Question

Marion is a 92-year old patient who weighs 78 pounds. She has poor eating habits for at least 20 years. In addition, Marion had been a heavy smoker all her life and suffered frequent respiratory problems. During the past two years she has become quite forgetful, has suffered a broken hip as a result of a fall out of bed, and has been treated for pneumonia. In spite of Marion's protest, she is admitted to a nursing home. However, she quickly adjusts to her new home and likes the care and the attention that she receives.

During her third week in the nursing home, Marion develops a cough, high temperature, and respiratory problems. She is hospitalized with a diagnosis of pneumonia. The attending physician suggests that in addition to treatment for pneumonia, Marion will also need to have a pacemaker inserted to regulate her heartbeat.

Marion clearly explained to her family her wishes not to receive extraordinary measures to prolong her life. She also signed a living will indicating her wishes. After thoughtful discussions with other family members, Mario's daughter tell the physician that they do not want to put their confused mother through the surgical procedure and the pain while recovering from the surgery. Further, they are concerned that their mother will not survive an anesthetic and surgical procedure in her frail condition.

The physician seems to be understanding of this decision. He says that will place into Marion's chart their request not to have the pacemaker inserted. However, the floor nurses take the daughters aside on several occasions to tell them that this is not a dangerous procedure and that they should sign a permit for surgery. The nurses make the daughters feel that they are not acting in their mother's best interest by not signing the surgical permit. Marion returns to the nursing home without a pacemaker. She lives another four years without any cardiac problems.

1- Use the seven-step ethical model to evaluate the case. Follow the steps in the ethical model to develop your analysis.

2- Where the nurses carrying out their responsibility as licensed healthcare professionals or were they overstepping their role?

3- Were Marion's daughters acting in the best interests of their mother because they knew that if she had the surgery she could not return to the nursing home where she was receiving good care?

4- What should happen when a physician agrees with the family members and the nursing staff does not?

Answer 1

1.Seven steps of ethical model are:-

a. State the problem - Marion's daughter is having confusion regarding the cardiac surgery .

b. Collect the facts - Facts or importance of cardiac surgery must be assessed to find out whether there is a benefit of doing Marion's daughter goes through the facts related to pacemaker surgery.

c. Identify the relevant factors- indentify the cause behind the confusion or dilemma ,here the nurses are creating confusion for the daughter regarding surgery.

d. Develop list of option - In this daughter makes list of the alternatives that can be done instead of surgery.

e. Test the options- daughter checks whether the decision made by her will cause any harm to her mother,what the society will say ,what the organisation will say etc.

f. Make a choice- Finally ,the daughter makes the choice to avoid surgery based upon the condition of her mother.

g. Reviews of all the above steps - a thorough review of above steps is done by daughter to confirm her decision after going through all pros and cons .

2. The nurses were overstepping there role by again and again explaining the daughter about the surgery and it's benefits. The patient has the right to refuse treatment , either the doctor or the nurses can't force the treatment on patient. Irrespective of having the living will nurses was encouraging them for surgery which was against the professional ethics.

3. Marion's daughter was acting in the best interest of her mother because her mother does not want to get operated and also she can't bear the post surgical pain ,the anaesthetic drugs used during surgery,etc due to her diseased and fragile condition.

4. When the physician agrees with the family members and the nurses does not - Nurses have a major role in the care and safety of patients . They work hard to prolong and give quality life to there patients .But it does not mean that they can force treatment on them . Nurse's should respect patients decision and wishes and act accordingly. Nurse's must look the situation from patients side and through good therapeutic relationship make the decision.