Trevor, a RN, was assigned to care for a 76-year-old man with chronic obstructive pulmonary lung disease and cor pulmonale who had developed tracheal necrosis and paratracheal abscesses from prolonged mechanical ventilation. Several days ago, his physicians had decided that his trachea could not be repaired. Now they discovered that he was also suffering from sepsis. After discussing the prognosis with his physician, the family agreed to discontinue treatment. The patient was now semicomatose and incapable of participating in this critical decision. The plan was to make him as comfortable as possible until his inevitable death from sepsis and respiratory failure.
During the morning the patient was visited by his oldest daughter who lived thousands of miles away and had not seen her father for several years. She was visibly alarmed by his condition and by the fact that no treatment was being carried out for his declining physical condition. After conferring with the rest of the family, she announced that the family would like to try an alternative treatment. They called the physician and requested that massive doses of vitamins be given to him. The physician agreed to their request. He then called Trevor and asked him to begin the massive IV vitamin therapy.
Trevor protested the use of this form of therapy in the care of an inevitably dying patient. He consulted his supervisor. The supervisor agreed with the physician and the family. The supervisor stated, “I don’t understand why you are protesting about vitamins, it won’t take much of your time and it won’t cost the family a lot of money; and it might help them cope with their father’s imminent death. Besides, vitamins won’t hurt the patient. He won’t even notice them because he is dying anyway. So what’s the fuss?”
Trevor still disagreed with the plan. He argued, “We are giving the family false hopes and we are setting a precedent for family requests for any treatment on dying patients.” According to Trevor, is was not so much the cost of the requested therapy as the fact that a family could make requests of nursing staff that were of no proven benefit to the dying patient. Was it fair that the family could make such requests? Trevor did not think it was fair.
Does the family have the right to request any treatment that they believe would be a benefit to a dying family member? What ethical theory would support your point of view?
Is the professional integrity of the nurse compromised by providing a treatment that seems incompatible with the understanding of his profession? Are there ethical principles involved?
What provision of the ANA Code of Ethics for Nurses would provide guidance for Trevor? Why?
Does the cost of a treatment have any bearing on whether or not it should be provided based upon the wishes of the family? Why or why not?
