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52 unit 1 | Professional Considerations CikguOnline
case of Mr. Sussman, some of the questions that More recently, the Terri Schiavo case gained
could be posed by Gail to the family are as follows: tremendous media attention, probably becoming
the most important case of clinical ethics in more
■ “I have noticed the amount of time you have
than a decade. Her illness and death created a
been spending with your father. Have you
major medical, legal, theological, ethical, political,
observed any changes in his condition?”
and social controversy. The case brought to the
■ “I see Dr. Washburn spoke to you about the test
forefront the deep divisions and fears that reside in
results and your father’s prognosis. How do you
society regarding life and death, the role of the gov-
feel about the situation?”
ernment and courts in life decisions, and the treat-
■ “Now that Dr. Washburn has spoken to you
ment of disabled persons. Many aspects of this case
about your father’s condition, have you consid-
will never be clarified; however, many questions
ered future alternatives?”
raised by this case need to be addressed for future
Changes in patient status, availability of medical ethical decision making. Some of these are:
treatment, and social facts may call for reevaluation
1. What is the true definition of a persistent
of a situation.The course of treatment may need to
vegetative state?
be altered. Continued communication and cooper-
2. How is cognitive recovery determined?
ation among the decision makers are essential.
3. What role do the courts play when there is a
Another model, the MORAL model created by
family dispute? Who has the right to make
Thiroux (1977) and refined for nursing by Halloran
decisions when an individual is married?
(1982), is gaining popularity. The MORAL
4. What are the duties of surrogate decision
acronym reminds nurses of the sequential steps
makers? (Hook & Mueller, 2005)
needed for resolving an ethical dilemma. This ethi-
cal decision-making model is easily implemented in The primary goal of nursing and other health-care
all patient care settings (Box 4-3). professions is to keep people alive and well or, if
this cannot be done, to help them live with their
Current Ethical Issues problems and die peacefully. To accomplish this,
During fall 1998, Dr. Jack Kevorkian (sometimes health-care professionals struggle to improve their
called Dr.Death in the media) openly admitted that knowledge and skills so they can care for their
at the patient’s request, he gave the patient a lethal patients, provide them with some quality of life,
dose of medication, causing death. His statement and help return them to wellness. The costs
raised the consciousness of the American people involved in achieving this goal can be astronomical.
and the health-care system about the issues of Questions are being raised more and more often
euthanasia and assisted suicide. Do individuals have about who should receive the benefits of this tech-
the right to consciously end their own lives when nology. Managed care and the competition for
they are suffering from terminal conditions? If they resources are also creating ethical dilemmas. Other
are unable to perform the act themselves, should difficult questions, such as who should pay for care
others assist them in ending their lives? Should when the illness may have been due to poor health-
assisted suicide be legal? There are no answers to care practices such as smoking or substance abuse,
these difficult questions,and patients and their fam- are also being debated.
ilies face these same questions every day.
Practice Issues Related to Technology
Genetics and the Limitations of Technology
In issues of technology, the principles of benefi-
box 4-3
cence and nonmaleficence may be in conflict. A
The Moral Model
specific technology administered with the inten-
M: Massage the dilemma
tion of “doing good”may result in enormous suffer-
O: Outline the option
ing. Causing this type of torment is in direct con-
R: Resolve the dilemma
flict with the idea of “do no harm” (Burkhardt &
A: Act by applying the chosen option
Nathaniel, 2007). At times, this is an accepted con-
L: Look back and evaluate the complete process, including
sequence, such as in the use of chemotherapy.
actions taken
However, the ultimate outcome in this case is that