End-of-life controversies exist in modern American society because not all people are ready to accept their beloved ones’ deaths, relying on their cultural and religious beliefs. In the case under analysis, NK is a 32-year-old patient who remains comatose with no brain activity during the next 24 hours after losing consciousness due to a severe headache (Weiner & Sheer, 2020). His wife, SK, is an Orthodox Jew, and she does not believe in her husband’s death until his heart stops beating. Although computed tomography proved subarachnoid hemorrhage and hydrocephalus, there is a need for additional confirmative testing to prove brain death.
Still, the wife expects to continue keeping the patient on the machines anyway. Regarding the evident cultural and religious impact on health care in this case, my ethical position is to treat the patient with respect, kindness, and understanding and provide time to demonstrate my reasonable restraint and objectivity.
In nursing practice, there are many cases related to brain death debates. Sometimes, families of patients with no brain activity are ready to let their beloved ones go and stop machine life support. However, some people are not able to cope with the shock of losing and search for solutions in their cultures, traditions, and religions. This scenario impacts me, as a nurse practitioner, in several ways, provoking doubts, regret, and a feeling of inevitability. On the one hand, I cannot reject the wife’s request to keep the patient on the machines. She has to trust me and my intentions to help and support. On the other hand, I should be honest in this situation, which makes me say about zero chances for her husband to come back. To avoid personal disagreements, I must stay objective and rely on the results of all brain death diagnostic tests.
At this moment, I have several sources to rely on and defend the chosen position. First, there is the Uniform Determination of Death Act, according to which a person is defined as dead due to irreversible cessation of all brain functions (Pope, 2018). Secondly, Jewish law also permits withholding life-prolonging interventions when rabbis support the idea of not taking new steps, causing the heart to stop with time (Weiner & Sheer, 2020).
Still, one of the ethical principles of justice underlines the importance of distributing resources and services equitably (Weiner & Sheer, 2020). Such a statement provokes new debates because health equity means to care for patients when they need it. In this case, it is hard to define this necessity. From a professional perspective, I would pay attention to the patient’s opinion on life-prolonging service (many Americans are obliged to choose if they want to be supported by machines or not).
Addressing the issue of religious and professional opinions about brain death, the only solution I see at the moment is to wait and provide the wife with enough time to grieve. The establishment of positive trustful relationships with a family is an important task for nurse practitioners. It is a chance to learn their interests and beliefs and help them accept and understand the situation. Collaboration and communication should explain the importance of additional tests to prove death by neurological criteria. However, even after obtaining the results, the health and nursing care team must be ready for additional ethical issues like the conflict between science and spirituality or between truth and hope.
In general, it is never easy to advise people who have to get prepared for losing their beloved ones to make final decisions. Brain death is a complex health and spiritual issue that does not have one clear explanation. Nurse practitioners have to cooperate with families and demonstrate their support and respect even if they are confident in the absurdity of their decisions. To reduce misunderstandings, it is better to choose correct words, never give vain hope, and remember about the uniqueness of each case.
References
Pope, T. (2018). Brain death and the law: Hard cases and legal challenges. Hastings Center Report, 48, 46–48. Web.
Weiner, R. J., & Sheer, C. (2020). How should clinicians respond when patients’ loved ones do not see “brain death” as death? AMA Journal of Ethics, 22, 995-1003. Web.