Discuss about the Bachelor of Nursing for Baby Thomas’s Medical Care.
The case study presents the ethical dilemma related to Baby Thomas’s medical care and life threatening diseases, with which he was born. Thomas was born at 24 weeks of gestation, with a number of life threatening difficulties. Thomas has been transferred to the neonatal intensive care unit (NICU), where he is administered several invasive measures for ensuring adequate cardio-respiratory function and cerebral perfusion. He is in NICU for 52 days, but has shown no improvement. However, Thomas’s condition was not improving with the medical efforts. In this condition, the ethical dilemma is the decision of withdrawing the baby’s treatment and related medical facilities for Thomas’s treatment, as Thomas is not responding to the expensive medical care provided to him in NICU (Hockenberry et al., 2012). However, his parents are not agreed with the decision of the medical and financial department, as it is very likely that if the life medical care is stopped, Thomas would not survive and if survive; it would significantly affect his normal life (Butts & Rich, 2012). Thus, this essay will focus on the ethical and legal dilemma regarding the withdrawn of the medical care and support system of baby Thomas.
The stakeholders in a case scenario refer to the people, who are affected by the ethical dilemma in Thomas’s medical care withdrawn. If the life supportive system of Thomas along with all his medical care is withdrawn, the major effect will be on baby Thomas; the consequences can include severe disabilities, physical difficulties or even fatal consequences. In this context, the baby Thomas is the main stakeholder, who will be affected by these consequences of the case scenario. On the other hand, his family will also be affected by the consequences of medical care withdrawn. In the multidisciplinary team, the NICU physiotherapist and the nurse-attending baby Thomas will be affected by the consequences of his medical care withdrawn (Munhall, 2012).
The ethical theory, the “virtue ethics” depicts the moral character or virtue of an individual in a particular situation. According to this theory, the virtues of an individual can promote the moral thinking and can modify a context to be moral. With the accordance of the ethical theories and principles, Thomas’s case can be explained and analyzed. In the case scenario, it has been seen that, the child, Thomas has been born with several physical difficulties. Expensive life supporting and assisting medical care has been provided to Thomas, but he showed no improvement. There are 7 principles of ethics, in nursing; these include beneficence, non-maleficience, respect for autonomy, paternalism, truthfulness or fidelity, integrity and justice (DeKeyser Ganz & Berkovitz, 2012). Here, in baby Thomas’s case can be categorized according to these ethical principles. In this context, according to the principle of beneficence, the health care professional should practice any kind of medical care, from which the patient benefits. Here, Thomas is getting no benefit from the life supporting system and the other medical practices in NICU since last 52 days. On the other hand, according to the principle of Justice, everyone should be treated similarly and get all the benefits available in health care settings (Butts & Rich, 2012). As a living being, baby Thomas has all the rights to get adequate treatment for the improvement of his health status. According to the principle of fidelity, the health care professionals, including nurses and social workers are accountable for the truthfulness, loyalty, fairness and advocacy in practice. Paternalism principle of ethics is also applicable in Thomas’s case, as he is too younger to take his decisions and depends upon his parents to take the appropriate decision about his health and medical care (Hockenberry et al., 2012). According to the principle of integrity and totality, the health care professionals have to consider the patient’s mental, physical and emotional status, while deciding the medical intervention. Therefore, in this case scenario, the therapeutic procedure should consider Thomas’s situation entirely.
As a human being, Thomas has all the rights to live, withdrawing his life supporting system and ceasing all the medical support clearly pushes him towards certain death. If in case, death does not occur, he would face severe physical disability throughout the life. Thus, it is ethically not right for Thomas. In contrast, from the legal perspective, Australian legislation does not comply with euthanasia, which is the “painless killing of a patient suffering from an incurable and painful disease”. From the philosophical and social perspective, Varcoe et al. (2012) argued that “if the life of an infant is so miserable, that there is no way to keep the infant alive and healthy, from the internal perspective of the being who will lead that life and if there are no ‘extrinsic’ causes for keeping the baby alive, for instance, the feelings of his parents; it is better to help the baby die without further suffering”. However, from the ethical perspective, like other normal healthy infant, Thomas has the same rights to live and get medical support until his life ends (Hockenberry et al., 2012). From the ethical perspective, the ethical consideration of Thomas’s condition is controversial, as the consideration includes both the treatment cost and the quality of newborn’s life. Here, in this case study, it has been seen that through 52 days treatment in NICU, Thomas’s health status has been shown to deteriorate day by day, without any kind improvement in his quality of life, on the other hand, the financial department has estimated that $3000 per day is the cost of treatment for Thomas, which is becoming worthless. Thus, withdrawing the treatment process is morally not incorrect (Hockenberry et al., 2012). However, his parents are not willing to stop their child’s treatment; thus, undertaking steps without their consent is also not morally correct, which is also against the human right legislations. The controversial dilemma also include legal perspective, as baby Thomas is getting not benefits from the NICU expensive medical care, whereas in Australia, the act of euthanasia is not legally approved, especially for infants or child (Johnstone, 2015).
According to the “Code of ethics for nurses” by the NMBA board, “Nurses should value the quality nursing care for all”, therefore, to make the medical care ethically sound, the nursing professional have to ensure that Thomas is getting equal medical care like another infant of his age. In the second ethical statement in the “code o ethics”, it has been said, “nurses should show respect and kindness to all people’. From the aspect of kindness, Thomas’s life support system withdrawn would not be morally sound, as his parents also do not want to stop their child’s treatment. 8th value statement of “Code of ethics”, is has been mentioned that nurses should promote health and wellbeing in socially, ecologically and economically sustainable environment (Staunton & Chiarella, 2012). The financial department has estimated that for Thomas’s treatment, a huge amount of money is being used, which is worthless. Thus, from the ethical perspective, wasting that much of money in such a treatment, which is not worthy, is not ethically correct. From the above discussion, the ethical and legal dilemma of Thomas’s case has been cleared.
