The scenario in question considers the case of Mr. Cote, who has Alzheimer’s disease in its end stage. His severe condition is complicated by a recent stroke, and the health care team has faced a serious dilemma regarding future work. Mr. Cote is unable to swallow on his own, and in the past month, there have been two occasions when he pulled out a feeding tube. Most of the time, he is unconscious and unable to make decisions on his own, which, in turn, has led to an ethical dilemma. His wife insists on continuing tube feeding, although, according to the physicians, this could extend Mr. Cote’s life by only a few months. As a result, the health care team has faced the challenge of how well-grounded the decision to extend the patient’s life support is.
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Based on the case, the two most pertinent ethical principles involved are non-maleficence and fidelity. According to the Canadian Nurses Association (2017), non-maleficence implies considering potential harm to the patient, which should be avoided. The principle of fidelity is associated with an obligation to follow high-quality care procedures (Canadian Nurses Association, 2017). As the stakeholders, three interested parties are represented: Mr. Cote, his wife, and the health care team. Mrs. Cote is in charge of the decision due to her husband’s incapacity. Mr. Cote and the health care team are affected by the decision because the former is forced to be on a life support system, and the physicians need to continue to monitor the patient’s condition. From a legal perspective, Mr. Cote is eligible for skilled health care following the Canada Health Act or the Nursing Act (“Practice standard,” 2019). In this case, no laws are violated; however, while analyzing the potential outcome, if the patient is disconnected from life support without the consent of his wife, it would be contrary to the national health legislation. This outcome is associated with direct harm, which is inadmissible.
The health care specialists are convinced that it makes no sense to maintain the patient’s life. This is because he is unconscious and can harm himself by turning off his feeding tube. Mrs. Cote, in turn, is convinced that she has no right to decide the fate of her husband and is not ready to disconnect him from the life support apparatus. From the perspective of medical facts, the health care team gives a disappointing prognosis. The organism of Mr. Cote, weakened by Alzheimer’s disease and a recent stroke, will not be able to recover. Therefore, the continuation of the maintenance of life is associated exclusively with ethical aspects.
In this scenario, the nurse can adhere to two different options: support the position related to the termination of life or share the views of the patient’s wife about the inadmissibility of such an action. Supporting the latter option is preferable because doing possible harm contrary to the patient’s best interest is unacceptable from a professional’s ethical perspective (Winnipeg Regional Health Authority, 2015). In addition, the violation of the will of a person representing the interests of an incapacitated person is inadmissible from a legal standpoint. To make an objective decision, the IDEA concept may be relevant, which includes four steps and implies exploring all the options and determining the ethical principles involved (“IDEA,” 2012). As a result, the decision to continue supporting Mr. Cote is adequate in light of the aforementioned conditions, including professional and ethical requirements.
The key takeaway from this scenario is the need to follow all ethical standards and be guided not only by individual views but also by legislative provisions dictating medical professionals’ working norms. In this case, the right position to adhere to is to resolve the ethical dilemma by making concessions to Mr. Cote. Compliance with ethical principles is a critical attribute of working with patients at their end-of-life stages. The experience gained can enhance my skills of interaction with the population and expand my knowledge of the legal aspects that determine the responsibility of medical personnel in controversial cases requiring comprehensive assessments.
Canadian Nurses Association. (2017). Code of ethics for registered nurses. Canadian Nurses Association.
IDEA: Ethical decision-making framework guide & worksheets. (2012). Saskatoon Health Region.
as little as 3 hours
Practice standard. (2019). College of Nurses of Ontario.
Winnipeg Regional Health Authority. (2015). Ethical decision-making framework: Evidence informed practical tool. WRHA Ethics Services.