Reflective Journal - Week 6

This week was tough for me.  I felt like there were so many things that were all due at once, and it was pretty overwhelming.  I'm not sure my learning this week was effective as it could have been.  Mostly I was just doing the assignments to get them done, rather than making an effort to learn anything.

XXXXX

Our team activities this week were to come up with interview questions about firing and discipline, as well as two discussions on ethics.

Ethics are not my favorite (neither is philosophy).  There are no concrete answers.  It's hard to determine what is right and what is wrong, and sometimes there isn't a right answer.

For example, one of the discussions this week presented this case study:

A 17-year-old female presented to an emergency department (ED) with a Chief Complaint of fatigue and general malaise. The day prior she had been seen in a local family practice clinic and started on oseltamivir for presumed influenza. In the ED, her hemoglobin was 4mg/dl and creatinine of 17 mg/dl. She was admitted to the ICU of a local community hospital. During pRBC transfusion, she developed acute dyspnea and sudden cardiovascular collapse. A "Code Blue" was called. She received chest compressions, was intubated, and given vasoactive medications. She was obtunded (without sedation) and remained on ventilator support after the cardiac arrest.

The family was devastated. Their daughter came to the ED for “just a cough and cold.” Brain MRI was consistent with severe hypoxic brain injury.

The family requested transfer to AMEX Children’s Hospital (ACH).

Upon arrival here, she remained unresponsive but had spontaneous respiration. She was extubated two weeks after transfer. She was diagnosed as being in a persistent vegetative state secondary to anoxic brain injury (without any improvement over a period of weeks to months, a diagnosis of permanent vegetative state results). Despite this, the family requested all available medical care be provided, including resuscitation in the event of a cardiac arrest and dialysis.

The renal team was concerned that the family’s perceptions were unrealistic and dialysis was futile. The staff was also concerned that dialysis may be causing suffering, as she is unable to communicate if in pain from cramping. In addition, they wondered if they were potentially violating professional integrity by providing medically inappropriate therapy and prolonging the dying process.

An ethics consult  is called for.  Your team is the Ethics Committee.  The staff is asking the following question: Would it be ethical to discontinue dialysis for this patient who has irreversible, profound neurological impairment because she lacks signs of thought, sensation or purposeful behavior? (do not just give an opinion, backup your opinion with facts research and examples.)

I, personally, believe it is not unethical to stop dialysis on this patient.  Many of the articles I was looking at while researching this topic suggested that "all available evidence suggests that those who are brain-dead have no chance of regaining consciousness or of making a full recovery."  In this case, I don't believe it is right to continue to prolong the life of this patient, and my teammates were of the same mindset.

This week we also had to watch the film My Sister's Keeper.  Again, the ethics of this one were hard.

The basic plot of this movie is that a girl (Anna) was born just to save her sister (Kate).  She is a genetic match and is expected (by their parents) to donate her compatible organs, blood, and tissue.  When Kate turns 15, she goes into renal failure and Anna, 11, knows she will be forced by one of her parents to donate one of her kidneys.  Anna loves her sister and wants to help her, but she knows that she won't be able to live the life she wants to if she helps Kate.  And Kate actually doesn't want for fight anymore, so she convinces Anna to sue their parents for medical emancipation and the rights to her own body.

I don't agree with the ethics involved with having a child just to save your other child.  To me, that is essentially sacrificing one child for the sake of another, which I don't think is right.  Talk about choosing a favorite child...

As I mentioned before, this week presented some extremely difficult ethical situations.  It made me grateful that we have ethics committees that are responsible for determining that medical decisions (including research and experimentation, as well as decisions on ethics of care) are carried out in an ethical manner in accordance with national and international law.  There are a lot of situations, like many of those presented this week, where I as a nurse would be concerned, but I wouldn't necessarily understand or know what the "right" decision was or honestly what the laws surrounding the case may determine.

I really liked this quote, and I think that's an important part of ethics, but also the reason ethics is so tricky.  There are so many different theories in ethics, and different people have different perspectives.  It's so difficult to make a concrete decision.