Ethical Leadership and Collaboration
Ethics Case Assignment Guidelines
Directions:
Examine a clinical case with attention to ethical principles and theories. Each student should
select one of the cases listed in this week’s module and answer the questions that accompany the selected case. List each question and provide your response immediately afterward. This
assignment is not a formal paper; no abstract or table of contents is required. A properly
formatted title page and reference page are required. The paper should adhere to a maximum of four pages (double-spaced), not including title page and references. Points may be deducted for papers that exceed four pages.
You have the option of your choice of the posted cases; there are no restrictions on how many
classmates may select a specific case. You must provide thoughtful, concise information that
reflects attention to ethical theories and principles in your responses. Submit your paper by
midnight (CT) on the date listed in the course schedule.
Current literature (within 7 years) from scholarly peer-reviewed journals must be
included in the discussion of your selected case.
Case Study
Mr. T. is an 82-year-old widower who has been a patient on your unit several times over the past 5 years. His CHF, COPD, and diabetes have taken a toll on his body. He now needs oxygen 24 hours a day and still has dyspnea and tachycardia at rest. On admission, his ejection fraction is less than 20%, EKG shows a QRS interval of greater than 0.13 seconds, and his functional class is IV on NYHA assessment. He has remained symptomatic despite maximum medical management with a vasodilator and diuretics. He tells you, “This is my last trip; I am glad I have made peace with my family and God. Nurse, I am ready to die.” You ask about an advance directive, and he tells you his son knows that he wants no heroics, but they just have never gotten around to filling out the form. When the son arrives, you suggest that he speak with the social worker to complete the advance directive, and he agrees reluctantly. You page the physician to discuss DNR status with the son. Unfortunately, Mr. T. experiences cardiac arrest before the discussion occurs, and you watch helplessly as members of the emergency response team perform resuscitation. Mr. T. is now on a ventilator and the son has dissolved into tears with cries of, “Do not let him die!” What is the action the nurse needs to take? It is the ethical obligation of this nurse to support the self-determination of this patient. This patient had capacity when he voiced “no heroics” and the expectation that his son, as his surrogate decision maker, would honor his expressed wishes. Mr. T. met the criteria for hospice referral prior to hospitalization, but even more now that he has a history of cardiac arrest (National Hospice Organization, 1996). The attending physician is not discussing the facts of the case with the son and has never brought up the topic of hospice. The nurse practitioner also musters the courage to start a conversation with the physician and discovers that Mr. T. has been his patient for 20 years. Though both physician and son initially are defensive, the nurse’s assertiveness and perseverance get results. Mr. T. is removed from the ventilator 24 hours later. He dies peacefully in the presence of his family and physician.
1. What is your role as a nurse in patient self-determination?
2. What are the needs of the son? How would you address them?
3. As the advanced practice registered nurse, what would be your conversation with the physician?
4. Did the son have the legal right to have an advance directive completed on his father?
5. Are there any other actions or issues to consider?
6. What ethical principle is applicable to this case and why?
7. Which of the provisions in the Code of Ethics for Nurses are applicable and why?
A 2015 read-only updated version of the Code is available at
http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html
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Formatting
Title Page
Citation
Outline
