Ethical Dilemma DNR

The Ethical Case Study

The following essay examines an ethical case study involving a 79-year-old woman who was taken to the hospital with advanced ovarian cancer, COPD, stomach discomfort, excruciating back pain, asthma, depression, and anxiety. Following her prior admission to Happy Valley Nursing Home, she was referred to the facility. She was returned back to the nursing home after intervention by the ER staff since she could breathe on her own. After 24 hours, she was sent back to the hospital because she was still experiencing back and stomach pain. Despite the patient's family signing a DNR and suggesting comfort care only, they revoked it when her condition deteriorated. Nobody recognized the fact that the patients was dying. Thus, she passed on after 51 days of hospital stay, a day after the family signs in another DNR.

The Entities Involved

The three entities involved included the health care organizations and their medical teams as well as the patient and the patient's family. All the entities played a crucial role in providing health care. First, the Happy Valley Nursing Home played its role as a healthcare organization by referring the patient to a more advanced facility where she could be taken care of. On the other hand, the referral hospital as well as the medical support team involved were bound by the ethical principles of beneficence (helping the patient when possible), non-maleficence (obligation to avoid harm), patients' autonomy and justice in fair allocation of medical resources (Luce & White, 2009). The two principles of beneficence and non-maleficence are the paternalistic models which guide the medical ethics laws whereby the healthcare providers are required to act in the best interest of the patient without necessarily consulting them (Luce & White, 2009).

Complexities in the Case

There are various complexities involved among the three entities in this particular case. First, medical ethics requires the patients to be autonomous and make decisions concerning their healthcare and how they should be treated. However, in this case, the patient was in a critical condition, and decisions regarding care were therefore made by the family. Thus, the outcomes of this intervention can be the result of the decisions made by the family as well as the team of healthcare providers involved. The patient's family had the right to agree to a DNR for a number of reasons. First, based on the patient's age and health condition, there was not so much hope for her recovery. Therefore, they did not wish the medical bill to accumulate to levels beyond their financial capability (Yuen, Reid, & Fetters, 2011). Secondly, the decision to sign a DNR could have been part of the patient's wish. However, the family's decision to rescind the DNR could have been influenced by the emotional reaction when they realized that the patient's condition was deteriorating. Therefore, they got in touch with the reality of what was happening, and they sympathized with her.

Lack of Inconsistency and Coordination

The lack of inconsistency, especially in DNR, could have greatly contributed the death of the patient. In this case, it would have been much better if the healthcare providers applied the ethical rule of beneficence and non-maleficence. By provoking this paternalistic model of ethics, the healthcare providers would have been in a better position to convince the family of the patient to agree to a DNR at an earlier stage in order to limit the extent of her suffering. This could have been what was best for the patient under the circumstances. Therefore, by convincing the family to agree to a DNR, the medical team would not be "playing God." On the other hand, the physicians treating the patient acted unilaterally and did not have any form of coordination that could have aided in the dispensation of high-quality care to the patient. The hospital allowed the patient to be taken back to the Happy Valley Nursing Home regardless of the abdominal and back pain which she was suffering from. Also, the medication prescribed was only a temporary solution. Therefore, there should have been a better coordination between the nursing home and the referral hospital. In addition, the physicians who attended the patient should have coordinated the treatment process to better monitor the patient as well as the entire treatment process.

Ethics Consult and Recommendations

An ethics consult to the case can go a long way in unearthing any form of recklessness that could have been registered in this case. An ethics committee can be consulted in case a complaint was launched by any stakeholder in relation to the death of the patient. This could be through a court injunction. An ethics committee could come up with a number of recommendations based on the case such as a thorough audit of the hospital programs, especially on palliative care. The only form of palliative care evident from the case is the referral as well as timely attendance of emergency cases. Also, statements can also be collected from the hospital management as well as all the physicians who were involved with the patient. In addition, the financial policy of the hospital and how they bill the patients can also be inspected since it could have been a primary factor in the family's DNR decision.

References

Luce, J., & White, D. (2009). A History of Ethics and Law in the Intensive Care Unit. Critical Care Clin, 25(1), 221.

Yuen, J., Reid, M., & Fetters, M. (2011). Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them. Journal of General Internal Medicine, 26(7), 791-797.