Azotam (2012) presented a clinical case study involving an adolescent patient who suffered from terminal cancer. During his end-of-life care, the patient made wishes that were against those of his parents by asking chemotherapy to be stopped and giving orders against resuscitation. The researcher, therefore, sought to solve this ethical dilemma by applying ethical principles.
Max, a 17 year old patient, suffered from lymphocytic leukemia. He would receive chemotherapy on a biweekly basis. However, he was not coping well with chemotherapy, as he experienced pain, nausea, and other discomforts during treatment. The cancer had progressed to osteosarcoma, while organ failure had occurred due to metastases. Max had suffered enough in the pediatric intensive care unit and no treatment plan was responsive. He, therefore, wanted to, “preclude further extraordinary treatment and have a “do not resuscitate (DNR)” (Azotam, 2012, p. 581) order implemented. Although the medical team felt that Max was competent enough to make the decision, his parents wanted the treatment to be continued and the DNR order be rejected.
Max’s parents stopped the palliative care waiting to see whether other treatment options would work. Unfortunately, his condition worsened to the point where resuscitation, intubation, and dialysis had to be done as emergency interventions. Max went into a coma. At this point, the nurse who was taking care of Max suggested the conflict between Max and his parents be resolved by an ethics committee, as she also reinstated palliative care.
This case required the application of all the four ethical principles of, “autonomy, nonmaleficence, beneficence, and justice” (Azotam, 2012, p. 582) to come up with the best position. On one hand, Max’s autonomous choice was superseded legally by the autonomy of the parents because he was still a minor, according to the laws of the US. In addition, the act of Max’s parents continuing with the treating and escalating the intensity of care did not violate the nonmaleficence principle, as they only wished Max well. On the other hand, it was found that Max’s autonomy was violated, as he was considered as a competent minor under the US AAP policy statement. In addition, the principles of beneficence and nonmaleficence lost their ground due because the treatment that Max was receiving was futile, leaving palliative care, which was Max’s choice, as the best treatment strategy. The case was resolved by having Max’s wishes fulfilled.
The case of Max shows the importance of applying the principles of ethics in nursing and health care in general. The use of the four principles of ethical decision making to address the dilemmas that nurses and other health care professionals come across during practice can help in resolving conflicts without bringing legal consequences or harming the patients.
Max’s case is very relevant in the current nursing practice, given that there are increasing cases of cancer and other chronic diseases that require end-of-life care. The scenario in Max’s case is bound to happen in everyday end-of-life care nursing practice, thus knowing how to solve such conflicts ethically is important for end-of-life caregivers.
Finding a solution to the ethical issues in Max’s case was important because failure to do so would have different consequences for the patient, the parents, and the caregivers. For instance, Max would continue to suffer without any hope for improving if the caregivers followed the parents’ decision. The team in the pediatric intensive care unit had the obligation to resolve the deadlock between Max and his parents in a way that would respect all parties, while abiding to the legal and ethical obligations.
Reference
Azotam, A. N. (2012). Pediatric consent: Case study analysis using a principles approach. Nursing Ethics, 19(4), 581-585.