In Thomas’s case, the withdrawn of his life supporting system would be the best solution, as it has been seen that through a long period of 52 days, Thomas has not responded trough the medical treatment. In the modern era of advanced medical science, the life supporting systems are playing a significant role in supporting the life of people, who do not have the ability to survive in normal condition (Johnstone, 2013). However, the life supporting system should be applied if the patient’s recovery is assisted by the life supporting devices, as the medical supporting systems are expensive enough. In case of Thomas, he was born with several difficulties and disorders and the medical care at NICU was not successful in preventing hypoglycaemia, hypothermia, malnutrition, thromboses and sepsis and he was experiencing apnoea requiring resuscitation and decreased cardiac output. At this situation, the life sustaining supporting system has been implemented in Thomas’s treatment, through which he survived 52 days, without any kind of improvement in his health status; he even not responding through the treatment procedures. Thus, withdrawing the life supporting system is the best option. However, this is not only the solution, as it is likely that withdrawing the advance life supporting system, Thomas would not survive, thus, preparing his family member is very important (Johnstone, 2016). It is because, according to the principle of paternalism, without their consent, chance in Thomas’s medical process cannot be done.
Thomas’s parents are ready to protest against the consequences. For this, the medical multidisciplinary team should arrange a counseling session for Thomas’s parents, where they would be discussed about the pros and cons of withdrawing the advance life supporting system from Thomas. As it is legally not accepted in Australia, discussion is very important, because, they can take legal steps against the professional, associated with withdrawing Thomas’s life supporting system (Orentlicher, 2012). In the medical session, Thomas’s parents should be respectfully discussed about Thomas’s condition, the chance of his survival and normal life leading. They can be suggested that, they might have a normal and healthy baby next time. If Thomas survives, he might not be a healthy baby and will live with several difficulties and disorders. In this context, Thomas would not get a normal life. Everyone has a right to get a healthy life, which is might not be applicable for Thomas. Thus, he should be helped to have a painless death, rather than a painful life with disabilities. According to the ethical principle of Beneficence, the professionals should ensure that the patient is having benefits from the medical intervention, but Thomas has shown no benefits from the interventions, in spite of expensing a huge amount of money (Bilsen et al., 2009). According to the legal perspectives, the euthanasia was legal in Australia in past days, however, now it is not legally accepted. Nevertheless, in Australia, this practice is not legally accepted, but in this case, evaluating the economic and ethical aspects of Thomas’s condition, it has been revealed that withdrawing the life supportive system would be the suitable option for Thomas and his family (Staunton & Chiarella, 2012).
However, he should be kept in the NICU unit, with other medical support, without the advanced life supporting system. The social workers in the multidisciplinary team should advocate Thomas’s parents about the positive sides of their decision with respectful approach. Thomas’s parents wanted to contact with media regarding this conflicts, which can make the situation more complicated with legal issues (Cundiff, 2012). In contrast, if they are advocated through an effective communication and counseling process, including the ethical principles and its effect on the dilemma, they might get moral and emotional support to take the toughest decision, to provide their consent, about withdrawing their son’s advanced life supporting system. According to the “code of ethics” of nurses, without taking the consent from the infant’s parents, medical steps cannot be undertaken, especially, if it is as life-threatening decision as Thomas’s case (Hockenberry et al., 2012).
In this assignment, the focus was the ethical dilemma regarding the life sustaining supporting system, administered to the infant Thomas. Thomas has not been shown any improvement throughout 52 days of treatment, thus, the dilemma is whether it is ethical and legal step to withdraw the supporting system from Thomas’s treatment or not. It has been revealed that, withdrawing the system is the best option, as it is not helping Thomas to recover, rather, if he survives, he will get a painful life. In addition, to get his parent’s consent, an in-depth and emotional discussion is needed with his parents.
Reference List
Bilsen, J., Cohen, J., Chambaere, K., Pousset, G., Onwuteaka-Philipsen, B. D., Mortier, F., & Deliens, L. (2009). Medical end-of-life practices under the euthanasia law in Belgium. New England Journal of Medicine, 361(11), 1119-1121.
Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers
Cundiff, D. (2012). Euthanasia is not the answer: A hospice physician’s view. Springer Science & Business Media.
DeKeyser Ganz, F., & Berkovitz, K. (2012). Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care. Journal of advanced nursing, 68(7), 1516-1525.
Hockenberry, M. J., Wilson, D., & Wong, D. L. (2012). Wong’s Essentials of Pediatric Nursing9: Wong’s Essentials of Pediatric Nursing. Elsevier Health Sciences.
Johnstone, M. J. (2013). ‘Death with dignity’-doubts and demands. Australian Nursing and Midwifery Journal, 21(4), 26.
Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.
Johnstone, M. J. (2016). Key milestones in the operationalisation of professional nursing ethics in Australia: a brief historical overview. Australian Journal of Advanced Nursing, 33(4), 35.
Munhall, P. L. (2012). Nursing research. Jones & Bartlett Learning.
Orentlicher, D. (2012). The alleged distinction between euthanasia and the withdrawal of life-sustaining treatment: conceptually incoherent and impossible to maintain. University of Illinois law review, 1998, 837.
Staunton, P. J., & Chiarella, M. (2012). Law for nurses and midwives. Elsevier Australia.
Varcoe, C., Pauly, B., Storch, J., Newton, L., & Makaroff, K. (2012). Nurses’ perceptions of and responses to morally distressing situations. Nursing Ethics, 19(4), 488-500.
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