Tonya’s Case: Ethics and Professional Codes
Several ethical dilemmas surround end-of-life care. While there have been technological advances in medical treatment, they do not assure recovery, they can support life with or without meaningful existence or with secondary support, such as ventilators or feeding tubes (Kinlaw & Levine, 2007). Therefore, such progress in medicine has empowered patients and families with a crucial task of deciding their treatment options during end-of-life care (Kinlaw & Levine, 2007). In the healthcare setting, there is a need to apply relevant professional codes of ethics in different dilemmas.
In Tonya’s case, there is a need for sound decision making on the health of the child. A major ethical issue relates to the cessation of medical support ventilation to the patient. The rationale for the hospital’s decision is because the burdens of continuing mechanical ventilation are offsetting any benefits the patient may receive since the person has suffered permanent brain death. Although the ventilator and other medical interventions could sustain Tonya’s body functions, the damage caused by cardiac arrest will worsen, and there is a certainty that Tonya will not recover any brain function.
Ethical leadership understands ethical beliefs and values and emphasizes the dignity and patient rights. This form of leadership is linked to such ethical principles like trust, autonomy, beneficence, non-maleficence, and justice (Chassin, 2013). The principle of beneficence implies actions that benefit the patient or other individuals. In the current case, the medical staff had exerted their best attempts to help Tonya but had determined that no further support will change her current health condition. Autonomy means respect for a patient’s capacity to make their own choices concerning their life or health. However, Tonya Archer is below 18 years without any advance directive and thus, not able to make sound decisions on her life or health.
The principle of non-maleficence, which refers to actions that do not harm patients and others, is applicable in this case (Aulisio et al., 2009). Tonya is diagnosed with permanent brain death, and her dependence on ventilated treatment will prevent her from having a quality life. Therefore, based on these principles and the medical evidence of unlikely recovery from the brain damage, the hospital should remove life support. The hospital can achieve this by consultation through an ethics committee or other suitable resources to conform to ethics guidance.
The withdrawal of care is a practical subject in moral philosophy. Mandal, Ponnambath, and Parija (2016) argue that utilitarianism and deontological theories are pertinent in ethics linked to decision-making, deontology is patient-centered, while utilitarianism is society-based. Often, utilitarianism is guided by the measured benefits or harms for evidence-based intervention. In Tonya’s case, withdrawal of the ventilator is a utilitarian decision since the limited resources can save other lives and lower the morality of the medical institution. In Tonya’s case, she cannot have a quality life, meaning that prolonging the process leads to physical and mental suffering to the family. This reasoning is in line with the consent declaration by the Society of Critical Care Medicine’s Ethics Committee (SCCM), which limits “futile” treatment to that without any physiological advantage to the patient (Aulisio et al., 2009). Moreover, death ascertained through neurological criteria is a lawfully valid determination; thus, hospitals are not legally bound to continue the physiologic support of these patients.
The second provision of the ANA’s nursing code of ethics states that the basic commitment of nurses is to their patients, be it personal, family, community, group, or population (Munson, 2014). Therefore, any care plans should reflect the fundamental obligation of nursing to the individuality, self-respect, and patient worth. Since the medical diagnosis has established that Tonya could not lead a quality life after suffering permanent brain death, keeping the patient on ventilator support does not reflect the nurse’s commitment to the patient’s dignity and worth. The code of ethics for nurses also obliges the practitioners to give patients a chance to engage in the planning and adoption of healthcare and support suitable to the patient. This provision, however, does not apply to the decision in Tonya’s case since she is incapacitated and cannot fully participate in care planning and implementation. Moreover, provision 2 of the ANA’s Code of Ethics maintains that tackling patient interests needs acknowledgment of the patient’s position in the family and other relationships.
Organizational documents, such as the mission, vision value statements, and core values, can guide a challenging process of deciding in end-of-life care cases. These values can apply in difficult ethical choices similar to that of Tonya Archer since the hospital has done its best to provide compassionate, competent, and comprehensive care to the patient. However, since Tonya’s medical conditions show that no signs of future recovery exist, the hospital’s decision to recommend for the withdrawal of a ventilator is in line with its vision and core values. The hospital cannot promise any positive improvements in the patient’s condition; therefore, withdrawing the ventilator system does not violate any of its core values.
The current Advanced Certification Program for Palliative Care by the Joint Commission is meant to identify hospital inpatient programs demonstrating excellent patient and family-focused care. The certification is designed to improve the quality of life for patients with severe sickness. This unconventional certification can guide decision-making in Tonya Archer’s case, as the hospital will have to ensure the presence of a quality program centered on realizing optimum care (The Joint Commission, 2016).
Terminating Tonya’s life support seems the appropriate ethical decision for the hospital. The consent is not achievable without improved attention to communication with the family and other proxies. Consent is in line with the Joint Commission Standards on Patients and Family Rights, which emphasizes the need for hospitals to inform patients and families on their rights and duties to forgo or remove life-supporting treatments.
References
Aulisio, M. P., Moore, J., Blanchard, M., Bailey, M., & Smith, D. (2009). Clinical ethics consultation and ethics integration in an urban public hospital. Cambridge Quarterly of Healthcare Ethics, 18(4), 371–383.
Chassin, M. R. (2013). Improving the quality of health care: Where law, accreditation, and professionalism collide. Health Matrix: Journal of Law-Medicine, 23(2), 395–407.
Kinlaw, K., & Levine, R. (2007). Ethical guidelines in pandemic influenza [PDF]. Retrieved from http://www.cdc.gov/od/science/integrity/phethics/panFlu_Ethic_Guidelines.pdf
Munson, R. (2014). Intervention and reflection: basic issues in bioethics (concise ed.). Boston,
MA: Wadsworth.
Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and deontological ethics in medicine. Tropical Parasitology, 6(1), 5-7. doi:10.4103/2229-5070.175024
The Joint Commission. (2016). Retrieved from https://www.jointcommission.org