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Tonya’s Case: Ethics and Professional Codes
Nia B. Thompson
PHI-FPX3200
Ginger Raya
May 17, 2023
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Tonya’s Case: Ethics and Professional Codes
When it comes to end-of-life issues and care, all hospitals are affected and often face moral and ethical dilemmas depending on the situation. In this case study, we have Tonya Archer, a 15-year-old female who went in for what should have been a routine ACL surgery at Saint Anthony Medical Center. The surgery is a success, however, during transportation to her recovery room, she suffered a sudden cardiac arrest episode. The staff quickly began CPR, and she is intubated and placed on a ventilator. The resuscitation effort went on for seven minutes and as a result, Tonya suffered irreversible brain damage. It is determined that Tonya has complete brain death from the cardiac arrest and will never recover. Doctors and other members of the hospital administrative team have explained her condition to her parents. The staff feels strongly that the damage will get worse, and she should be removed from the mechanical ventilator. Her parents are adamant about leaving her on the machine as her body is still warm and she has a heartbeat, therefore she’s not dead.
Ethical Considerations
“During EOL care, ethical dilemmas may arise from situations such as communication breakdowns, patient autonomy being compromised, ineffective symptom management, non-
beneficial care, and shared decision making” (Pirschel, 2016). If we want to view this from the place of patient autonomy, the patient herself would be the one to make the decision. In Tonya’s
case, she’s only 15 years old and she is unable to make the decision for herself. Therefore it is the parents who would be called on to make that decision. Some physicians feel very strongly that this decision should not be made by family members. Family members are often lead by their emotions and don’t make the most appropriate decisions. This will often result in a hospitals ethics committee getting involved to help resolve any issues.
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The hospital staff informed Tonya’s parents of her diagnosis, the outcome of what would happen to her by keeping her on life support, and what the best next steps would be. This showed the practice of Kantian ethics because it is the responsibility of healthcare personnel to be truthful and unbiased regarding the care that would need to be taken. The cardiac arrest forced the healthcare team to think quickly on what the chances of her survival would be. When they told the parents the truth, they did so with the knowledge that they were telling the parents they felt it best to remove life support thus effectively ending Tonya’s life. If the parents opt to keep Tonya on life support, then the hospital staff would need to respect that decision, but also keep the parents informed on the gradual effects of what would happen to her. Tonya is considered brain dead, the best course of action for Tonya and her parents would be to maintain minimal life-support and offering the parents the option to obtain a second opinion.
Nursing Code of Ethics
Nurses are typically seen as the middleman between the physicians and the patients and their families. They often walk a tightrope between their values and morals and what is ethically best for the patients. “To practice competently and with integrity, today’s nurses must have in place several key elements that guide the profession, such as an accreditation process for education, a rigorous system for licensure and certification, and a relevant code of ethics” (Epstein & Turner, 2015). The American Nurses Association is responsible for establishing the guidelines for the nursing code of ethics. The four main principles considered an invaluable part of the nursing code of ethics are:
1.
Autonomy – recognition of each patient’s right to make their own decisions.
2.
Beneficence – acting for the good of others by displays acts of kindness
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3.
Justice – exhibiting fairness in decisions and care no matter a patient’s race, ability to pay religion, sexual orientation, and gender.
4.
Non-maleficence – the most well-known principle of “do no harm”.
(Gaines, 2023)
Nurses are often faced with the dilemma that there are no right answers. This is especially a fact when it comes to end-of-life measures. They have to delicately balance being a mediator and advocating for their parents with their code of ethics. Tonya was immediately provided care once she went into cardiac arrest and this shows that while the best efforts were made, she still ended up on a mechanical ventilator with no immediate brain function. While there is an obligation to consider the best care possible for the patient, there is also consideration for the emotional, mental, and financial toll this will take on her parents. The nurses will assist the physicians with keeping the parents informed of her condition and the potential outcome.
Mission Statement
Providing exceptional care for all residents and creating a healthy and safe community is a top
priority for hospitals. One of our local hospitals, Jackson Hospital, lists their mission statement as “
Jackson Hospital is a not-for-profit organization committed to improving the health of all members of our community by providing superior, patient-centered and cost-effective care in a safe, compassionate environment” (About Us). Jackson Hospital’s overall goal is to provide empathetic care filled with kindness and compassion for their patients. They also pride themselves on educating their patients, staff, and the surrounding communities. In Tonya’s case,
if she were being treated at Jackson Hospital, they would go above and beyond to ensure that her
parents are educated on what her status is and what the outcome would be. Providing them with the best possible information and being honest with them, while also being compassionate and
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kind, is one of their most important values. They would also take pride in working with the patients’ family to determine the best course of action for her care regardless of their ability to pay. Accreditation
Along with ethical and moral guidelines, hospitals and medical care facilities must also be accredited by federal organizations. Jackson Hospital is fully accredited by the Joint Commission. This organization has operated in accreditation for more than 70 years and prides itself on establishing quality standards when it comes to evaluating organizations. The family of someone suffering from a brain damage this severe would most likely want to seek a second opinion. Once this is done and possibly confirmed what was originally suspected, removing Tonya from life support would be seen as the most ethical thing to do by the Joint Commission. Conclusion
In conclusion, it is not an easy decision for a family member to make when it comes to removing their loved one from life support. The nursing code of ethics along with the hospitals mission and vision would be taken into consideration in providing the best care for the patient and allowing for the family to make the best possible decision. Whatever decision the family makes, the hospital must respect that decision and provide them with any additional support they may need. Allowing them room to seek a second opinion so that they are in a position to make the best decision will prove to be invaluable. It is also important that the healthcare staff is following the ethical and professional guidelines by being honest with the family and showing compassion for what they are going through, while informing them of the statistical chance for Tonya’s condition to change for the better.
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References
Pirschel, C. (September 06, 2016). Ethical Dilemmas at the End of Life
https://voice.ons.org/news-and-views/ethical-dilemmas-at-the-end-of-life#:~:text=During
%20EOL%20care%2C%20ethical%20dilemmas,care%2C%20and%20shared
%20decision%20making
.
Nwozichi, C.U., Guino-o, T.A., Madu, A.M. (Jul-Sep 2018). Kant in Present Oncology Nursing
Realities
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5996581/#:~:text=Kant's
%20prescription%20on%20autonomy%20entails,the%20knowledge%20of%20the
%20patient
.
Gaines, K. (April 18, 2023). What is the Nursing Code of Ethics?
https://nurse.org/education/nursing-code-of-ethics/
Epstein, B. & Turner, M. (May 31, 2015). The Nursing Code of Ethics: Its Value, Its History
https://pubmed.ncbi.nlm.nih.gov/26882423/
About Us. Our Mission.
https://www.jackson.org/about-us/our-mission/
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