Ethics Case Study #1

Baker College

By: Amanda Stohon, Aeriel Stanton, Madeline Clarke,

Jequnnia Mitchell, Merryl Marasigan,
Tiffany Miller, & Jessica Davis
Overview
● Our case study is based on Mr. T.
■ 82-year-old widower
■ Frequently admitted due to CHF, COPD, and diabetes
● Experiencing decreased quality of life
■ States “This is my last trip; I am glad I have made peace with my family and
God. Nurse, I am ready to die.”
● No advanced directive
● Mr. T goes into cardiac arrest before papers are signed
■ Resuscitated and put on a ventilator
● The son cries out “Do not let him die!”
 As a nurse,
what would you do?
 Autonomy vs. Beneficence

Autonomy and beneficence are both principles of bioethics. These principles

Challenge 1
also include nonmaleficence, justice, and fidelity (Lynn, 2015). The patient has
lost his right to autonomy due to the fact that legal papers verifying his wishes
were not in place at the time of his resuscitation. Beneficence in this case
plays more highly in favor of the son (instead of the healthcare provider), who
is not yet ready to lose his father regardless of his father’s wishes (Pantilat,
2008).
 Autonomy vs. Beneficence continued...
In this scenario the patient’s right to nonmaleficence was not comprised, no staff
member put the patient in harm and the patient went into respiratory distress
naturally. The principles of justice and fidelity go hand and hand in this dilemma
because justice refers to giving a patient their rights and/or respect, while fidelity
refers to promises kept to the patient from the nurse or other health care providers
(Lynn, 2015). In this situation the patient's right to justice and fidelity was not
adhered to only because of the sudden onset of his emergency condition, his
rights were not intentionally neglected by the nurse who insured the patient that
she would put in his advance directive.
 Provision I

“The nurse practices with compassion

and respect for the inherent dignity,
worth, and unique attributes of every
person” (Lachman, O’Connor-Swanson,
Winland-Brown, 2015).
Recommended
Action
● While following Provision One, maintaining the patient's
dignity while being compassionate, the actions should be to
respect the wishes of the father.
● To help the son we would have a social worker come in to
discuss the father's last wishes and ease the son into agreeing
to his father’s wishes.
● The nurse can see if the patient can squeeze his hand or blink
his eyes to answer yes or no questions.

Patient expressed his
wish to the nurse
Patient’s son pleads
Patient goes into
for his father to be
cardiac arrest before
kept alive (despite his
his wish was carried
knowledge of father’s
out
wish)

Phase 1 Phase 2 Phase 3 Phase 4 Phase 5

The nurse Patient’s being kept

acknowledged alive by ventilator
patient’s wish, and
begins the advocate
role
Mr. T stated that his son knows he does not want heroics, but they

have never filled out the form; this does not specify that the forms

were going to be DNR forms, or forms to make the son the power

of attorney. An alternative option is to let the son decide whether or

not Mr. T should stay on life support, and make him the power of

attorney.
 Non-action Outcomes:
Patient: The patient would be upset because he was ready to go, he knew the risks and did not want
to be saved. Mr. T also verbalized his thoughts to the nurse.

Family: Each family member would have a different perspective of Mr.T on the ventilator depending
on their relationship to him. His son was not ready to accept that his father was ready to pass away,
even though he knew his father did not want to be resuscitated.

Nurse: The nurse might feel guilty because of the previous conversation that her and Mr.T had. He
made it clear he was ready to go and wanted no heroic action.

Co-workers: Could be biased and unwilling to help with advice or care of the patient.

Other patients: Mr.T could be a donor for some of his organs that are in good use, but if he remains
on the ventilator the other patient may not receive the organs in time.

Workplace: If the patient's son feels the health care team is being biased, he could take legal action
against the hospital.
Additional ANA Principle
Provision 8 : The nurse collaborates with other health
professionals and the public to protect human rights, promote
health diplomacy, and reduce health disparities (Lachman,
O’Connor-Swanson, Winland-Brown, 2015).
The nurse should now be proactive in collaborating with physicians, social work,
patients, and families to make sure that the proper paperwork is done before this
situation repeats itself.

Making advanced directives a priority will better protect human rights!

References

Lachman, V.D., Swanson, E.O., & Windland-Brown, J. (2015). The new ‘code of ethics for nursing with interpretive

statements’ (2015): Practical clinical application, part 1. MedSurg Nursing, 24(4), 269-368. Retrieved from

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-

2015-Part-1.pdf

Lynn, L. T. (2015). Fundamentals of nursing: The art & science of person-centered nursing care (8th ed.). Philadelphia, PA:

Wolters Kluwer.

Pantilat, S. (2008). Autonomy vs beneficence. UCSF School. Retrieved from

http://www.missinglink.ucsf.edu/lm/ethics/content%20pages/fast_fact_auton_Bene.htm