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The main topic of the film My Sister’s Keeper mainly covers the subject of organ donation. The ethical dilemma revolves around kidney donation to a patient who is also suffering from acute promyelocytic leukemia. The patient’s name is Kate and is she supposed to receive a kidney from her sister Ann. Ann is a test-tube baby and the decision to cultivate her through this method is suggested by an oncologist called Dr. Wayne. Wayne believes that the umbilical cord tissue from the birth of Ann can be used to treat Kate’s cancer. Their parents, Sara and Brian, yield to the suggestion, which in the end does not work.
Ann despite her good relationship with her sister is not ready to donate her kidney to save her life. According to Ann, she is not able to donate the kidney as it will interfere with her future career and interests. Kate on realizing that her sister Ann is not ready to donate her kidney willingly chooses to be left to die. Attempts of Kate’s mother to stop her from euthanasia through legal procedures prove futile as judge Joan Salvo rules in her favor.
This paper will present the ethical implications surrounding organ (kidney) donation. It will discuss the characters in the film and the decisions they make regarding kidney donation. It will also evaluate whether these decisions were legal in relation to legal and ethical issues in nursing. Lastly, the paper will describe a decision-making process to show how such a process can influence how decisions are made in nursing.
Ethical Implications in Organ Donation
Organ transplant is regarded as one of the most significant medical advances as it gives life to patients who suffer from terminal failures of important organs. Organ transplants require the voluntary participation of donors and the society at large in donating the vital organs from living or deceased members of the society (Guido 2010). At the moment, there is an acute imbalance between organ supply and their requirement. This has been precipitated by the ever-rising cases of organ failure as compared to the few individuals who are willing to donate their organs. At times, the situation becomes so bad that medics resort to replacing the organs that have malfunctioned with animal ones (Farrell, 2011, p. 124).
There have been several ethical and moral implications regarding the practice of organ transplants. Some societies believe that it is wrong to take an organ from a deceased person even if it was his or her dying wish. On the other hand, some people do not want their organs extracted even after death; worse still, the same societies believe that it is unethical to replace someone’s organ with equivalent ones from animals (Farrell, 2011, p. 127).
In order to regulate clinical practices regarding organ transplants, several ethical and moral standards have been set. The first standard involves the rules governing the giving and receiving of body organs. As regards giving and receiving, individuals who wish to donate any of their organs after they die must state this in their wish before they pass on. Despite such declarations, the surviving kin to the deceased still remains the ultimate decision-maker on whether the organ can be removed or not (Farrell, 2011, p. 129).
The second ethical standard is public compensation, which is concerned with paying and providing vital organs. There have been suggestions that organ donors should be compensated toward ensuring a steady supply of such body organs and to help those in need. This is also another way of showing recognition to those who donate or allow for retrieval of their organs when they die (Farrell, 2011, p. 131). The compensation, in this case, is required to be public and not private to ensure that organ procurement and organ allocation procedures remain separate entities. The only serious objection facing this proposal is that it encourages the commoditization of the human body (Farrell, 2011, p. 132).
Routine retrieval of organs is another ethical standard that is also common in organ transplants. It is presumed consent, which allows medical practitioners to retrieve all vital body organs from the dead. This procedure can only be stopped by a request from individuals or their surviving family members that bars the retrieval of body organs. This policy is the most effective in increasing organ supply. However, it has a serious shortfall: it undermines the spirit of charity as it changes the procurement of organs from donating to taking without consent (Guido, 2010).
Lastly, the supply of vital organs can be enhanced by conducting public recognition and making the community understand the importance of organ donation. Recognition can be done by holding ceremonies for those individuals who voluntarily accept to donate their organs. This is a way to promote organ donation as a civic duty and not a philanthropic activity. This ethical policy does little to encourage individuals or families with moral reasons for not donating their organs (Farrell, 2011, p. 135).
