Ethics Dilemmas Colleen Schabacker BA RRT FAARC Objectives
Ethics Dilemmas Colleen Schabacker, BA, RRT, FAARC
Objectives • Discuss ethical principles as they apply to patient care • Apply ethical principles to patient care dilemmas • Describe the role of an ethics committee
Dr. Strickland’s Dilemma • “John” calls AARC for help with CRCE course • John says he’s taking course for a friend • John asks for dual CRCE credit
Very Brief Overview of Ethical Principles • Beneficence / Non-malfeasance – Provide benefit / Do good – “Above all do no harm” – Benefit should outweigh harm
Very Brief Overview of Ethical Principles • Respect for Human Dignity – Autonomy – Informed consent
Very Brief Overview of Ethical Principles • Justice – Patients must receive fair treatment • What is fair? – Distributive justice – Utilitarian system – Personal responsibility/business model
AARC Statement on Ethics and Professional Conduct • Selected Points; – Demonstrate behavior that reflects integrity, supports objectivity and fosters trust in the profession and its professionals – Respect and protect the legal and personal rights of patients, including the right to privacy, informed consent and refusal of treatment – Provide care without discrimination on any basis, with respect for the rights and dignity of all individuals
AARC Statement on Ethics and Professional Conduct • Selected points: – Refuse to participate in illegal or unethical acts – Refuse to conceal, and will report, the illegal, unethical, fraudulent or incompetent act of others – Avoid any form of conduct that is fraudulent or creates conflict of interest and shall follow the principles of ethical behavior
American Nursing Association • The nurse practices with compassion and respect for the inherent dignity, worth, and personal attributes of every person, without prejudice. • The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. • The nurse promotes, advocates for, and protects the rights, health and safety of the patient. • The nurse has authority, accountability, and responsibility for nursing practice, makes decisions, and takes action consistent with the obligation to provide optimal care.
American Nursing Association • The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. • The nurse, through individual and collective action, establishes, maintains, and improves the moral environment of the work setting and the conditions of employment, conducive to quality health care. • The nurse collaborates with other health professionals and the public to protect and promote human rights, health diplomacy, and health initiatives.
Case Studies • Actual case studies • Names have been changes • Due to HIPPA some information has been changed • A couple cases came from the media
Case 1: Ripped from the Headlines • 32 year old fell 16 feet to the ground from a tree stand • Spinal trauma resulted in paralysis and ventilator dependency • At family’s request he was brought out of sedation to decide on treatment • He chose to be removed from life support
Case 1: Ripped from the Headlines • The physician writes an order for respiratory to turn off the ventilator and extubate the patient • Should you carry out the physicians order?
Case 1: Ripped from the Headlines • The ethical dilemma – Autonomy – Non-malfeasance
Case 1: Ripped from the Headlines • What really happened? – He was removed from the ventilator and extubated
Case 2: The Smoking Mom • 5 year old boy has been brought to the ER twice due to asthma • Mother admits to smoking in the house • Mother refuses to stop smoking around the child
Case 2: The Smoking Mom • Should you file a report with child welfare that the boy is being neglected?
Case 2: The Smoking Mom • The ethical dilemma – Autonomy – The mother has a right to smoke – Non-malfeasance –The child is being harmed – Legal requirements?
Case 2: The Smoking Mom • Things to try before reporting – Re-educate the Mom – Help the Mom stop smoking – Modify where / how Mom smokes
Case 3: Smoking and Oxygen • Bob is a 62 year old COPD patient • He qualifies for home oxygen therapy • He smokes 1 pack per day and has no plans to stop
Case 3: Smoking and Oxygen • Should she write the order for home oxygen.
Case 3: Smoking and Oxygen • The ethical dilemma – Is it safe for a smoker to have home oxygen? – Would you be enabling his nicotine addiction? – Bob has a right to make his own decisions
Case 3: Smoking and Oxygen • What are your options? – Educate Bob on oxygen safety – Offer smoking cessation assistance
Case 4: Required Flu Vaccine for Healthcare Workers • Hospital requires all HCWs to get seasonal flu vaccine • Allows exemption for medical & religious reasons • Jenny refuses vaccine because it isn’t “natural”
Case 4: Required Flu Vaccine for Healthcare Workers • You are Jenny’s manager? Should Jenny be fired?
Case 4: Required Flu Vaccine for Healthcare Workers • The ethical dilemma: – Jenny’s right not to have her body “invaded” – Need to protect vulnerable population – Religious exemption vs. personal belief
Case 5: Suicide • Man with end stage prostate cancer • Secretly told his nurse he was going to commit suicide
Case 5: Suicide • Should you report her to your supervisor?
Case 6: Terminal Wean • 24 year old woman with multi-system failure and ARDS • Receiving Pavulon to facilitate ventilation • Currently on PCV/ rate 35/VT 150 ml/PEEP 15/100% O 2
Case 6: Terminal Wean • The resident discusses the situation with the family. They decide to D/C vasopressors and turn down ventilator support. “Let nature take it’s course”. • The resident instructs you to place the patient on CPAP
Case 6: Terminal Wean • Should you immediately place the patient on CPAP?
Case 6: Terminal Wean • The ethical dilemma: – You have a duty to follow the physician’s order – Can nature take its course if patient is paralyzed
Case 7: Refusal of Blood Transfusion • Critical motor vehicle accident • Patient lost a lot of blood and needs a blood transfusion to sustain life • Patient is unconscious and there is no family present • The patient is a Jehovah’s Witness
Case 7: Blood Transfusion Should the physician order the blood?
Angel of Death • Efren Saldvar, Glendale, CA – 1998: co-worker reports to supervisor – Other co-workers fail to report – Admits to killing up to 50 people but recants – He and four other RT fired – 2000/2001 autopsies show 6 victims with Pavulon – 6 counts 1 st degree murder – Life without parole
Ethics Committees • Multidisciplinary Group – Caregivers (doctors/nurses/RTs/sleep techs) – Clergy – Attorney – Ethicist
Ethics Committee • What is their function? – Provide consultation when ethical dilemmas arise – Help staff & families/patients arrive at a decision – Develop policies on handling ethical dilemmas
Other Ethical Dilemmas • Getting “too close” with your boss or coworker • Helping yourself to other’s property • Gossiping • Not doing your share of the work • Claiming Workman’s Comp wrongfully
• “People often say that motivation doesn’t last. Well, neither does bathing – that’s why we recommend it daily. ” ~ Ziglar
THE END! • schabacker. colleen@gmail. com
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