Ethical Dilemmas in Brain Death, Research Paper Example

Brain death versus actual death- where do we draw the line? The end-of-life issue reflects the complicated ethical considerations in healthcare and emphasizes the need for continual training and education in communication and ethics for healthcare providers. For example, healthcare experts may prioritize the medical information around the patient’s condition and recommend withdrawing life support. In contrast, the patient’s family may have strong religious or cultural beliefs that impact their decision to do so. In this paper, I will discuss the 2008 controversial case of Mordechai “Motl” Brody, a 12-year-old child from Brooklyn, New York, diagnosed with a brain tumor and declared brain dead by his physicians. His case sparked the ethical dilemma of differentiating between brain death-the irreversible loss of all functions of the brain (Setta, 2013), and death, the irreversible cessation of all biological functions that sustain an organism (Greer, 2021). There are intricate legal, cultural, and ethical matters regarding end-of-life care planning. The decision-making process can become extremely difficult for family members and medical professionals alike. Fourteen years later, brain death remains a relatively unfamiliar concept for the public. By understanding the ethical dimensions of end-of-life, healthcare providers can assist families and patients with the support and care they need during such difficult moments.

Background

Mordechai Brody was a 12-year-old Brooklyn native diagnosed with a brain tumor in early 2008. By November, the brain tumor had stopped his brain functioning, and Mordechai was pronounced brain dead by his physician at the tender age of 12 (Setta, 2013). What makes this issue complicated to a layman is that Mordechai’s heart continued to beat. How can we assign death to one that has a beating heart? Although doctors insisted that there was nothing more than they could do for Mordechai, the family was not ready or willing to accept this fate. According to the physicians, Mordechai could no longer breathe on his own and required medication to sustain his blood pressure. He was maintained on a ventilator. “His eyes are fixed and dilated. His body neither moves nor responds to stimulation. His brain stem shows no electrical function, and his brain tissue has begun to decompose” (Setta, 2013). Despite the medical counsel provided by the hospital, the family fought to keep him on life support due to their strong religious convictions. Still, the medical community thought that the child’s brain had already suffered irreparable damage and that keeping him on life support did not serve Mordechai any good (Setta, 2013).

As this case unfolded, several components were at the forefront. Culture, religion, morals, and ethics were competing as this case became public. Mordechai’s family escalated their concerns to the Courts, fighting to keep their Motl “alive.” As Orthodox Jews, one interpretation of Jewish religious law states that death occurs after the heart has ceased beating. According to Setta (2013), Motl still had a beating heart. This interpretation drove the family to fight for Motl and continue treatment for him, at the very least, until his heart stopped beating. The family’s lawyers stated that the basis of their defense was on behalf of the family’s obligation to their religion, which the hospital should not have jurisdiction over. They argued that this case violated the Religious Freedom Restoration Act, which protected religious freedom. A judge heard initial arguments on November 10 but delayed ruling until further hearings can be held. Unfortunately, Motl’s had his last heartbeat a few days later, on November 15, 2008, and the case had not been resolved as of this date (Setta, 2013)

Motl’s case brought up several ethical issues, such as the family’s right to decide on the child’s care, the medical profession’s responsibility to uphold maleficence and beneficence, religion, and the moral considerations of end-of-life. It is of utmost importance to consider the patient and family’s faith, customs, and culture when manufacturing a care plan for the patient. For Motl, there was no chance of recovery medically- in fact, he would likely further deteriorate if the Court had awarded the family with sustained life support measures. However, the family held religious beliefs that contradicted the medical team. Unfortunately, Motl did not maintain a beating heart long enough for the case to finalize in Court. It would be interesting to see how the Court concluded the case if given the opportunity.

Nursing Code of Ethics

LPN must operate within the confines of The Nursing Code of Ethics. When handling cases similar to Motl’s, LPN’ must relate all medical interventions to the nine provisions under the Nursing Code of Ethics. Under Provision 1, the nurse practices compassionately and respects every person’s dignity, worth and unique attributes (Spears et al., 2022). Given the tragic nature of the Motl Brody case- with him being so young and struck with a debilitating disease, the nurse must utilize compassion when interacting with the family. Understanding that this situation may be one of the most difficult. By being supportive, actively listening, and handling this delicate situation with care, the nurse would abide by the guidelines under Provision 1.

Under Provision 2, the nurse’s primary commitment is to the patient, whether an individual, family group, community, or population (Stievano & Tschudin, 2019). In the Motl case, the nurse would be committed to the customs, cultures, and religious beliefs that the family upheld. In this case, they believed that Motl was still a living being since he still had a beating heart. Provision 3 implores the nurse to promote, advocate for, and protect the patient’s rights, health, and safety. Stievano & Tschudin (2019) opine that being a patient advocate means being the eyes and ears for the patient. Given Motl’s inability to speak for himself and being a minor, the nurses’ responsibility would be to advocate on behalf of the family and the patient to ensure he gets the care needed. The nurse could further reach out to other departments, such as the ethics committee in the hospital, and collaborate with the family, the hospital’s representatives, and the Rabbi to come up with a decision that was within reason for all, particularly for the patient. Provision 4 states that the nurse has the authority, accountability, and responsibility for nursing practice, make decisions and takes actions consistent with the obligation to promote health and provide optimal care (Stievano & Tschudin, 2019). The nurse assigned to Motl must adhere to evidence-based practices to provide the best appropriate care.

