A.
IDENTIFY THE PROBLEM
Competing Ethical Claims
The patient does not have any advance directives, hence, the family entrusted the
physician to make the ‘right decisions.
The patient was not able to decide what she wants before the beginning of her new
treatments as the physician claims to have the authority to decide what’s best.
Conflicting Obligations (situation in which two laws apparently oblige at the same time and yet
only one can be observed)
The nurse assigned to Mama Rhunong believed that the patient is receiving inappropriate
aggressive treatment, which the latter has expressed to not want such extensive treatment.
When nurse Betty asked Dr. Galing, the physician, to please ask Mama Rhunong what
she wants before they begin the new treatment, Dr. Galing responded that the patient is
“not competent because of her illness, and prolonged stay in the ICU”.
With this, the patient’s rights were violated such as:
Right to Appropriate Medical Care and Humane Treatment.
- Mama Rhunong’s course of treatment show how badly she was handled by
giving her inappropriate aggressive treatment which thwart the progression of
her health development, and on how her right to refuse of treatments was
ignored.
Right to consent or refuse treatment & Self-Determination
- Any person of legal age and of sound mind may make an advance written
directive for physicians to administer terminal care when he/she suffers from
the terminal phase of a terminal illness: Provided That a) he is informed of
the medical consequences of his choice; b) he releases those involved in his
care from any obligation relative to the consequences of his decision; c) his
decision will not prejudice public health and safety.
Personal and Professional Values
The nurse involved in the patients care believes that it is inappropriate to continue
treating her aggressively and that the patient does not such want extensive treatment.
Acknowledge the emotional and communication issues
They believe that she is able to make decisions regarding her life, even though she cannot
speak.
The patient is weak and her writing is often difficult to read.
B. GATHER DATA
(Distinguish the morally relevant facts including medical, nursing, legal, social, and
psychological facts; clarify the patients religious and philosophical beliefs and values)
Medical Facts
The patient has a large anterolateral MI.
She has suffered from CHF, pulmonary edema and hypertension, and has developed
ARDS.
Nursing Facts
The patient’s blood pressure thwarted when she receives morphine and other medications
to keep her pain-free.
The nurse involved in her case believe that it is inappropriate to continue treating her
aggressively.
The nurse suggested asking the patient about what she wants before they begin new
treatments to the physician, thus, implementing the right of the patient which the
physician refuses.
Religious Facts
The patient is a Catholic.
C. IDENTIFY THE INDIVIDUALS INVOLVED IN THE PROBLEM DEVELOPMENT
AND WHO SHOULD BE INVOLVED IN THE DECISION MAKING
INDIVIDUALS INVOLVED IN THE PROBLEM DEVELOPMENT
Mama Rhunong
Family
Nurse Betty
Doctor Galing
WHO SHOULD BE INVOLVED IN DECISION MAKING
The nurse have observed that Mama Rhunong is able to make decisions in regarding her
life even when she could not speak. She has stated that the patient make appropriate
gestures and maintains eye contact with the nurse.
The patient's family should be involved in the decision making on behalf of the patient as
they know what the patient wants and the health professionals would guide them for the
betterment of the patient’s condition.
Factors that may impede the patient's ability to make the decision
The physician has stated that the patient is not competent because of her Illness and her
prolonged stay in the Coronary care Unit (CCU).
The patient has ventilator support to maintain adequate oxygenation.
PLAN
Look into institutional
Consider all Identify the risk and Analyze if plan is in
policies and/or
possible courses of benefits from each accordance with ethical
procedures that
actions. option. theories and principles
address the issue
1. The nurse, together with other healthcare providers, must talk to the family and discuss
the following:
a. The importance of their participation in decision making as surrogate decision maker.
b. The patient’s diagnosis, treatments, and prognosis.
c. Complications of continuing and stopping the treatment.
d. Patient’s anticipated quality of life with or without the treatment.
2. According to the ANA Code of Ethics, it is the nurse’s responsibility to advocate for the
patient. Vital part of this is finding support from other physicians, nurse manager, and
advanced practice nurse. Thus, the nurse must advocate for patient to stop extensive
treatment.
Ethical principles:
a. Autonomy – The nurse believes that the patient does not want such extensive
treatment.
b. Fidelity - The nurse maintains faithful to the patient’s best interest.
c. Nonmaleficence: This will prevent any complications of CCU care.
PROS:
- The patient will no longer suffer from aggressive treatments.
- The patient’s autonomy would not be violated.
- This will uphold the patient’s right to refuse treatment and medication.
CONS:
- Patient will experience extreme pain.
- Conflict between physician and nurse might arise.
3. Support the physician in continuing all the necessary aggressive treatment.
Ethical principles:
a. Nonmaleficence - The nurse must provide a standard of care which avoiding risk or
minimizing it, as it relates to medical competence and to reach a beneficial outcome.
b. Beneficence - The nurse is obligated to act to promote good and well-being of the
patient.
PROS:
- Patient’s condition may improve if quality of care continues.
- Patient will be pain-free.
CONS:
- Patient might experience adverse effects from treatments.
- Patient’s interest is violated because she does not want to continue the treatment.
- Patient’s right to refuse will be violated.
4. Consider placing patient in Palliative Care.
Ethical Principles:
a. Autonomy- If we respect autonomy, it automatically follows that we should never do
anything on the patient without the person’s consent.
b. Beneficence - Patient is treated in an ethical manner not only by respecting their
decisions and protecting them from harm, but also by making efforts to secure their
well-being. Such treatment falls under the principle of beneficence.
PROS:
- Provides relief from pain and other distressing symptoms
- Affirms life and regards dying as a normal process
- Offers a support system to help the family cope during the patient’s illness and in their own
bereavement
- Enhances quality of life and may positively influence the course of illness
CONS:
- It can be emotionally draining, especially given the patient probably will not get better.
