With regard to the medication administration itself, in a life saving circumstance, which this clearly is not the weight of the potential for depression of respiration and cardiac status is clearly indicated, yet it would seem unethical under these circumstances, if the review of the documentation proves its validity and clearly indicates the patients wishes, to deny at least the smallest dosage (2mg) of ordered Morphine to reduce the pain and potentially allow the patient to regain calm, which will clearly improve his status with regard to short-term treatment.
If the fear of doing harm, drives every medical decision, based on the extreme notion that all patients can be saved under all circumstances then bioethical decisions are futile. The observations and communications of others in the immediate vicinity to care, including the family, other nurses, support staff and most importantly the orders of the doctor to administer palliative care for this presumably dying patient should be taken into consideration.
If this kind of care is outside the comfort zone of the individuals within the emergency room, then a reevaluation of training and procedures should be done. Additionally, if the patient is in dire need of intervention, other staff should question the action or inaction of the individual making the decision to deny palliative care even if it means creating strife and/or...
As an incoming staff member the first response that the individual should have is to see the patient, and make a decision based upon the doctor's orders and the wishes of the patient and his family. If the individual is still alert and asking for Morphine the lowest dose should be administered with frequent subsequent pain scale checks to determine if more of the drug is needed to maintain the comfort of the patient. If the need for the medication seems to exceed the ordered dosage then the new nurse, should communicate with the physician and evaluate the need to change the treatment protocol. Above all the needs and desires of the patient should not be ignored, and a clear sense of the need for palliative care is essential in this case scenario.
References
Andre, J. (2002). Bioethics as Practice. Chapel Hill, NC: University of North Carolina Press.
Forsythe, C.D. (2005). Protecting Unconscious, Medically-Dependent Persons after Wendland & Schiavo. Constitutional Commentary, 22(3), 475.
Mantz, a. (2002). Do Not Resuscitate Decision-Making: Ohio's Do Not Resuscitate Law Should Be Amended to Include a Mature Minor's Right to Initiate a DNR Order. Journal of Law and Health, 17(2), 359.
Saunders, D.E. (2003). Removing…
