Two crucial ethical dilemmas posed by the case of a 50-year-old Middle African American male include an unknown medical history and a lack of advanced directives. The absence of advanced directives challenges upholding patient autonomy and desires for end-of-life care. In such a case, health practitioners make an ethical decision on which aggressive treatment is suitable for the specific health scenario. Part of the development was questions about access to healthcare and its disparities on a societal as well as its systemic level, taking into view patients’ continued negligence towards medical attention and no visits to primary care for 30 years. It details the ethical imperative of dealing with healthcare inequities and ensuring evenly spread accessibility to preventive care. The incidence regarding bystander CPR and the consequent EMS intervention creates an ethical dilemma in emergency care provision. The futility of aggressive interventions and the potential for compromising the quality of life after that remained concerns regarding extending time to further downtime and secondary cardiac arrest.
Moreover, the transfer to the ICU and subsequent cardiac arrest highlights a conflict between rendering medical interventions and comprehension of a good life in general. Healthcare professionals must make complex decisions considering whether continuing aggressive treatment in this situation may be helpful or burdensome for the woman. They should consider it while making decisions using their values and preferences.
Nursing perspective of the case.
The scenario of a 50-year-old African American male with no advanced directives and with very minimal medical history presents intricate challenges from the nursing point of view. The fact that no advanced directives only creates a dilemma in nursing care as this has to steer the balance between letting patient autonomy and intervention, where necessary, prevail. The apparent callous disregard of access to care on the part of the patient for many years raises issues on preventive strategies and warrants health education for the said population. The evidence of the initial collapse within the first public space substantiates a review of community-based CPR training and access to automated external defibrillators (AEDs). The extended times in both incidents prove significant challenges for nursing care, putting critical importance on efficient, timely interventions and emergency response systems. The following admission to the ICU brought to focus the nursing role in dealing with complex, critical issues that involved holistic care, communication with other healthcare providers, and support provided to the patient and his family when such a difficult decision was made.
Then, take on the view of a patient or family member.
From the perspective of the patient or family member, a 50-year-old African American male expresses a very disturbing experience full of confusion and lost opportunities for prevention. In the absence of advanced directives, deciding in such a critical condition is left to the highest degree of ambiguity and strife for the family members while deciding whichever option supports what the patient wants. The decline of primary care in the decade is of longstanding system origin, underscoring how difficult it is for many people to get through trying to access care. The implosion was within a public space, and the ensuing emergency response heightened the shock and trauma for the family. Feelings of powerlessness and frustration are likely exacerbated by the long spells when things seem to go wrong in both events. To compound the emotional weight, the transfer to ICU, as well as the subsequent cardiac arrest, amplifies this difficulty in that the family has to face challenging conversations regarding arguing against aggressive medical interventions. This story highlights the importance of effective communication amongst healthcare providers and with families, ensuring a common understanding about the nature and prognosis of such medical emergencies, which ultimately are rare in incidence but still relevant to their patients.
References
Abrams, Darryl C., et al. “Ethical dilemmas encountered with the use of extracorporeal membrane oxygenation in adults.” The Ethical Challenges of Emerging Medical Technologies. Routledge, 2020. 327-333.
Haahr, Anita, et al. “Nurses experiences of ethical dilemmas: A review.” Nursing Ethics 27.1 (2020): 258-272.
Pursio, Katja, et al. “Professional autonomy in nursing: An integrative review.” Journal of Nursing Management 29.6 (2021): 1565-1577.
Stovall, Mady, Lissi Hansen, and Michelle van Ryn. “A critical review: Moral injury in nurses in the aftermath of a patient safety incident.” Journal of Nursing Scholarship 52.3 (2020): 320-328.
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