Ethical Considerations in End-Of-Life Care, Research Paper Example

Ethical Dilemmas in Brain Death

Ethical dilemmas often arise in the treatments involving children on whether to administer certain medications or to withdraw some treatments. Physicians often find it hard to make overall conclusions since parents and relatives may have the opposite opinion. Brain death is defined as the “irreversible cessation of all functions of the entire brain, including the brainstem.” (Maundrell, 2022, p. 1). Brain death raises many questions in healthcare due to conflicting parties, for example, religion, ethical principles, and societal issues and beliefs. For example, religious groups believe the doctor cannot declare and remove any treatment from the patients. A 12-year-old boy from Brooklyn faced the same situation when the physicians decided to terminate the treatment since he was diagnosed with brain death (Associated Press, 2008). However, the parents could not take it in since their religion did not allow anyone to declare or interfere with the life of any human. This paper will analyze the ethical dilemmas surrounding the case study and how ethical principles like beneficence, non-maleficence, and respect for autonomy apply in the scenario.

Background

Motl Broody of Brooklyn was diagnosed with Brain death which made the doctors declare him dead, and he could no longer remain on the life support machine. The boy had brain cancer and was admitted to Northwest Washington Hospitals for many days (Associated Media, 2008). After six months, the doctors performed brain tests to determine his condition and response to medication. The results revealed that the brain had ceased to work; hence, they declared him brain-dead and decided he would be removed from the treatment. The parents could not accept the idea since their Jewish culture did not support that move. Eluzer and Broody said that their religion and culture did not classify death based on the cessation of brain activities. Therefore, they considered the doctor’s murders and could not allow them to remove treatments from their son since they believed the boy would heal and walk again.

The case was presented to the court to determine the best move for the scene. The hospital lawyers argued that the hospital could not keep a mere corpse and remains in the life support machine. They maintained that the hospital had done all the tests relating to the matter and was certain that the brain had ceased its duties (Veatch, 2016). However, the family remained strong in their beliefs on the issue of death. Sophia Smith said that the child was no “longer alive and that withdrawing the treatments” was the only approach that would help. (Wilber, 2008). “There is no activity in any portion of his brain, including the brain stem” (Wilber, 2008). However, the family lawyer, Zuckerman, argued that the family had nothing like brain death in their culture and could not account for the events.

Ethical Issues

The case presents many ethical issues, for example, culture, religion, ethics, and morality. The family maintains that their culture does not define death in the same method the doctors use to present the case. They believe death is based on the whole organism and not a single part. However, the doctors have maintained that they are on the right track. Ethical principles like maleficence require that physicians apply the best mechanism to help the patient achieve the best. The doctors maintained that the ethical principle of maleficence and beneficence applied in that treatment withdrawal was the perfect move for the team to apply. The family lawyers used the same principle to defend the family. For example, they claimed that their culture only recognized the heartbeat as the final measure of life (Setta, 2013). However, the doctors reported that the heart stopped beating a few days before the brain died.

In addition, autonomy issues arise since the victim could not present his view on the same case. However, ethics provides for the parents to make the final decision on the issues. The doctors maintain their standards on the issues without considering the autonomy of the parents. They held their points and could not give in easily. The parents and the physician could have made a shared discussion and communicated effectively to ensure both parties agreed.

Nursing Code of Ethics

Ethics allow professionals to work within certain limits and values that ensure the safety of patients. “American Nurses Association” defines it as the “Social contract nurses have with the United States public. It exemplifies our profession’s promise to provide and advocate for safe, quality care for all patients and communities. It binds nurses to support each other so all nurses can fulfill their ethical and professional obligations.”  (Faubion, 2023). The codes guide the operations and activities of the nurses, and they define the actions and limits that the nurses should not pass.

In this case, autonomy applied since the physician failed to incorporate mutual agreement by insisting that their take was the best option (Faubian, 2023). After in-depth education and consultation, the two parties could have agreed on the best approach to make a sound decision. Beneficence applies to the best actions a physician would perform to protect the best outcome for the patient. The doctors argued they could not proceed with further treatments since they did their best to support the child. In this case, the doctors obeyed the principle since they had supported the boy in the hospital for more than six months and administered all required treatment without causing any harm (Akdeniz et al., 2021). Non-maleficence applies that the doctors cannot apply any method that would infringe on or cause harm for the patient. The boy was already declared brain dead, and the heart was not functioning well. Thus, there was no pain in removing the life support machine. Justice was applicable in this case since the doctors used science without incorporating cultural disrespect when making the decisions.

Breach of Ethical Standards in Nursing

The breach of the principles has serious implications for the nurse’s life. For example, if a nurse ignores a patient who refuses medication, it may lead to other serious issues like death (Griffith, 2019). The nurses face a long jail term based on the legal implications of the principles. Therefore, nurses should adhere to the principles to control patient harm and death.

Alternative Actions

Open communication and education are some of the alternatives for ethical issues. The parents and the nurses should communicate openly to help solve the matter. The physicians should educate the family based on the case’s physiological aspects and principles. They should outline what brain death means and the implications for the boy (Greer et al., 2020). This would have helped them to solve the matter without facing the court.

Conclusion

The case has raised many ethical issues which brought confusion for both parties. Brain death is considered the final stage in “most brain cancer cases.” The patients no longer have any vital organs operating since the main engine has stopped working. The physicians consider “removing the treatments to reduce costs and conserve resources.” However, the parents may not understand the situation which makes it hard to solve. Autonomy and education that enlightens the two parties can help solve the situation. The 8 “nursing code of ethics is entrenched in principles” that respect cultural diversity, prioritize patient autonomy, and advocates for working with other healthcare practitioners to ensure safe and effective care. All the above factors should be in place to “minimize any conflict between parents and physicians.”

References

Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations in end-of-life care. SAGE Open Medicine, 9, 20503121211000918. https://doi.org/10.1177%2F20503121211000918

Associated Press (2008). Parents opposed end-of-life care for brain-dead sons. NBC News. https://www.nbcnews.com/id/wbna27611868

Faubion, D. (2023). The 9 nursing codes of ethics every nurse must adhere to. Nursingprocess.org – Your Guide to Nursing & Health Care Education. https://www.nursingprocess.org/nursing-code-of-ethics-and-interpretive-statements.html

Greer, D. M., Shemie, S. D., Lewis, A., Torrance, S., Varelas, P., Goldenberg, F. D., … & Sung, G. (2020). Determination of brain death/death by neurologic criteria: the world brain death project. Jama, 324(11), 1078-1097.

Griffith, R. (2019). Negligence and the standard of care in district nursing. British Journal of Community Nursing, 24(1), 35–37. https://doi.org/10.12968/bjcn.2019.24.1.35

Maundrell, R. (2022). Brain Death: Still A Puzzle After All These Years. Neuroethics, 16(1), 7. https://link.springer.com/article/10.1007/s12152-022-09513-y

Setta, S. M. (2013). Determining Death: Perspectives from World Religions. In Death, Dying, Culture: An Interdisciplinary Interrogation (pp. 117–124). Brill. https://doi.org/10.1163/9781848881730_012

Veatch, R. M., & Ross, L. F. (2016). Defining death: The case for choice. Georgetown University Press. https://jamanetwork.com/journals/jama/article-abstract/2769149

Wilber, D. Q. (2008). DC Hospital Sues to Remove Boy, 12, From Life Support. The Washington Post.

https://hods.org/pdf/press/D.C.%20Hospital%20Sues%20to%20Remov…pdf