Based on case study two, David has various issues. To begin with, he is born prematurely which led to his being at the neonatal intensive unit for a long time. Despite the high-level medical care, his outcome was unpredictable according to the health professionals. Besides, David suffered arrests that led to severe damage to the brain. Regardless of the aggressive intervention including surgery, his condition worsened. At the age of nine months, he was sent home but with significant developmental delays. Further, he developed seizures, scoliosis, and contractures, conditions that have made taking care of him difficult. This has caused a financial and emotional strain on David’s parents because they not only work full-time but have other children aged 4 and 7 to take care of. The medical team feels that prolonging the life of pain will cause more suffering to both David and his parents. On the other hand, his parents believe that he will be lucky to survive and with minimal interventions.
Diagnosis
The ethical problem, in this case, revolves around the dilemma between autonomy and beneficence. Autonomy, at its core, gives the patient the right to decide what happens to them while beneficence, on the other hand, involves advocating for the wellness of the patients and concentration to ensure they give the best treatment (Nelson, 2017). In this case, however, the medical team is for the opinion that life-prolonging interventions will increase suffering to David. In other words, they suggest that life-prolonging interventions should be withdrawn from the pediatric patient. The withdrawal of treatment would definitely result in death. On the other hand, the parents of David want their son to continue with the treatment despite the unpredictable outcome. The medical team’s decision and that of the parents are opposed to the two principles of nursing; beneficence and autonomy.
Delegate your assignment to our experts and they will do the rest.
Plan
The first step would be assessing the psychosocial needs of the parents. According to the Psychosocial Standards of Care Project for Childhood Cancer, there has been an increasing number of medically complex cases of children outside cancer (Jones, Currin-Mcclloch, Pelletier, Sardi-Brwon & Wiener, 2018). David’s case is no exception. Furthermore, assessments can exist in the domains of the parent’s burden as revealed in David’s case. It is also the responsibility of the medical team to communicate with the parents. Good communication is an important aspect of pediatric palliative care. Based on the ethical principle of beneficence, nurses are expected to give the best treatment to the child as well as their caregiver. In the process of doing so, the team should communicate with David’s parents, giving them adequate information they should hear. Therefore the second plan would be for David’s team to have a sitting in with the parent during the next visit.
Depending on the outcome of the meeting the next plan would be to either continue medication or stop the life-prolonging interventions. Following the medical history of David, the best course of action would be to withdraw life-sustaining interventions. This poses the dilemma of whether it is ethically permissible for a nurse to withdraw life-sustaining treatment even after parent objection.
Implementation
Assessment of the psychosocial needs of David’s parents would be done in the next clinic. The sooner it is done, the faster it is to arrive at a solution that will be of best interest to the patient. After the assessment, the medical team would continue with the aggressive treatment of David and book another appointment after a week. This meeting will be for the purpose of communicating with the parents about the progress of David and for discussing the final decision. Nurses are expected to make decisions that are to the interest of the patient, not their parents, or the medical team. The final course of action is to withdraw life-prolonging interventions from David.
Ethical Theory and Principle
In this case, the principle of autonomy underscores the obligation of the nurse to act and make a decision that would be beneficial to the patient and not the parents. One can see that the respect for autonomy and beneficence has been in conflict in regards to the best interests of David. It is worth noting that the decision made by the medical team does not take account of autonomy. This is because for small children such as David, autonomy and previously expressed wishes do not hold (Nelson, 2017). The child cannot communicate and their decisions have to be made by their parents. Therefore, weighing the relative benefits and burdens to the patient under consideration, the decision to withdraw life-prolonging interventions is largely dependent on the principle of beneficence (Wolfe, 2019).
Such a decision is based on the reasoning that the benefit of David being alive outweighs or rather trumps the burden of the aggressive treatment at the neonatal intensive care unit. Besides a quality life is of more importance. David’s life has significant delays in development as well as prolonged life associated burdens of the ongoing medical interventions since his birth, yet with no meaningful interaction or the possibility of gaining meaningful interaction is not at the interest of the patient. Further complying with the parent’s requests to prolong life despite the extremities could result in more harm. Furthermore, currently, the patient becomes irritable and cries out of mere touch due to pressure ulcers. Reasoning from this perspective of the pain and suffering the patient is going through, being alive is outweighed by the burden of pain, prolonged suffering and other factors such as the dignity of the patient.
It is also worth noting that the decision to withdraw life-prolonging intervention from the patient is based on the deontological ethic theory. At its core, deontology does not determine how an act is wrong or right based just on its consequences ( du Pré, P, Tissières, & Brierley, 2020). Instead, much emphasis is placed on the rules and duties. Thus it is the obligation of the nurse in such a case to make a decision that is to the interest of the patient. Furthermore, nurses have the mandate to do so.
In addition, the deontological ethical theory requires that the dignity of the patient to be held, even though it means withdrawing life-prolonging interventions. In this case, David is using their own person as a means to an end and not his parents. Deontology also stresses honest communication. Nurses have the moral obligation to make David’s parents understand the situation. Since communicating with the parents as part of the plan and course of action in this case, the decision arrived at was largely based on the deontological theory.
According to deontology, beneficence is also important. This means that in pediatric palliative care, even if the patient parents do not have the same preferences as the medical team, their opinion does not count as much. Instead, the decision made by the medical team based on duty, roles, and moral obligation is considered (du Pré, P, Tissières, & Brierley, 2020).
In general, the values of the patient’s interests should be determinative of such a case. This is because regardless of the parent’s being given a wide discretion for a long time, their decision to prolong the life of David continues to instill pain and suffering. David’s parents’ decision has major consequences which include the worsening of the child’s condition, thus the decision to override the principle of autonomy. Even though the product of the decision has a bad consequence of death, some characteristics of it are morally good, in that it will end the suffering of the patient.
References
du Pré, P., Tissières, P., & Brierley, J. (2020). Discontinuation of Life-Sustaining Therapy in Intensive Care: Ethical and Legal Issues. In Critical Care of Children with Heart Disease (pp. 617-622). Springer, Cham.
Jones, B., Currin-Mcculloch, J., Pelletier, W., Sardi-Brown, V., Brown, P., & Wiener, L. (2018). Psychosocial standards of care for children with cancer and their families: a national survey of pediatric oncology social workers. Social work in health care , 57 (4), 221-249.
Nelson, B. (2017). Autonomy or Beneficence: An Analysis of End-of-Life Care in Pediatric Patients (Doctoral dissertation).
Wolfe, I. D. (2019). Intractable Conflict in Pediatric Critical Care: A Case Examination and Analysis of Futility
