Question

You are a student nurse caring for Ms. Cranford. She is an 87 year old mentally competent woman who has lived alone since her husband died 10 years ago. She was admitted to the hospital with chest pain, feeling faint, a pulse of 48, and a blood pressure of 98/56. The physician and the nurses stabilize Ms. Cranford with medication and intravenous fluids but later inform the patient and her only son that she would need a heart pacemaker to regulate her heartbeat. After the physician explained the procedure and the risks involved. Ms. Cranford pondered the situation for a long while before discussing it with her son and the physician. Her medical history includes a long term adult onset diabetes, chronic renal failure, and atrial insufficiency. She feels very tired. She decided that she does not want a pacemaker. Once Ms. Cranford tells her son her wishes, he is quite upset, and he meets with the physician to discuss the options. The physician and Ms. Cranford's son revisited the issue with her in an attempt to persuade her to change her mind, but she continues to refuse the recommended treatment. She and her son have a loud argument about the issue. The physician tries to explain to Ms. Cranford that the pacemaker is for her benefit and in her best interest. It involves very minimal risks to her and would extend her life. She feels like they are "ganging up" on her and becomes angry. Once the RN becomes aware of the problem, you and the RN visit with Ms. Cranford and her son to assess and evaluate the ethical issues involved with her case.

Imagine that you are a nurse on the ethics committee consulted about Ms. Cranford's case. Answer the following questions:

2. What principles are in conflict with this case?

3. What did the physician mean by "best interest" for the patient?

4. What is the role of the nurse caring for the patient in resolving this situation with the ethics team, her healthcare providers and her son?

Answer 1

2. The principle of ethics involved in above case is AUTONOMY.

the principle of autonomy states that every patient should be respected as indvidual and there decision regarding the choice of medical care should be respected after providing with full information regarding the treatment.

Healthcare professionals face a serious issue when Competent patients refuse life saving medical treatment. Patients autonomy, freedom and liberty should be respected by physician according to ethical point of view. The patient’s decision to refuse a treatment should be accepted by the doctor. But sometimes the patient may not adequately comprehend the benefits of medical care or be overly anxious about pain resulting in impaired judgement by the patient. to avoid such scenarios the physician must ensure that the patient understands the risks of not taking the treatment. physician should also ensure that the proposed treatment plan is realistic and have a positive outcome.

3. the phrase "best interest" used by the patient in the above case refers to the best favourable medical treatment and care that will benefit the patient's health.

4. Firstly, the nurse caring for the patient should look for every aspect of the above case. the nurse should assess the situation from patients perspective as well the physician and the son.

the nurse should then talk to the patient regarding her condition, reason behind her refusal for treatment and then try to convince her to take the treatment by making her understand its benefits. even after all this patient still refuses the treatment the nurse should respect her choice.

The nurse should then assume the role of patients advocacy in the ethical committee and represent patients choice and the reason behind it.