Provision 5 states 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 (Faubion, 2023). I believe this situation would have been ideal for the nurse to obtain unique and professional development, especially on brain death and when to remove patients from life support. The nurse must put aside their feelings and beliefs to provide competent and professional care. Provision 6 states the nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work settings and conditions of employment that are conducive to safe, quality health care (Stievano & Tschudin, 2019). With tensions running high for the hospital and the Brody family in the public eye, the nurse must maintain neutrality, confidentiality, and professionalism.

Provision 7 states the nurse in all roles and settings advances the profession through research and scholarly inquiry, professional standards of development, and the generation of nursing and healthcare policy (Stievano & Tschudin, 2019). Again, this provision is ideal for the Motl Brody case. Research and providing teaching and learning can all improve the healthcare environment and allow nurses to improve the care they render to future patients. Provision 8 states the nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities (Stievano & Tschudin, 2019). The most sacred human right is life, and that was the basis of the Motl Brody case. As aforementioned, the nurse could collaborate with interdisciplinary, interprofessional, and religious clergy to establish a guide to care for this patient. Finally, Provision 9 states the nursing profession, collectively through its professional organizations, must articulate nursing values, maintain the profession’s integrity, and integrate social justice principles into the nursing and health policy (Faubion, 2023). This is important due to nursing is a well-respected profession. The actions of one can impact the impressions of all, particularly with a well-televised case. By maintaining the core nursing principles, the nurse can be confident that optimal holistic care has been provided to the patient and the family.

Implications of Breaches in Ethical Conduct

Breach of ethical standards can have serious repercussions, such as harm to one’s professional reputation, but more importantly, distress to patients and their loved ones. Being hospitalized is when the patient and family depend on the nurses and medical team the most. Disrupting their trust may allow them to feel that any additional teaching or medical advice given is equally untrustworthy, and this may negatively impact the patient (Greer, 2021). The family may not follow the advice given, even if it is in the best interest of the patient and the only opportunity for recovery. It can weaken the trust between patients and healthcare providers, undermine the nurse’s professional identity, and harm the standing of the nursing field as a whole (Faubion, 2023). In addition, it has monetary and legal repercussions, including lawsuits and license revocation.

Alternative Approaches to Ethically Challenging Circumstances

There are ways to approach ethically challenging circumstances, and it may start with the nurse bridging trust to the family. For Motl, educating the family on the cause and consequences of brain death may allow them to understand better why certain bodily functions remained while others ceased. By providing factual information, research, and evidence-based practice, while exercising compassion, empathy, sensitivity, and awareness of the patient’s culture and religion, the nurse may have made a difference in this case. In addition, involving the health care team, ethics committee, and Rabbi, alternatives could have been discussed before it ultimately led to the courts. Healthcare professionals and the family can receive direction and assistance from an ethical committee while making challenging choices (Faubion, 2023). Conclusively, the family can better grasp Motl’s health and make care decisions if they are well-informed.

Conclusion

The moral conundrum of whether to keep a patient with brain death on life support has been difficult for medical experts and the patient’s family due to the competing values and beliefs at stake. In the case of 12-year-old Mordechai Brody, the family’s religious convictions ran counter to the doctors’ advice to discontinue life support after determining brain death. The nursing code of ethics is entrenched in principles that respect cultural diversity, prioritize patient autonomy, and advocate for working hand-in-hand with other healthcare practitioners to ensure safe and effective care. (Faubion, 2023). Mordechai’s case demonstrates the importance of open communication between medical professionals and the family and the engagement of an ethics board to help with morally challenging decisions. Violating the ethical code of conduct can have serious repercussions, including injury to patients and families, loss of faith in the medical system, and legal action. Thus, healthcare professionals must work to uphold the values of non-maleficence, beneficence, and regard for patient autonomy in their practice (Faubion, 2023). Some alternative strategies for dealing with ethically complex situations include incorporating the patient’s family in the decision-making, providing knowledge and resources to promote informed decision-making, and leveraging interdisciplinary teams to provide holistic treatment. The patient’s wants and preferences must be respected to offer compassionate care, necessitating a careful evaluation of medical facts, cultural beliefs, legal frameworks, and ethical standards.

References

Faubion, D. (2023). The 9 nursing code 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. (2021). Determination of brain death. New England Journal of Medicine, 385(27), 2554-2561. DOI: 10.1056/NEJMcp2025326

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

Spears, W., Mian, A., & Greer, D. (2022). Brain death: a clinical overview. Journal of Intensive Care, 10(1), 1-16. https://doi.org/10.1186/s40560-022-00609-4

Stievano, A., & Tschudin, V. (2019). The ICN code of ethics for nurses: a time for revision. International nursing review, 66(2), 154-156. https://doi.org/10.1111/inr.12525.