Nurses provide guidance and address the problems in the end-of-life decision-making process. It is the nurse’s role to explain to families and other healthcare professionals when an advance directive would be put to use. An advance directive serves as a guide for clinicians to respect and honor the autonomous decision of the patient when they are in a position to not be able to express their wishes (Roux & Halstead, 2009). Nurses could assist in ensuring the patient needs are met along with protecting their rights. The registered nurse act as client advocates in health maintenance and clinical care (Standards of Nursing conduct or practice, 2003). Advocating for patients could bring implications such as conflicts with physician and families regarding decision on the plan of care. Nurses struggle with having the feeling of powerlessness towards family decision rather than supporting patient decision. Nurses also experience moral distress and outrage at unsuccessful attempts at becoming patient advocate.
According to provision two of the American Nurses Association nursing code of ethics, the nurses’ primary commitment is to the patient, whether an individual, family, group, or community (American Nurses Association, 2001). This code impacts the nurses’ professional decision because if conflict arises, they are the ones to assist in resolving it. The loyalty of the nurse is still towards the patient especially when conflict persists. They inform patient and their families of options leading towards decision making. Nurses however, have to ensure patient safety, oversee what is important, and support whatever decision the patient made.
Mr. E’s scenario of being placed on the respirator has multiple ethical implications. Ethical implications such as not honoring Mr. E’s decision regarding refusal use of a life-prolonging procedure, legally not abiding by his advance directive, and intubating with use of a ventilator without power of attorney’s consent. Physicians could refuse to follow an advance directive on the basis of conscience objections to such care or treatment. Federal law requires that the patient or patient’s power of attorney be provided with written policies at the time of admission to the hospital of any limitations on carrying out decisions, including the range of medical conditions or procedures affected by the conscience objection. However, state laws differ in that it needs to identify legal authority permitting a conscience objection.
Ethical considerations that Mr. Y should weigh before agreeing to authorize the use of the ventilator for his brother should be that wishes be respected and followed, consider all the options given to him by the healthcare team, receive guidance to assist in addressing decision with the end goal being honoring his brothers choice when he was still capable of making them. ...