An ethical dilemma arises when the clients and health care providers differ in their understanding of what is right or wrong (Narrigan, 2004). As nurses we often deal with ethical dilemmas in our everyday clinical practice; and as professionals we have the responsibility to analyse and examine any ethical problems that may arise. Any decision should be based on ethical principle that protects the best interest of both the patient and the health care provider. This paper will outline a critical incident which occurred in one of my clinical experience in intensive care unit (ICU).It presents the clinical case, identifies the ethical dilemma, and discusses the principles that apply to this situation.
Mrs G was a 76-year old woman who was brought to emergency department (ED) after her carer found her in respiratory distress.
The ED doctor noted that the patient was minimally responsive to verbal stimuli, afebrile, normotensive, tachycardic to 130 bpm, and tachypneic to 30 breaths/min.A chest radiograph revealed a right lower lobe consolidation. Based on her old notes it was found out that she had been recently admitted for investigation of significant weight loss and it was found to be a result of advanced bowel cancer ,with lungs, bone and brain metastases. While in ED Mrs G’s respiratory functions deteriorated and a referral for ICU was made. She was then seen and reviewed by our junior registrar and after discussion from the ICU consultant, Mrs G was admitted to ICU for closer observation. I was then tasked to look after this patient for that shift. After knowing the brief history of the patient from my team leader, I was then asking the doctor of what do we do for this coming admission? Are we going to intubate and ventilate this patient in case she developed respiratory failure? And what are the chances of her recovery from this critical illness? Has it been discussed to the next of kin before the plan for ICU admission? The doctor then replied that it was his consultant’s decision, and so we will just have to wait when this patient will arrive in the unit.
. Within 24 hours of being transferred to the ICU, Mrs G’s condition deteriorated rapidly and a decision was made to talk with the family of what we should do in the event of cardiac arrest. Relatives need to be involved in discussions about end-of life issues so that they are fully aware of the appropriate decisions to be made; and that all parties involved understand the situation (McDermott, 2002).The son was immediately informed about his mother’s condition and it was revealed that Mrs G had previously stated to him that she does not want any heroic measures in the event of cardiac arrest. The conversation with Mrs G’s son over the phone resulted in the decision to initiate a not for resuscitation (NFR) order. The purpose of the NFR order is to deliberately withhold life-saving measures when the patient’s respiratory or cardiac function suddenly stops (Costello, 2002).