Maria Sheena S.

Salveron, RN

This personal experience refers to my allocation to the Adult ICU. We had

a 70-year-old male patient who came in due to loss of consciousness, his CT
Scan result revealed a burst cerebral aneurysm, and a procedure called
craniotomy is needed. The Neurosurgeon discussed the risks to the family
members which include the consequences of the procedure, money that is
needed to prepare, survival rate, and the possible problems that the patient will
experience neurologically such as problems with speech and memory.

The family then understood the plans and treatments needed for the
patient. The patient's son recalled that their father once told them that if
something bad will happen to him, let him die without doing anything to prolong
his life since he lived his life long enough. At first, the family told us to do
whatever it takes to let their father live as they will do their best to prepare for the
operation as soon as possible. The family was doing their best to find enough
amount of money for the surgery, bills, and medications. The surgeon
emphasized that the longer we wait to do the surgery the lesser the time it takes
to improve their father's condition.

However, as we wait for the family to prepare financially, the patient

deteriorated and went into cardiac arrest. He was revived and was placed on life
support as consented by the patient's son. The family was again told about the
patient's current status and since the patient went into a comatose state, the
surgery is not an option at the moment since the doctor can’t guarantee the
effectiveness of the surgery.

After his family members gathered for a meeting, they decided to sign a
waiver for ‘Do Not Resuscitate’ in case the patient will encounter a cardiac arrest
again as it is their father's will. To gather more information for that, the waiver
includes no cardiopulmonary resuscitation, no defibrillation, no giving of
emergency drugs, and inotropic medications.
 As the days pass, their hospital bills kept increasing that they could no
longer cope and it has already came to a point where they could no longer buy
the medicines. Aside from that, we also saw them getting angry and irritated
when asked which is caused by their physical and emotional stress.

With no choice left, the family decided to withdraw the life support. The
doctors explained everything to them as well as the expected outcome if the tube
will be removed. All family members agreed and the patient's son will be the one
to remove it by following the hospital's protocol.

Furthermore, in ethical principles, the respect for autonomy and

recognition of dignity and privacy of patients, Non-maleficence, and right of
refusal to treatment can be applied in this scenario. Respecting other people’s
wishes and supporting them in their decisions should be observed as the patient
had his will before he was admitted.

But because of the care and love of his family members, other options
were done first to revive their father. The patient has the right to expect our laws
to recognize the right of an adult person to make a written consent instructing
doctors to withdraw life-sustaining treatment in the event of a terminal condition
or permanent unconscious condition. And if the patient is unable to do so, an
authorized representative is illegible to sign on his behalf depending on the
organization's protocol.

Another ethical principle is Non-maleficence. Wherein, after cardiac arrest,

surgery would be no longer an option since it will do no good and might cause
harm to the patient. In certainty, the right of refusal to treatment is allowed
therefore one who doesn't want to be treated with his illness is acceptable as
long as the patient and family were apprised of the risk and benefits of their
decision.