Balancing Rights and Duties in ‘Life and Death’ Decision Making Involving Children: a role for nurses?

2001 ◽  
Vol 8 (5) ◽  
pp. 397-408 ◽  
Author(s):  
Martin Woods
Keyword(s):  
Health Care ◽  
Decision Making ◽  
New Zealand ◽  
Health Care Personnel ◽  
Medical Team ◽  
Life And Death ◽  
Ethical Decisions ◽  
Moral Ideals ◽  
Seriously Ill

In recent years, increasing pressures have been brought to bear upon nurses and others more closely to inform, involve and support the rights of parents or guardians when crucial ‘life and death’ ethical decisions are made on behalf of their seriously ill child. Such decisions can be very painful for all involved, and may easily become deadlocked when there is an apparent clash of moral ideals or values between the medical team and the parents or guardians. This article examines a growing number of such cases in New Zealand and analyses the moral parameters, processes, outcomes and ethical responses that must be considered when life and death ethical decisions involving children are made. The article concludes with a recommendation that nurses should be recognized as perhaps the most suitable of all health care personnel when careful mediation is needed to produce an acceptable moral outcome in difficult ethical situations.

Mass-Casualty Training Exercise Using High-Fidelity Computerized Simulators and Involving Time and Resource Limitation

2021 ◽  
Vol 36 (3) ◽  
pp. 313-320
Author(s):  
Phillip A. Jacobson ◽  
Paul N. Severin ◽  
Dino P. Rumoro ◽  
Shital Shah
Keyword(s):  
Health Care ◽  
Resource Limitation ◽  
Mass Casualty ◽  
Health Care Personnel ◽  
High Fidelity ◽  
Medical Team ◽  
Training Exercise ◽  
The Mean ◽  
Medical Teams

AbstractPurpose:Training emergency department (ED) personnel in the care of victims of mass-casualty incidents (MCIs) is a highly challenging task requiring unique and innovative approaches. The purpose of this study was to retrospectively explore the value of high-fidelity simulators in an exercise that incorporates time and resource limitation as an optimal method of training health care personnel in mass-casualty care.Methods:Mass-casualty injury patterns from an explosive blast event were simulated for 12 victims using high-fidelity computerized simulators (HFCS). Programmed outcomes, based on the nature of injuries and conduct of participants, ranged from successful resuscitation and survival to death. The training exercise was conducted five times with different teams of health care personnel (n = 42). The exercise involved limited time and resources such as blood, ventilators, and imaging capability. Medical team performance was observed and recorded. Following the exercise, participants completed a survey regarding their training satisfaction, quality of the exercise, and their prior experiences with MCI simulations. The Likert scale responses from the survey were evaluated using mean with 95% confidence interval, as well as median and inter-quartile range. For the categorical responses, the frequency, proportions, and associated 95% confidence interval were calculated.Results:The mean rating on the quality of experiences related trainee survey questions (n = 42) was between 4.1 and 4.6 on a scale of 5.0. The mean ratings on a scale of 10.0 for quality, usefulness, and pertinence of the program were 9.2, 9.5, and 9.5, respectfully. One hundred percent of respondents believed that this type of exercise should be required for MCI training and would recommend this exercise to colleagues. The five medical team (n = 5) performances resulted in the number of deaths ranging from two (including the expectant victims) to six. Eighty percent of medical teams attempted to resuscitate the “expectant” infant and exhausted the O- blood supply. Sixty percent of medical teams depleted the supply of ventilators. Forty percent of medical teams treated “delayed” victims too early.Conclusion:A training exercise using HFCS for mass casualties and employing limited time and resources is described. This exercise is a preferred method of training among participating health care personnel.

Casuistry—Past and Present: A Search Engine for the Resolution of Ethical Dilemmas in Health Care

1998 ◽  
Vol 6 (3) ◽  
pp. 241-254
Author(s):  
Stephen J. Freeman
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Search Engine ◽  
Human Behavior ◽  
General Principle ◽  
Ethical Dilemmas ◽  
Moral Principles ◽  
Ethical Decisions ◽  
Alternative System ◽  
Unique Individual

Ethical dilemmas within any system are created when moral principles are cited for opposing actions with neither side presenting the obvious right course to follow. Principle-driven decision making has its obvious limitations. Casuistry presents an alternative system for making ethical decisions. Principles in this approach are neither ignored nor discarded; rather they serve as general statements describing human behavior, out of which come “paradigm cases” illustrating the most manifest breaches of the general principle for the casuist. Scrutiny of a series of cases from the simplest most parsimonious to the most complex is undertaken to resolve the doubt inherent in ethical dilemmas; reasonable expectations are discovered in subsequent cases, driving the search until resolution is reached. The casuist sets out to join unique individual cases with general principles without discounting the validity of either, all the while determining how exactly to act in a particular situation.

