Question

Ethics Case A

Mr. T. is an 82-year-old widower who has been a patient on your unit several times over
the past 5 years. His CHF, COPD, and diabetes have taken a toll on his body. He now
needs oxygen 24 hours a day and still has dyspnea and tachycardia at rest. He has
remained symptomatic despite maximum medical management with a vasodilator and
diuretics. He tells you, "This is my last trip: I am glad I have made peace with my family
and God. Nurse, I am ready to die.” You ask about an advance directive and he tells you
his son knows that he wants no heroics, but they just have never gotten around to filling
out the form. When the son arrives, you suggest that he speak with the social worker to
complete the advance directive and he agrees reluctantly. You page the physician to
discuss DNR status with the son. Unfortunately, Mr. T. experiences cardiac arrest before
the discussion occurs and you watch helplessly as members of the Code Blue Team
perform resuscitation. Mr. T. is now on a ventilator and the son has dissolved into tears
with cries of, "Do not let him die!" What is the action the nurse needs to take?

Answer 1

The nurse should have already documented the patient’s wishes in the chart as a direct quote from the patient. If not, do that now.

A multidisciplinary team meeting should be held, without and then with the son to discuss his father’s wishes.

Legally, the health care team has to do what the son asks. Best case scenario, son withdraws support. Next best case, the patient recovers enough to come off the ventilator & sign DNR paperwork.