Problem
The Case... Clinical Application of Ethical and Legal Concepts
Legal Aspect of the Case
Recently, the coronary care unit was short-staffed on the evening shift. As the nurse in charge, you were the most experienced, and were working with a young RN who recently finished her coronary care classes and orientation. A student nurse extern was assisting with basic care measures. You were delivering care to one of the patients when you heard the central alarm sound. From the central monitor, you identified that a young female patient had developed ventricular tachycardia; the patient had been hemodynamically stable when assignments were made and suffered from rheumatic heart disease. You immediately went to the room, called a "code," and began resuscitative measures. The code team responded and followed ACLS protocol, including defibrillation and pharmacotherapy. In spite of all interventions, the young lady survived but was comatose.
You have just learned that the husband of the young lady has filed a lawsuit against the hospital staring that the recorded revealed an extended delay between when the time that the patient's arrhythmia was identified and the first attempt to defibrillate. The plaintiff's attorney contends that earlier intervention would have increased the young lady's chance to survive the arrhythmia without residual damage.
Ethical Aspect of the Case
The young lady remained on ventilator support for a week, in the comatose state. The husband was told by the medical care team that it was very unlikely she would "wake up" and suggested studies to determine brain activity. The husband talked to his wife's parents and they supported the studies. The wife's sister called the husband and begged not to proceed with the studies "yet." The husband moved ahead on the studies and it was determined that the patient was brain dead. After talking with the parents again, the husband decided to withdraw life support, understanding that the ventilator support was keeping her oxygenated, but her brain function would not return. The sister quickly talked the parents into disagreeing with the husband. An attorney on behalf of the parents got involved to stop the withdrawal of support and a battle ensued. The ethics committee of the hospital was convened to discuss the issues at hand.
Other information includes: all family members are Catholic, there is no living will, and the husband knows that his wife has stated in the past "never let me on life support if there is no chance I recover."
Answer the following questions about the case, using the subheadings.
Discuss the legal issues of the case:
1) What evidence would the plaintiff's attorney have used to support an allegation of delay? What circumstances may have contributed to a delay? What is a likely explanation of the evidence of delay?
2) What legal theory/ies (from readings) support the allegation of malpractice against the hospital? Comment on what nurses can do to protect themselves in this type of situation.
Discuss the ethical issues of the case:
1) What additional information can you gather from the husband? Care team?
2) What ethical/moral principles (from readings) are involved in this case?
3) Who is the decision maker for the patient?