Case Study –Ethical Issues

Mr. Bailey is a 90 year old admitted with exacerbation of COPD. He is short of breath and has worsening pulmonary edema. He is oxygen dependent. He is alert and orientated. His code status is DNR and has a supportive family. He is very SOB when talking. Mr. Bailey tells the nurse that he wants to talk to the doctor about taking the O2 off and leaving it off so he can go to sleep. He shares that he is tired of being sick. “I know this disease will kill me.”

Mr. Bailey’s family arrives and he discusses the above with his children. They openly discuss that if the O2 is removed he will die. The family is upset but supports his choice. The MD comes in and turns off the O2 and removes the nasal cannula.

An hour and a half after the O2 is removed, Mr. Bailey dies.

1. Is this case unusual?
Yes, he discusses that he wants to speak with the doctor about taking the Oxygen off, but there wasn’t a discussion with the doctor.

2. What is the Patient Self Determination Act?

This act requires healthcare facilities that receive Medicare/Medicaid funding to inform their patients about their right to initiate an advance directive, and the right to consent to or refuse medical treatment.
3. Describe the purpose of 3 advanced directives (ex. Living Will, DPOA, Health Care Proxy)
-A living will gives you some say in the medical decisions that must be made while you can't respond. It is the formal document that states your wishes for specific health care decisions to be made for you in the event you are unable to express them yourself.

-The purpose of a Durable Power of Attorney (DPOA) is to give authority to someone else to act on your behalf if they were you. The person who holds a DPOA for all intents and purposes stands as if they were in your position and acts as your agent.

-The Health Care Proxy Law gives you the power to ensure that health care professionals know your wishes regarding medical treatment.

4. Define euthanasia.
Euthanasia can be defined as the act or practice of killing or permitting the death of hopelessly sick or injured individuals in a relatively painless way for reasons of mercy

5. Is euthanasia the same as physician-assisted suicide?

Yes, they both are done to end suffering in a similar manner.

6. Create two columns and list 3 arguments that support euthanasia and 3 arguments against it.

Supportive Non-supportive 1) Ends suffering 1)Religious beliefs 2)Less financial costs 2)Practicing euthanasia for the wrong reason (depression)
3)Allowed to have a choice 3)Undermine funding of research in these areas

7. What are 5 physical signs/symptoms the nurse may observe while caring for someone dying?
-Changes of skin color
-Irregular heart beat
-Increased respiration rate
-Lower body temperature
-Sleeping amount increases

8. Discuss the religious considerations regarding the circumstances of Mr. Bailey’s death.

Some religions feel that God will take them when it is “their time.” If Mr. Bailey believed it is God’s choice when to take his life, he may not have chosen to remove the oxygen.