iMrs. R is a 75 y.o. patient in a long-term care facility. Her presenting diagnoses were congestive heart failure (CHF), hypertension (HTN), chronic renal disease & Alzheimer’s disease. A few years earlier, she completed a Power of Attorney (POA) for Healthcare, naming her daughter Sarah as her surrogate. At the time the document was signed, she had a long conversation with Sarah, outlining her wishes should she be unable to make decisions for herself. Mrs. R’s primary fear was that she would be kept alive on life-sustaining equipment. The POA document was placed in Mrs. R’s medical record and staff were informed.
Mrs. R suffered an acute myocardial infarction (MI) and was transferred by ambulance to the local hospital. During the initial assessment in the ED, she arrested again and CPR was initiated. Her heart rate stabilized and she was intubated, placed on a ventilator and transferred to the ICU. When Sarah arrived, she was angry and as her mother’s POA, insisted that her mother be taken off the ventilator and allowed to die peacefully per her wishes. You are the RN caring for Mrs. R in the ICU.
Please answer the following questions:
1.Which ethical principles are applicable here, given the fact that the pt’s advance directives were disregarded?
2.From an ethical standpoint, what would your next steps be as the RN to address this situation in the ICU?
3.Looking back, discuss points where miscommunication concerning Mrs. R’s advance directive could have occurred. What lessons can be learned here?
