Present reflective narrative of a nursing clinical situation that led to Ethics Team consult with the following scenario: Elderly 85 year old disoriented male patient with end stage lung cancer, is septic, has low blood pressure only maintained by pressers for an extended period of time, and family insisted on intensive care. The patient full code, and still undergoing invasive procedure. 2 pages
Title: Ethics Team Consult: A Reflective Narrative on Clinical Decision Making
Introduction:
In this reflective narrative, I will discuss a nursing clinical situation that led to an Ethics Team consultation. The scenario revolves around an 85-year-old male patient with end-stage lung cancer, who is disoriented, septic, and experiencing low blood pressure. The patient’s family insists on intensive care, despite the patient’s deteriorating condition. This narrative aims to explore the ethical dilemmas that arise when caring for critically ill elderly patients with limited prognoses and the decision-making process involved in such cases.
Background:
As a registered nurse, I was assigned to care for an elderly patient, Mr. Smith, who had been admitted to the intensive care unit (ICU) due to complications related to end-stage lung cancer. Mr. Smith’s condition had rapidly deteriorated, leading to sepsis and low blood pressure. He was dependent on pressors to maintain his blood pressure at an acceptable level, and his mental status had significantly declined, leaving him disoriented and confused.
Ethical Challenges:
The ethical challenges surrounding Mr. Smith’s care emerged from the conflict between the patient’s prognosis and his family’s desire for intensive care. As an 85-year-old individual with end-stage lung cancer and multiple comorbidities, his chances of recovery were extremely slim. Continuing intensive care with invasive procedures and a “full code” status seemed contrary to providing comfort and allowing for a peaceful transition in his final days.
The Consultation:
Recognizing these ethical challenges, the healthcare team decided to consult the Ethics Team for guidance. The Ethics Team consisted of a diverse group of healthcare professionals, including physicians, nurses, social workers, and ethicists, who specialized in addressing complex ethical dilemmas. Their guidance aimed to support the medical team, the patient, and the patient’s family in making informed decisions that respected the patient’s autonomy and beneficence.
During the consultation, the Ethics Team facilitated an open discussion, allowing each member of the healthcare team to express their concerns, perspectives, and values. The objective was to promote a collaborative decision-making process in an attempt to reach an ethically sound resolution.
Ethical Principles:
The discussion at the Ethics Team consultation focused on four key ethical principles: autonomy, beneficence, non-maleficence, and justice. Autonomy referred to respecting Mr. Smith’s right to make decisions regarding his healthcare, even if those decisions seemed contradictory to the medical team’s recommendations. Beneficence emphasized the need to promote Mr. Smith’s well-being and best interests, while non-maleficence highlighted the principle of doing no harm. Finally, justice addressed the fair distribution of healthcare resources.
After considering Mr. Smith’s declining condition and his family’s insistence on intensive care, the Ethics Team sought to balance these ethical principles. The team acknowledged the importance of respecting Mr. Smith’s autonomy by allowing his family to participate in care decisions while also ensuring that his well-being was not compromised.
Decision-Making Process:
The decision-making process revolved around thorough discussions among the healthcare team members, the patient’s family, and the Ethics Team. They sought a consensus that would uphold Mr. Smith’s autonomy while protecting his overall well-being and maintaining ethical standards in healthcare delivery.
Importantly, the healthcare team provided the family with a realistic understanding of Mr. Smith’s prognosis, emphasizing the limited chances for significant recovery. They also discussed the potential harms associated with invasive procedures and the psychological implications of prolonging the dying process. These conversations aimed to help the family make an informed decision that aligned with their loved one’s best interests.
Conclusion:
In conclusion, the case of Mr. Smith presented complex ethical challenges in caring for a critically ill elderly patient with end-stage lung cancer. The decision to consult the Ethics Team served as an essential step in facilitating a collaborative approach to decision-making that considered Mr. Smith’s autonomy, beneficence, non-maleficence, and justice. By engaging in open dialogue and providing the family with accurate and comprehensive information, the healthcare team aimed to support informed decision-making that was in the best interest of the patient.