Ethical and Legal Responsibilities
Jaconda Williams
Bauder College

What are the ethical and legal issues in this case? Include the nurses’ ethical and legal responsibilities.
The case of patient Patricia Newman is a complex situation involving ethical and legal issues. An ethical issue that the family is facing is the sudden onset of illness with their mother. Ms. Newman was initially hospitalized for pneumonia when she suddenly had a hemorrhagic stroke. As suspected the patient’s family received the news with mixed emotions and could not agree on a treatment plan. Ms. Newman’s son wanted his mother to be resuscitated in an attempt to save her live. The daughter on the other hand believed her mother had suffered enough and a “do not resuscitate order” (DNR) should be initiated. However, the patient seemed to not have an advance directive or a power of attorney. The patient apparently did not have a DNR written at the hospital and was not conscious to make the decision. In cases where the families cannot agree can make things difficult for the patient, family, and hospital staff. Both children have valid reasons for the treatment they chose for their mother. Legally the patient has the right to have care until the time of death. Canada did a research that involved about 25 physicians (Alexandrov, etc., 1996). In this research many of the doctors agreed that DNR orders are appropriate when at least two criteria are present. These criteria include severe stroke, life threatening brain damage and comorbidities such as pneumonia and cardiomyopathy. If the Canadian research became law it could then mean doctors could make a DNR decision without the families. In situations like this the nurse can support the families’ decision. If I was the nurse I would first comfort the family. I would then answer any questions the family may have regarding their mother’s situation. The nurse has taken an oath and is legally responsible for providing care until the time of death. The nurse should act as a support and resource for the patient and family.
What resources does the nurse have in managing this patient’s care? The nurse can support the patient and family by collaborating with other healthcare specialists such as case management, hospice, and rehab facilities. The nurse can also be supportive of the patient and family by offering clergy for prayers and support. The nurse should be supportive by listening and being an advocate for the patient. The nurse is expected to be knowledgeable about end-of life decisions to assist in offering options to the patient.
What family and psychosocial issues impact the nursing care of this patient? The family and psychosocial issues that impact Ms. Newman’s care are the sudden onset of illness. Many times when a person becomes ill there is nothing in writing about final wishes and plan of care. Ms. Newman’s children obviously care a lot for their mother so making a final decision for her is very difficult. The son was adamant that he did not want a DNR order for his mother. He wanted everything possible to be done to save his mother. The daughter on the other hand believed her mother had suffered enough and believed everything possible was done for Ms. Newman. This ongoing battle with the patient’s family can cause a shift from the care of the patient to a family feud. At the end of the day it is the patient who is most important. Therefore, the indecisiveness of the children to make a final decision is impacting the care of Ms. Newman.
How would you respond to the physician’s request? I would respond to the physician request by reminding him that nurses have an ethical and legal responsibility to protect and advocate for the patient. Sometimes physicians are not as sensitive to a patient’s need as much as a nurse. I would definitely speak with the family about their options. I would also respectfully tell the physician that the patient’s physical status and lifestyle is important but should not be used in determining whether to continue to provide care. I would also remind the physician that in some case patients may survive and have quality of life even after a serious illness such as a massive stroke. According to Ethics, Law and Policy written by Vicki Lachman, PhD, morals allow nurses to confidently face dilemmas regarding late timing of DNR planning as well as lack of communication by physicians’ concerning the patient’s prognosis (Lachman, 2010).

References:
Alexandrov AV, Pullicino PM, Meslin EM, Morris JW. Agreement on disease-specific criteria for do-not-resuscitate orders in acute stroke.Stroke 1996; 27: 232-37.
Lachman, V. (2010). Do-Not-Resuscitate Orders: Nurse's Role Requires Moral Courage. MEDSURG Nursing, 19(4), 249-252.