In recent decades, developments in medical practice made it possible to prolong human life, sometimes even past its natural limits, which entails various end-of-life dilemmas. Brain death, for instance, is associated with several ethical and legal controversies. A person’s brain is no longer functioning, but their heartbeat may be maintained, creating misunderstandings. In Tonya Archer’s case, her parents refuse to allow life support withdrawal because they believe that their daughter is still alive (Cappella University, 2020). Hence, the medical team is presented with a difficult decision on how to approach the situation.
For the current case study, it is essential to consider the basic principles of healthcare ethics. They include autonomy, beneficence, justice, and non-maleficence (Stanford University, n.d.). This situation may be associated with the conflict between some of these principles. Autonomy requires that patients and their family members make informed decisions that are to be respected. Therefore, some might claim that Tonya should be left on a ventilator according to her parents wish. However, there is no recovering after brain death, so staying longer on life support will not benefit her.
Moreover, considering the principles of justice and non-maleficence, one can argue that supporting Tonya’s body may distract resources from where they are actually needed. For instance, one older study describes how, in similar situation, the medical team sustained a patient on a ventilation system for two days while all other beds in the unit were occupied (Cranford, 1999). Karnik and Kanekar (2016) advise weighing a patient’s or their career’s autonomy against the use of expensive equipment if the case is futile. Hence, while it is important to be gentle with parents feelings, it might be advisable to withdraw life-sustaining treatment in Tonyas case.
Some guidance can also be found in the American Nurses Association’s Code of Ethics. While the code prescribes respecting the patient’s or surrogate’s right to make a decision, it also emphasizes the role of a nurse in providing accurate medical information (American Nurses Association, 2015). In Tonya’s case, it can mean giving further explanations to her parents. For instance, neurologists point out that many confuse brain death with coma, which leads to unreasonable insisting on life support (Hoffman, 2019). Experts suggest spreading awareness on brain death being equivalent to cardio-pulmonary death (Hoffman, 2019). Therefore, it should be the nurse’s duty to provide the necessary clarifications to convince Tonya’s parents. Moreover, the Code of Ethics suggests that nurses should recognize situations when the right for self-determination can be outweighed by the needs of other patients (American Nurses Association, 2015). My current hospital’s mission statement is, “Above all else, we are committed to the care and improvement of human life!”. Since providing further treatment will not save or improve Tonya’s life, it is advisable to redirect resources to provide quality care to those who need it more.
However, it is also important to analyze how accrediting bodies would approach such a decision. Accreditation implies evaluation of health facilities performance, assessing their operations from both legal and ethical perspectives identifying the best practices, and facilitating improvement (National Conference of State Legislatures, 2017). From a legal standpoint, the withdrawal of life support is expected to follow brain death (Pope, 2018). In most states, considerations to religious views of the patient or their agents, if exist, are limited to maintaining the body functions for twenty-four to forty-eight hours (Pope, 2018). Therefore, it seems that the accrediting bodies that operate within the established legal framework would support the decision to withdraw life support in Tonya’s case.
Recent advancements in medical technology can save and improve many patients’ lives, but, at times, there is nothing that even they can do to help. In might be challenging both for a patient’s relatives and medical workers to admit it, but providing efficient healthcare sometimes requires understanding its limitations. From an ethical standpoint, it is essential to ensure that all medical operations should be done to benefit a patient, and, if they no longer can, it is crucial to redirect valuable resources to save others.
References
American Nurses Association (2015). Code of ethics for nurses. Silver Spring, Maryland.
Capella University (2020). Case study: Tonya Archer. Web.
Cranford, R. E. (1999). Discontinuation of ventilation after brain stem death: policy should be balanced with concern for the family. BMJ: British Medical Journal, 318(7200), 1754-1755.
Hoffman, M. (2019). Ethical issues and the public understanding of brain death. Neurology Live. Web.
Karnik, S., & Kanekar, A. (2016). Ethical issues surrounding end-of-life care: A narrative review. Healthcare (Basel), 4 (2), 24. Web.
Pope, T. (2018). Brain death and the law: hard cases and legal challenges. Hastings Center Report, 48, S46-S48.
Stanford University (n.d.). Medical Ethics 101. Web.
National Conference of State Legislatures (2017). Accreditation to approve health plans and providers. Web.