Death and Dying
430 Chapter 17 Death and Dying
Case 17-1 When Parents Refuse to Give Up1
Nine-year-old Yusef Camp began experiencing symptoms soon after eating a pickle bought from a street vendor. He felt dizzy and fell down, he could not use his legs, and he began to scream. By 10:00 p.m., he was hallucinating and was transported to the DC General Hospital by ambulance. He went into convulsions. His stomach was pumped, and they found traces of marijuana and possibly PCP. He soon stopped breathing, and by the next morning, brain scans showed no activity.
Four months later, Yusef’s condition had not changed. The physicians believed his brain was not functioning and wanted to pronounce him dead based on brain criteria. Several difficulties were encountered, however. First, there was some disagreement among the medical personnel over whether his brain function had ceased completely. Second, at that time the District of Columbia had no law authorizing death pronouncement based on brain criteria. It was not clear that physicians could use death as grounds for stopping treatment. Most important, Ronald Camp, the boy’s father, protested vigorously any sug- gestion that treatment be stopped. A devout Muslim, he said, “I could walk up and say unplug him; but for the rest of my life I would be thinking, was I too hasty? Could he have recovered if I had given it another 6 months or a year? I’m leaving it in Almighty God’s hand to let it take whatever flow it will.”
The nurses involved in Yusef’s care faced several problems. Maggots were found growing in Yusef’s lungs and nasal passages. His right foot and ankle became gangre- nous. He showed no response to noises or painful stimuli. The nurses had the responsi- bility not only for maintaining the respiratory tract and the gangrenous limb, but also for providing the intensive nursing care needed to maintain Yusef in debilitated condition on life support systems. Had the aggressive care been serving any purpose, they would have been willing to provide it no matter how repulsive the boy’s condition was and in spite of there being many other patients desperately needing their attention. However, some of the nurses caring for Yusef were convinced that they were doing no good what- soever for the boy. They believed they were only consuming enormous amounts of time and hospital resources in what appeared to be a futile effort. In the process, other patients were not getting as much care as would certainly be of benefit to them. Could the nurses or the physicians argue that care should be stopped because he was dead? Could they overrule the parents’ judgment about the usefulness of the treatment even if he were not dead? Could they legitimately take into account the welfare of the other patients and the enormous costs involved when deciding whether to limit their atten- tion to Yusef?
1Weiser, B. (1980, September 5). Boy, 9, may not be “brain dead,” new medical examiner shows. Washington Post, p. B1. Weiser, B. (1980, September 12). Second doctor finds life in “brain dead” DC boy. Washington Post, p. B10. Sager, M. (1980, September 17). Nine-year-old dies after four months in coma. Washington Post, p. B6.
Title
Copyright
Contents
List of Cases
Preface
Introduction
What Makes Right Acts Right?
What Kinds of Acts Are Right?
How Do Rules Apply to Specific Situations?
What Ought to Be Done in Specific Cases?
Two Additional Questions of Ethics
What Kind of Person Ought I to Be?
What Does This Relationship Demand of Me?
Endnotes
Part I Ethics and Values in Nursing
Chapter 1 Values in Health and Illness
Identifying Evaluations in Nursing
Identifying Ethical Conflicts
The Rights of the Patient vs the Welfare of the Patient
Moral Rules and the Nurse’s Conscience
Limits on Rights and Rules
Chapter 2 The Nurse and Moral Authority
The Authority of the Profession
The Authority of the Physician
The Authority of the Institution
The Authority of the Health Insurer
The Authority of Society
The Authority of the Patient
Chapter 3 Moral Integrity andMoral Distress
Why Does Moral Agency Matter?
Moral Distress
Creating and Sustaining Healthy and Ethical Work Environments
Ethics Environment Assessments
Resources for Establishing and Sustaining Healthy Environments
Change Theory Models
Resources for Resolving Moral Distress
Part II Ethical Issuesin Nursing
Chapter 4 Benefiting the Patient and Others: The Duty to Produce Good and Avoid Harm
Benefit to the Patient
Uncertainty About What Is Actually Beneficial to a Patient
Health Benefits vs Overall Benefits
Benefiting vs Avoiding Harm
Benefit to the Institution
Benefit to Society
Benefit to Identified Nonclients
Benefit to the Profession
Benefit to Oneself and One’s Family
Chapter 5 Justice: The Allocation of Health Resources
The Ethics of Allocating Resources
Justice in Public Policy
Justice and Other Ethical Principles
Chapter 6 Respect
Ignoring a Person as a Person and Focusing Only on the Pathology or “Task” to be Performed
Arrogant Decision Making
Humiliating Others
Chapter 7 The Principle of Autonomy
Internal Constraints on Autonomy
External Constraints on Autonomy
Overriding Autonomy
Chapter 8 Veracity
The Condition of Doubt
Duties and Consequences in Truth Telling
Complications in Truth Telling
Chapter 9 Fidelity
Promise Keeping
Confidentiality
Chapter 10 The Sanctity of Human Life
Actions and Omissions
Criteria for Justifiable Omission
Withholding and Withdrawing
Direct and Indirect Killing
Voluntary and Involuntary Killing
Is Withholding Food and Water Killing?
Part III Special Problem Areas in Nursing Practice
Chapter 11 Abortion, Contraception, and Sterilization
Abortion
Contraception
Sterilization
Chapter 12 Genetics, Birth, and the Biologic Revolution
Genetic Counseling
In Vitro Fertilization and Artificial Insemination
Genetic Engineering
Chapter 13 Psychiatry and the Control of Human Behavior
Psychotherapy
Other Behavior-Controlling Therapies
Chapter 14 HIV/AIDS Care
Conflicts Between Rights and Duties
Conflicts Involving the Cost of Treatmentand Allocation of Resources
Research on HIV
Chapter 15 Experimentation on Human Beings
Calculating Risks and Benefits
Commentary
Protecting Privacy
Equity in Research
Informed Consent in Research
Chapter 16 Consent and the Right to Refuse Treatment
The Right to Refuse Treatment
The Elements and Standards of Disclosure
Comprehension and Voluntariness
Consent for Patients Who Lack Decision Capacity
Chapter 17 Death and Dying
The Definition of Death
Competent and Formerly Competent Patients
Never-Competent Patients and Those Who Have Never Expressed Their Wishes
Futile Care
Limits Based on the Interests of Other Parties
Appendix Ethics Resources on the Web Bioethics Research Library at Georgetown University
Glossary
Index
