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You Decide – Ethics Committee

You Decide – Ethics Committee

The case before the ethics committee of Marion General Hospital is of Margie Whitson, a 95-year-old woman that is requesting to have her pacemaker deactivated and allowed to die. Mrs. Whitson believes that the pacemaker is delaying her passing and feels there is no longer a need for the delay. She has reached this conclusion after a very trying 5 years with the death of her husband, Earl of 68 years, and the very recent death of her 73-year-old son William. Mrs. Whitson’s health has also been declining, and she has no other living relatives. She is 100% reliant on the pacemaker for survival. Her cardiologist Dr. Vijay has refused her request to have the pacemaker deactivated, citing that it goes against what is done in medicine by saving lives, not ending lives. Regardless of the doctor’s position, Mrs. Whitson is determined to move forward with her decision to have the pacemaker deactivated. Therefore the social worker Jane Robinson of Golden Oaks has decided to have her case reviewed by this committee. It is the role of the physicians, nursing staff, and social workers to ensure that Mrs. Whitson’s quality of life is preserved and she is receiving the absolute best care. It is within Mrs. Whitson’s rights to refuse medical care; however, we have the moral responsibility to ensure that there we are not inflicting harm and are being fair and respectful of the patient’s rights. It is the role of the ethics committee, along with the medical staff and social workers, to non-maleficence is not occurring while being respectful and mindful of the decisions Mrs. Whitson has the right to make in her ongoing care. It is also important to consider all of the risks and benefits that are associated the honoring Mrs. Whitson’s request to remove her pacemaker.

Information

It is the opinion of the nursing home administrator, Ms. Cindy Mackin, that Mrs. Whitson is going through the grieving process of just burying her son. She believes that over time her perspective will improve. Ms. Mackin did arrange for her to further discuss her options with Dr. Vinjay, the cardiologist. The deactivation of the pacemaker would expressly go against the code of ethics that Dr. Vinjay adheres to. By honoring the request of Mrs. Whitson, Dr. Vinjay would be causing intentionally causing harm to another. Dr. Vinjay also has strong ethical concerns about what this action will entail.

The Patient Self-Determination Act of 1990 was enacted to provide patients with informed consent and the ability to execute advanced directives to accept or refuse medical care [Kae13]. This act means that it is the responsibility of our facility to address Mrs. Whitson’s rights while maintaining the ethical integrity we are known for. Advanced directives will allow for the wishes of Mrs. Whitson should she become incapacitated and unable to make those decisions. The advanced directive will provide us with specific actions that should take place and will include her living will. The living will, will further serve in the place of a legal document outlining the treatments the patient wants and the treatments that they are refusing [Kae13].

Communication

In discussing this case with Ms. Cindy Mackin, CNHA and Dr. Vinjay are both opposed to honoring the request of Mrs. Whitson. While she has been in declining health in recent years, she is not suffering from a terminal condition that could ethically justify deactivating the pacemaker. It is their belief that, in time, Mrs. Whitson’s disposition will improve, and she is just making this decision because of the recent life events. Grief can be overwhelming at times, and things have not been easy for her. Ms. Robinson, MSW has suggested that this matter be reviewed by the ethics committee because of the severity of the situation.

Choice

It is important that the well-being and care of all our clients are met at all times. This is not an easy decision for this committee; however, based on the particulars of this case, we cannot grant the request of Mrs. Whitson to deactivate her pacemaker. This decision was made based on the fact that the patient’s health issues are not terminal. It is the further recommendation of this committee to work with the social worker to ensure the proper directives are in place for her future care. It is the right of Mrs. Whitson to refuse ongoing medical treatment in the future. We would also recommend that grief counseling be offered to assist Mrs. Whitson in coming to terms with her tremendous loss.

References

Book Example:

Gordon, K. E. (1993). The deluxe transitive vampire: The ultimate handbook of grammar for the innocent, the eager, and the doomed. New York: Pantheon Books.

Journal Example:

Jacobson, J. W., Mulick, J. A., & Schwartz, A. A. (1995). A history of facilitated communication: Science, pseudoscience, and antiscience: Science working group on facilitated communication. American Psychologist, 50(2), 750-765.

Website Example:

Lawton. K. A., Cousineau, L., & Hillard, V.E. (2001). Plagiarism: Its nature and consequences. Retrieved September 27, 2001, from Duke University Guide to Library Research web site: http://www.lib.duke.edu/libguide/plagarism.htm

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Question 


Scenario: You Decide

Activity or Assignment

Prepare a two-three page paper analyzing the key issues in this case and stating a recommendation. Be sure to include the following steps in your analysis.

You Decide – Ethics Committee

You Decide – Ethics Committee

Identification 

Identify the dilemma. What morals are involved? What morals are in conflict?

Information 

Get as much information as possible about the dilemma. Often this step is taken too quickly, without enough solid and detailed information, leading to bad decisions.

Communication 

Talk with other healthcare professionals on the case. Do they agree that there is a dilemma? Do they concur with your understanding of the dilemma? Do you know everything that they know about the case, and vice-versa?

Choice 

When all the talking is done, a choice needs to be made about what to do regarding the dilemma. A choice must be made. Even choosing not to decide is a decision!

Your role here is to prepare a recommendation on behalf of the ethics committee, with input from all participants, considering the best

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