The ethical dilemma that I was faced with while practicing bedside nursing was a situation in which a family could not decide whether or not to stop or continue dialysis on their mother despite her failing health. This particular patient was a seventy-three year old African American female who had various health problems that included end-stage renal disease, diabetes, hypertension, congestive heart failure (CHF) and multiple CVA’s. This woman had been on hemodialysis for three years and had generally lived a healthy lifestyle controlled by medication and diet.
The ethical dilemma occurred when she was admitted into the hospital with congestive heart failure (CHF) and suffered a CVA. She was unconscious for several days with a dangerously high blood pressure. The physician’s that were caring for her studied her condition very carefully. They never rushed into anything in regards to her treatment. It was one morning during hemodialysis that she suffered a severe CVA that left her with very little brain activity, which was shown on her EEG.
The neurologist talked with the family on several occasions informing them that this was a severe stroke that affected the brain stem area of the patient’s brain, which ultimately left her with very little brain activity. The family could never really grasp a complete understanding as to how serious their mothers condition was and the fact that she would never recover from this CVA like she had recovered from the CVA’s that she had experienced in the past.
The family still insisted that this patient be a full code and that aggressive measures should be taken to sustain her life. This lady suffered from cardiac arrest four times over the eight weeks that she was hospitalized. Each episode was worse than the one before. The nephrologists sat down with the family and with the neurologist and discussed the patients condition, informing the family that hemodialysis was to strenuous on the patients heart and that it was causing more harm than help to the patient.
After many weeks of discussion among the family and the physicians the ethics committee was called in to talk with the family and to help them make a decision as to how their mother’s end of life wishes would be carried out. The family was torn when it came to this discussion. They were not ready to see their mother die. No one had given any thought to the fact that this patient was suffering and that it was her body lying in that bed and not the lively energetic woman that everyone loved.
The ethics committee was non-judgmental, they did not know any of the parties involved and their main focus was the patient and the family. As a nurse I hated watching my patient suffer on a daily basis, but as a daughter I understood the heartache that the family felt when faced with the decision of stopping hemodialysis and the aggressive treatment that was being provided and provide only comfort measures to the patient. During situations like this it is not only hard on the family; it is hard on the healthcare professionals that care for these patients.
We have to separate our feelings and respect the decisions that the families and or patients make even when they are different from our own beliefs. I can still remember to this day how many of the nurses felt regarding this issue. Some felt as though the family was being selfish and not thinking of the patient, while others showed empathy towards the family. This particular situation led to a hospital wide educational in-service on death and dying and on the importance of consulting the ethics committee when faced with situations like this one.
I was shocked to learn that many nurses did not know about the ethics committee, nor did they understand what their purpose was within the healthcare organization. There needs to be an ethical decision making model available at every healthcare institution that will serve as a guide for patients and families that are faced with such ethical dilemmas as the one that I have just described. This model will provide guidelines for healthcare professionals to follow when faced with ethical dilemmas. Ethical standards will also be addressed and or identified in this ethical decision making model.