Professional Roles and Values

Professional Roles and Values

A good number of patients visiting emergency departments are in a position to make independent decision concerning their care. Nevertheless, a significant proportion of them are extremely incapacitated either mentally or physically to the extent that they cannot solely make decisions regarding their treatment. Some of the conditions associated with this incapacitation include organic brain disorder, hypoxia, or head trauma. Jones et al. (2005) describes an emergency department as a very hostile environment where patients may lose control of the nature of care they undergo. Such is the case scenario in this current study. Mr. E is developmentally delayed and hypoxic. Dr. K considers his situation as an emergency and a ventilator must support it. The fact that Mr. E had already signed an advance directive under the supervision of a patients advocate that he did not want a ventilator or cardiopulmonary resuscitation complicates the matter even further. Nonetheless, there is also an attorney's directive signed by Mr. Y to make medical decision on his behalf in case he is totally incapacitated.

Indiana law provides a necessary condition that physician have to get an informed consent from the patient before administering any form of care or treatment (IC 34-18-12-4). It is worth understanding that this consent not necessarily be in writing (IC 34-18-12-6). Nevertheless, if a patient presents a written consent, then the patient must sign it with at least another adult witnessing it. The adult witness should have also appended their signature. This signatory's signature only serves to prove that the decision contained therein in the written consent was informed (IC 34-18-12-2).

The provisions of this law stipulate that the written consent begin bargaining on the conditions that it was informed and that there was an adult to witness. According to the advance directive, Mr. E undertook the decision to reject a ventilator or cardiopulmonary resuscitation under the direction of a patient's advocate. However, there is absolutely no evidence that there was any involvement of his family members. Basing on the assumption that the patient advocate acted in utmost good faith and in accordance to the nursing standards, then it is undeniable that the advance directive becomes legal binding. Mr. E has a right not to undergo the procedure.

The American Nurses Association Guide to the Code of Ethics for Nurses (2008) requires nurses to have a moral basis of protecting the patient's rights, interests as well as their physical safety. As such, nurses are natural ethical responsibility for the patients to advocate on behalf of the patient's right and safety (Fowler, 2008).

My ethical responsibility as a nurse is to act in accordance with the patient's will as long as it does cause harm to the patient. This is an ethical dilemma when the patient life is hanging on a thin thread yet there exists a directive that expresses the patient's unwillingness to undertake the lifesaving procedure. Basing on the ANA code of ethics, I would certainly let Mr. Y know about the advance directive. I would also inform him that the final decision lies with him because the document signed by the attorney gives him the power to reverse his brother's earlier wish. Finally, I will discourage Dr. K from placing Mr. E on the respirator before the consent of his brother.

Placing the patient on the ventilator evidently discredits the patients wish. This is unacceptable according to the ANA code of ethics. In fact, the family of Mr. E has the legal right of opening legal suite against Dr. K for violating the rights of the patient. Mr. Y has several ethical considerations to make before authorizing the use of ventilator on his brother. First, he has to realize that the wish of his brother should be respected at all costs. Secondly, he must realize that the life of his brother is in danger and he needs to be saved. Lastly, because his brother entrusted him with the responsibility of making medical decisions in the event that he is unable, Mr. Y should act in accordance with the moral responsibility of physicians to save lives.