Question

You are working on the Operating Room and the trauma alert goes off.
You respond to the ER to provide support. Once in the ER, you receive
report that an 89 year old male is coming in with a self-inflicted GSW
(Gun Shot Wound) to the head. You listen to the radio traffic between
the ER and ambulance to get an idea what kind of surgery you need to
set up for and what will be needed as far as lines and fluid. Here is
the report:

HR: 121
B/P: 60/45
Saturation: 93%
Patient is intubated and non-responsive. Right pupil is fixed and
dilated. Paramedic also states there is a large extended family headed
to the ER. The patient lost his wife of 60 years 1 week ago and left a
note stating that he is too heartbroken to go on. The patient and
family arrive. The neurosurgeon discusses that their father's
potential outcome, even with surgery, is not good. The family still
insists that the neurosurgeon complete the surgery.

1. What are the ethical and legal issues in this case study. Be
specific and support your response with references

Once you have the patient in the room and you are prepped and ready
for surgery, the phone rings. You receive word that the patient signed
DNR orders two days ago.

2. As the OR nurse what are your legal and ethical issues now? Was the
patient of sound mind when he signed this order? Do you honor the DNR
or the family’s wishes? Explain and support your response.

Answer 1

1)The ethical issue is saving the patient from death because he has attempted suicide and not naturally detoriating in his life.

The legal issues is not responding to DNR of the patient .The patient can sue the treating surgeon after he survives from the surgery.

Being in surgeon in this position prior to surgery consent must have been given by the family member and not the patient

So it is better to carry as per the wish of family after explaining the potential outcome after surgery and his prognosis.

2)As a OR nurse it is the duty to do preparation for the surgery ethically. The legal issue is not caring for the patient.

The patient should be in a sound mind but in a state of depression due to his wife's death and not able to accept it and proceed his life and end it

DNR order cannot be honoured in favor of patient because its an act of suicide .At this time honouring the family's wish is right.