Brain death is a condition affecting the left and right hemispheres of the brain and is also referred to as legal death (Burkle, Sharp & Wijdicks, 2014). Brain death occurs when the brainstem (the last brain structure to die) ceases to function. Loss of brainstem function is a rare occurrence such that when it happens, death is inevitable. After the brainstem loses functionality, breathing stops and the heart stops beating. The absence of motor responses and an unstable, declining blood pressure result in death; hence brain death means the end of the patient (Burkle, Sharp & Wijdicks, 2014). In children, a brain dead patient is declared legally dead after two examinations by two different physicians that are conducted in a 12-hour interval (Burkle, Sharp & Wijdicks, 2014). Continuing life support after brain death is termed as vain because of the struggle in maintaining a brain-dead body. Nurses face ethical dilemmas when presented with such situations. The following is an analysis of how the principles of the ANA code of ethics apply to this situation.
Several principles within the ANA code of ethics are applicable in this situation. They include provision one which requires that nurses show compassion and respect the dignity of all people (American Nurses Association, 2015). The second provision provides that nurses are committed to their patients (American Nurses Association, 2015). Provision four gives nurses the authority to make clinical decisions, and they should take actions in the quest for adequate care (American Nurses Association, 2015). Provision six is another principle that requires nurses to establish, maintain and improve the ethical conditions of the working environment (American Nurses Association, 2015). Additionally, provision nine advances that the nursing profession should retain nursing values and professional integrity (American Nurses Association, 2015). These principles present ethical dilemmas when dealing with the parents of the brain-dead child, who refuse to let him off life support.
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According to the first provision, nurses are allowed to have dignity and respect for all people; hence they should let the family some time to grieve for their loss. This support could be enhanced through the provision of extra time to mourn before moving the body from the hospital bed (Burkle, Sharp & Wijdicks, 2014). On the other hand, the sixth provision promotes the upholding of an ethical working environment. Therefore, after the child is declared brain dead, they should be moved from the ICU to create more bed space for others in need of the facility for adequate care (Burkle, Sharp & Wijdicks, 2014).
Nurses are faced with the burden of making responsible decisions according to the fourth provision. Seeing as brain death translates to the end of a patient, nurses should decide to withdraw life support because of the impossibility of maintaining the child’s body. Moreover, in doing so, they are in line with the ninth provision that allows them to maintain professional integrity. Continuing life support would damage the professional integrity and cause moral distress on both the patient’s family and the nurses themselves (Burkle, Sharp & Wijdicks, 2014).
The clinical agency has resources that deal with such ethical dilemmas. One of them is allowing the family to grieve. Nurses should acknowledge the need for grief by other family members and organize the viewing of the body to facilitate this process. More so, nurses may recommend counseling help in dealing with the grief that comes after losing a loved one. In conclusion brain dead is considered as legal death and nurses should apply the principles of the code of ethics in dealing with such cases. They should also employ the resources set up to deal with the dilemmas.
References
American Nurses Association. (2015). Code of ethics with interpretative statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html
Burkle, C., Sharp, R., & Wijdicks, E. (2014). Why brain death is considered death and why there should be no confusion. Neurology , 83 (16), 1464–1469. Doi: http://doi.org/10.1212/WNL.0000000000000883