Clinical Issues

2021 ◽  
pp. 34-59
Author(s):  
Timothy E. Quill ◽  
Judith K. Schwarz ◽  
V. J. Periyakoil
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Oral Care ◽  
Oral Intake ◽  
Informed Choice ◽  
Dry Mouth ◽  
Health Care Proxy ◽  
Decision Making Capacity ◽  
Seriously Ill

VSED requires a decisionally capable, seriously ill patient who makes an informed choice to intentionally hasten death because of unacceptable current suffering or fear of imminent future suffering. In addition to being well informed and determined, patients must have access to ongoing caregiving support and a committed clinician partner. The treating clinician must carefully evaluate the reasons for the patient’s request and her decision-making capacity. Most patients who forgo all oral intake, food and liquids, die peacefully from dehydration within ten to fourteen days. Difficult symptoms of thirst and dry mouth can be adequately relieved with good oral care and access to medications to relieve additional distress. Many patients will be reassured by awareness of the option of VSED even if they never actually exercise it. Completion of advance directives (both health care proxy and instructional) as well as MOLST forms are recommended for anyone initiating VSED, as many patients lose decision-making capacity late in the process.

Parents and Professionals in the NICU: Communication within the Context of Ethical Decision Making—An Integrative Review

2005 ◽  
Vol 24 (3) ◽  
pp. 25-33 ◽  
Author(s):  
Frances Ward
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Ethical Decision Making ◽  
Care Providers ◽  
Ethical Decisions ◽  
Baby Doe ◽  
Centered Care ◽  
Treatment Plans

Communication between parents and professionals in the NICU is a necessary part of collaborative decision making in the provision of family-centered care. Decisions with ethical components, those regarding treatment plans or neonatal research enrollment, need to be made conjointly with parents and health care professionals. This article reviews the present state of knowledge of how parents’ input can be facilitated in regard to decisions made about their children. Research studies involving decisions made with ethical components in the NICU since the advent of the Baby Doe regulations reveal parents’ frustration with communication practices, their need for control of information, and the trust in their children’s health care providers that is required to best facilitate their input into ethical decisions made about their children.

Bias and POLST Facilitation

2017 ◽  
Vol 42 (1) ◽  
pp. 1-3
Author(s):  
Christian Brugger ◽  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Social Workers ◽  
Elder Care ◽  
Nursing Home Administrators ◽  
Life And Death ◽  
Care Facilities ◽  
Advance Planning ◽  
Life Options

In order to maximize POLST usage in particular populations, especially among residents at elder-care facilities, the POLST model relies on what it refers to as facilitators, that is, nonphysician health care personnel such as nurses, social workers, chaplains, admissions coordinators, and nursing home administrators. Facilitators initiate advance planning conversations, explain end-of-life options, answer questions about benefits and burdens of various options, help patients fill out forms, and refer completed forms to clinicians for their signatures. This is problematic because educating and counseling for informed consent, especially when life and death are at stake, are chiefly the role of a physician. Widespread use of the POLST paradigm risks the marginalization of the role of physicians in an area of medical care involving life-and-death decision making.

Awareness and Decision Making in Professional Ethics

2000 ◽  
Vol 5 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Ronny Swain
Keyword(s):  
Decision Making ◽  
Professional Ethics ◽  
Ethical Decision Making ◽  
Code Of Ethics ◽  
Professional Autonomy ◽  
Ethical Awareness ◽  
Ethical Decisions ◽  
The Right ◽  
Aid Decision

The paper describes the development of the 1998 revision of the Psychological Society of Ireland's Code of Professional Ethics. The Code incorporates the European Meta-Code of Ethics and an ethical decision-making procedure borrowed from the Canadian Psychological Association. An example using the procedure is presented. To aid decision making, a classification of different kinds of stakeholder (i.e., interested party) affected by ethical decisions is offered. The author contends (1) that psychologists should assert the right, which is an important aspect of professional autonomy, to make discretionary judgments, (2) that to be justified in doing so they need to educate themselves in sound and deliberative judgment, and (3) that the process is facilitated by a code such as the Irish one, which emphasizes ethical awareness and decision making. The need for awareness and judgment is underlined by the variability in the ethical codes of different organizations and different European states: in such a context, codes should be used as broad yardsticks, rather than precise templates.

Sign in / Sign up

Export Citation Format

Share Document