N520 Legal and Ethical Issues in Nursing Module 1 Assignment Case Study
Assignment:
Mrs. R., an 87- year- old patient, has a past history that
includes coronary artery disease, a previous stroke, and advanced Alzheimer’s
disease. Ten days ago, Mrs. R. was hospitalized for aspiration pneumonia and
has been ventilator dependent since being admitted to the intensive care unit
in a small rural hospital. Family members visit daily and have repeatedly
voiced their concern to the nursing staff about the continued ventilator
support that Mrs. R. is receiving, most notably the fact that Mrs. R. would
never have wanted such care. They also note that Mrs. R. has not recognized
them in past months and that they plan to visit less in future days, but can be
contacted should any change in Mrs. R.’ s condition occur. Her primary
physician has practiced in this community for multiple years; he is well known
for his reluctance to discontinue any type of life support for any patient.
When questioned, Dr. G.’ s consistent response is, if this were his frail 92-
year- old mother, he would prescribe the very same treatment for her. Dr. G.
has now requested that the nurses talk to the family about moving Mrs. R. to a
major medical center, where she can receive more advanced care, including
vigorous rehabilitation and physical therapy, so that she may eventually return
to a long- term nursing care facility. How might the nurses in this scenario
respond to the physician’s request? How would this scenario begin to cause
moral distress among the nursing staff, and what are the positive actions that
the nurses might begin to take to prevent moral distress?
Read Exercise 4.1 (Guido, p. 44) and apply the MORAL model
to resolve the dilemma.
Read the case study presented at the end of Chapter 3.
Examine the above scenario from the perspective of health care policy. How
would you begin to evaluate the need for the policy and the possible support or
lack of support for the policy from your peers, nursing management, and others
who might be affected by the policy? Do the 10 questions outlined by Malone (as
listed in Guido, p. 50) assist in this process? Draft a proposed policy to
address the issue you have identified.
What compelling right does this case address?
Whose rights should take precedence?
Does a child (here, a competent 14-year old) have the right
to determine what will happen to him? Should he ethically have this right?
How would you have decided the outcome if his disease state
had not intervened?