Characters in the Film and the Validity of their Decisions
The first ethical dilemma that is seen in the film is when Dr. Wayne advises Sara and Brian, the parents of Kate, to conceive a child with a similar genetic composure as that of Kate. The doctor argues that the umbilical cord tissue from the birth of the newborn can be used to treat Kate’s cancer. Anna, the child whose umbilical cord is to be used is cultivated in a test tube just to save Kate. At this point, all the characters involved in this film can be said to have made the right decisions.
The doctor is right to have advised the couples to conceive a child with the same genetic match of promyelocytic leukemia. His decision does not in any way undermine the ethical standards that guide medical practices. Sara and Brian who are the parents in this case are also right when they decide to give the doctor’s suggestion a try. They do this with the sole aim of saving their child. It is ethically acceptable for people to do everything within their power to save the lives of others provided that their actions do not put any other person’s life at risk.
Another ethical dilemma is evident in kidney donation, which is the main theme in the film. Kate after suffering acute promyelocytic leukemia for a long time ends up with kidney failure. Her body can only accept Anna’s kidney but she refuses to accept to donate her kidney to her sister, citing several reasons that do not make sense. Sara on realizing that the sibling who she thought loved her is unwilling to help her out decides to take a court order barring any further attempts to save her life and opts to die.
In the ethical dilemma, all the characters have a right to choose to belong to the different sides they take on the issue. Although Anna does not have proper reasons for rejecting the request for a transplant, she has the right to refuse to donate her kidney to her sister Kate as this process should be voluntary. Judge Joan Salvo who rules in favor of Kate is right to have done so given that it is within the basic rights of an individual to choose to die especially when they suffering from a terminal complication as in the case of Kate.
Ethical Decision-Making Process: Slippery Slope Argument
Slippery slope argument guides nurses in making decisions especially in cases that are perceived to generate a series of other actions. It encourages nurses to make the right decisions in issues that may be valid at present and which could turn out to be invalid after some time in the future. The model asserts that a decision will initiate a series of events, which may turn into undesirable events afterward as a result of disregarding the relevant contingencies. This argument is more speculative and holds that no decision can be made without causing the occurrence of other events, with some being undesirable. It is meant to save nurses from any liability from the decisions they make, which are mostly in the interests of the patients (Guido, 2010, p. 18).
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The main aim of this model is to promote the autonomy and individual uniqueness of every patient while under the custody of nurses. As a result, it enforces the responsibility of nurses as advocates to their patients (Guido, 2010, p. 19). Under this argument, nurses are allowed to defy any other order; this defiance can also apply to the physicians’ recommendations, which may be contrary to the safety and interests of the patients under the care of nurses. They are expected to carry out what they perceive as right and is in the best interest of their patients. This also means that nurses have the power to overrule proposals of the family members provided that such proposals are against the patients’ interests (Guido, 2010, p. 21).
The case that is described in the film falls under the slippery slope argument. The nurses who are assigned to take care of Kate at the hospital apply this argument in their move to overrule Sara’s decision in which she claims she does not want Kate to be allowed to make the decision to die. Kate’s decision is to be allowed to die so that she can stop bothering her parents and siblings, including Anna who refuses to donate her kidney to her. The nurses take the side of their patient Kate as they are expected to hold the patient’s interest above any other person’s. Judge Joan also understands the argument and grants Kate her wishes.
Nurses always rely on ethical decision-making models to make a proper decision regarding the status of their patients. The ethical principles applied in nursing conflict at times with one another bringing about ethical dilemmas. The case of kidney donation presented in the film My Sister’s Keeper is a good example of an ethical dilemma in which proposals of different individuals clash. One of the ethical decision-making models is the slippery slope argument; this is the strategy that is used to reach the decision that is made by the nurses and the judge in the film. The argument gives nurses the power to decide what they feel is in the best interest of their patients. Through the argument, they are allowed to overrule proposals of physicians and family members if they feel it is in the best interest of the patients.
Farrell, A. M. (2011). Organ shortage: Ethics, law, and pragmatism. Cambridge, IN: Cambridge University Press.
Guido, G. W. (2010). Legal & ethical issues in nursing (5th ed.). Boston, MA: Pearson.