Health Law and Ethics

NRS2301

Tutorial on Ethical Decision Making

Please read the following case scenario. In small groups, think about and discuss the
questions in preparation for presentation to the class.

Case scenario 1
At a seminar on ethical issues in clinical nursing practice, an experienced ICU nurse asked for advice on
‘’what more she could have done’’ in the situation which she then related as follows.

She had been involved in the care of middle-aged woman who, after suffering a massive myocardial
infarction, had been admitted (deeply unconscious) into local ICU. The woman had been intubated
before admission to the unit, and was placed immediately on a respirator. A few days later the medical
hopelessness of the patient condition was confirmed, and a medical decision was made to remove the
artificial life-support system that was sustaining her life.

The woman’s husband, who had been present most of the time since his wife’s admission, objected
strongly to this decision, however, and became very aggressive toward the medical and nursing staff. He
also threatened to sue the hospital. Recognizing the husband’s reaction as a manifestation of extreme
grief, the ICU nurse approached the woman’s adult children, who were also present, and, in a private
setting, discussed with them what they thought should or could be done to help their father deal with
the situation better. The children were unanimous that what was required was ‘extra time’- specifically,
that the removal of the life-support system be delayed so that they could console their father and help
him to see that the situation really was hopeless, that, tragic as it was, nothing further could be done.

Upon learning of the family wishes, the nurse offered to act as a mediator between them and the
medical staff, to herself removes the life-supporting from their mother at the appropriate time and to
seek support for their wishes from the attending medical staff. This the family accepted. Over the next
hour, the nurse was able to fulfill her role as ‘’mediator’’, and succeeded in obtaining full support from
medical staff involved in the case. This support included the medical staff agreeing to the nurse deciding
when and how to remove the life-support system from the patient. As a result of this mediation, extra
time was ‘bought’, and the woman’s husband and children were able to come to term with tragic
decision that had been made. The family were all able to sit with the woman as the nurse progressively
turned off the artificial life-support system. Later, the husband returned to the ICU and thanked the
nurse for here intervention.
Critical Questions:

1- What are your responsibilities as a professional caregiver in regard to caring

for people at the end stages of life?
2- How would you have handled this situation?
3- What advice would you have given the ICU nurse in response to her request
for advice on ‘’what more could have done’’?