Case Description and Ethical Issues
Mr. V. is a liver cancer patient who has undergone many admissions to the cancer unit, including a failed suicide attempt. The directives specify a morphine drip that will be adjusted for pain and reduced if the patient breathes less than four times per minute. Mr. V. repeatedly asks for an increase in the morphine drip during his shift, even though he does not appear to be in pain. Subsequently, he discovers that he is unarousable and has a respiratory rate of four beats per minute. After a while, Mr. V. stirs, accusing you of bringing him back against his will despite having a do-not-resuscitate order.
By his do-not-resuscitate order, Mr. V. declares his desire to be permitted to pass away. There is tension between the nurse’s duty to successfully manage his suffering and the patient’s autonomy and end-of-life preferences. There are difficulties in balancing giving comfort and not harming because there are worries that are increasing the drip in expediting his demise.
The patient’s frustration becomes vital to balance the patient’s autonomy, quality of life, and the provision of suitable palliative care. Due to the competing demands and feelings involved in managing the patient’s suffering while honoring his autonomy and end-of-life desires, the nurse may feel morally conflicted.
Terri Schiavo was a patient with a feeding tube in a prolonged vegetative state. Her story generated a legal and ethical discussion over when to stop giving patients life-sustaining care (Overbaugh et al., 2023), emphasizing the importance of obeying patients’ advanced directives and respecting their end-of-life desires. The parents of a young person in a vegetative condition named Karen Ann Quinlan campaigned for the right to have her ventilator turned off (Urofsky & Urofsky, 2020). Due to this case, the distinction between routine and unusual forms of therapy and the patient’s right to refuse treatment was made.
In Mr. V’s situation, the problem arises from the interpretation of resuscitation in pain management despite his do-not-resuscitate order. The nurse’s intention in adjusting the morphine drip was to alleviate his pain. Mr. V’s perception of being brought back from death conflicts with the nurse’s perspective that the actions aimed to manage his discomfort.
Dilemma Statement and Stakeholder Identification
The dilemma in this case study revolves around respecting the patient’s autonomy and adhering to their wishes for end-of-life care while ensuring their safety and well-being. On the one hand, Mr. V. has a do-not-resuscitate (DNR) order, indicating his desire to forego life-saving measures. The nurse is responsible for providing appropriate pain management and monitoring the patient’s condition.
The nurse made a clinical judgment based on the patient’s deteriorating condition, and the decision to stop the morphine drip aimed to prevent potential harm temporarily. This decision conflicted with Mr. V.’s expressed desire to die. The nurse’s response to Mr. V.’s accusation was to clarify that the intention was not to bring him back from death but rather to prioritize his safety.
The nurse is the primary caregiver responsible for Mr. V’s direct care. The nurse’s interests revolve around providing quality patient care, managing pain effectively, ensuring patient safety, and adhering to ethical principles. The nurse is also responsible for communicating with the patient, Mr. V, and his wife, addressing their concerns, and advocating for their well-being. His interests may include managing his pain, maintaining control over his end-of-life decisions, respecting his wishes, and preserving his dignity. Mr. V may also have emotional and psychological concerns that must be addressed.
Mr. V’s wife is involved as a family member and caregiver. Her interests may align with Mr. V’s in ensuring his comfort, respecting his wishes, and supporting him during his end-of-life journey. She has concerns about his safety and well-being. The healthcare team comprises physicians, specialists, and other healthcare professionals involved in Mr. V’s care. Their interests are centered around providing appropriate medical interventions, managing symptoms, ensuring patient safety, and adhering to ethical guidelines. They play a crucial role in assessing Mr. V’s condition, guiding the treatment plan, and addressing ethical dilemmas.
References
Overbaugh, K., Byrne, D., & DiGiacomo, P. (2023). Engaging Nursing Students in Advance Care Planning. Nurse Educator, 48(1), 36. Web.
Urofsky, M. I., & Urofsky, P. E. (2020). In the Matter of Karen Quinlan. In Who Decides? 405-426. Routledge.
