besides, CPR was not expected to work in her case, as it would simply prolong the dying process. As a result, it was legitimate to disregard it based on the legal assumption that no person should administer futile medical treatment. In addition, there were substantial indications that Mrs. Jordan’s life would be significantly reduced (NSW Health 2004). Moreover, even as the law states that where a patient is terminally ill, the physician or any one should not kill or actively quicken death regardless of how unbearable the patient’s condition is or whether he wishes to die. According to Section 17 of the Consent to Medical Treatment and Palliative Care Act 7995 (SA), a physician in charge of caring or treating a terminally ill patient is under no obligation to continue instituting life-sustaining measures to a terminally ill patient once the patient has elected that the measures be withheld. This is however on condition that the doctor is satisfied that the action would only serve to prolong the life of the patient without real prospects of recovery. b) Is Janet’s conduct ethically appropriate? Janet’s conduct is ethical. First, she was respectful of Mrs. Jordan’s life and care during her dying process. Ethically, terminally ill patients have the right to refuse life-prolonging treatment, which means physicians have an ethical, moral and legal obligation to respect the patient’s stated wish. This justifies Janet’s conduct in hastening Mrs. Jordan’s death (Megan-Jane 2011). Further, Janet also administered non-discriminatory care, which is ethically sound. In this regard, treatments during end-of-life care should be non-discriminatory and should rely entirely on the factors that are pertinent to the terminally ill patient’s wishes and values (Staunton and Chiarella 2005). 3. Legality of euthanasia In the original and the alternative versions of the case scenario, Janet withdrew the noradrenaline, thus hastening Mrs. Jordan’s death. However it is possible that her actions could have been treated as justifiable homicide. This may be an indication that it would be better if euthanasia and assisted suicide were legalized; only then would Mrs. Jordan have died in a dignified manner (Kerridge, Lowe and Stewart 2009). Moreover, euthanasia may be derived to mean an easy and a gentle death, which could as well be derived to mean “killing in the name of compassion”. Even as euthanasia has been considered by some quarters as legally and morally unjustified, in Janet and Mrs. Jordan’s case, it can be a morally justified and an ethically appropriate action as it was out of “compassionate motive”. In addition, the acceptance and disqualification of legal euthanasia is often judged on what is morally accepted. Besides, Mrs. Jordan was terminally ill and in a severe and persistent suffering. In this case, Janet’s decision was based on the need to relieve the patient’s pain and suffering. Probably, a key argument here is that the patient and her family were involved in an endless suffering and viewed that the process would facilitate the treatment of pain (Kerridge, Lowe and Stewart 2009). Euthanasia can as well be described as the painless method of putting to death of a terminally ill person through deliberate exclusion of withholding of life-sustaining measures. This description fittingly attempts to justify Janet’s action, meaning if the euthanasia is justified, Mrs. Jordan’s death could be made more dignified. Additionally, neither the medical ethics nor the law demands that a terminally ill person be forced to keep alive. Besides, Mrs. Jordan’s family had communicated her intention that in the event that she becomes terminally ill, then her treatment should be withheld. Thus, the reluctance to legalize euthanasia is like insisting against the terminally ill patient’s wishes and that of her loved ones (NSW Health 2012). 4. Advocacy as an ethically important role for a nurse Janet is seen to act as her patient’s advocate in the original version. First, she is seen to practice non-discriminatory care to Mrs. Jordan even when Dr. Johnson is hesitant (Staunton and Chiarella 2005). Indeed, at the end-of-life treatment as in this specific scenario, patient care should be non-discriminatory and should as well be based on aspects that are uniquely pertinent to the patient’s wishes and values. She is also seen to serve as her patient’s advocate when she appears to respect Mrs. Jordan’s life and care when her condition and suffering worsens (Chiarella, M 2006). Here, even as health care is intended to preserve life, in instances when this seems potentially futile, she shows respect and dignity of the patient and that of the patient’s family. Lastly, she is seen to act in the best interest of the patient by withholding and withdrawing life-sustaining measures. Again, end-of-life care is meant to offer best possible treatment (Megan-Jane 2011). 5. Giving Nurses Authority to write NFR order The DNR order means that the physician is not obligated to resuscitate the patient if the action would prevent unnecessary suffering. It can be argued that the difficulties and the conflicts that arose on both the original and the alternative scenarios wouldn’t have emerged if Janet, in her role as Mrs. Jordan’s nurse, had the authority to write a “not for resuscitation” (NFR) order for her patient. In this case, legal and ethical issues would have been averted (Staunton and Chiarella 2005). Ethically, if nurses had the authority to write NFR orders, it would make them more accountable to their patients. First, as Mrs. Jordan’s nurse, she had direct obligation to her patient, and having been close to the patient and the patient’s family, she was in a better position to make the right recommendations that are in best interest of her patient (University of Technology Sidney 2013). Legally, her actions could have been justified based on the principle of “double effect,” which justified withholding life-sustaining measures on condition that the doctor has substantially proved that doing so is necessary. If she had the authority to write the NFR order, which means that her role as a nurse would be recognized, as well as her independence of knowledge, of the dosages and drugs, to maintain a direct obligation to their patients. In fact, the principle of “double effect’ suggests that despite the fact that administration of drugs to hasten death (as Janet did) would naturally be unlawful homicide, the common law holds that, the action is justified where the patient has no potential to recover (University of Technology Sidney 2013). 6. References Australian Nursing & Midwifery Council, 2013, code of professional conduct for nurses in Australia, ANMC, Dickson Chiarella, M 2006, Policy in End-of-life Care, Ethics, Practice and Research, London, Quay Book, Chapter 3, pp 35-50 Kerridge, I., Lowe, M. & Stewart, C 2009, Ethics and law for the health professions, Federation Press, Annandale, NSW NSW Health 2004, Using Advance Care Directives, North Sydney, NSW Department of Health, pp 3-11 NSW Health 2012, Guidelines for end-of-life care and decision-making, North Sydney, NSW Department of Health, pp 2-10 McIlwraith, J & Madden, B 2006, Health Care and the Law, 4thed, Pyrmont NSW:Thomson/ Lawbook Company. Chapter14, pp 471-497. Megan-Jane, J 2011, Bioethics: A Nursing Perspective, Amsterdam, Elsevier Health Sciences Books, chapter 12 Staunton, P & Chiarella, M 2005, Nursing & the law, 6th edn, Churchill Livingstone, Sydney. University of Technology Sidney, 2013, 2329 Accountability in Nursing Practice, UTS: Handbook, Sidney Werth J & Blevins, D 2012, Decision-Making Near the End-Of-Life, Routledge, Taylor & Francis Group Read More