Week 3 – Ethical Dilemma

Please reply to the following discussion with one reference. 

Many ethical dilemmas are illustrated in the documentary The Invisible Patients.  The documentary follows Jessica, a nurse practitioner, as she confronts the challenges of caring for homebound patients.  One of her patients is Roger, a 30 year-old male with muscular dystrophy who is nearing end of life.

Jessica is faced with navigating the ethical issues pertaining to establishing a “do not resuscitate” order (DNR).  In the beginning of the film Roger is hesitant to sign a DNR.  He states that he is not ready to die and desires all available interventions that might allow him to continue living, even if that means “bringing him back.” 

Jessica feels that resuscitation would be a painful prolongation of the inevitable.  This stirs internal conflict for her.  She is faced with two opposing possible courses of action.  According to Hamric, an ethical dilemma occurs when a person is faced with two or more obligations that cannot be simultaneously met (2014).  This creates tension due to the differing and opposing demands of these obligations (Hamric, Hanson, Tracy, O’Grady, 2014)  Jessica has undoubtedly seen first-hand the violent and painful process of cardiopulmonary resuscitation, and she obviously knows that these efforts are usually futile, only resulting in unnecessary pain and suffering.  On the other hand, she is duty bound to respect the patient’s autonomy and his personal wishes. 

Jessica handles this situation very professionally.  She gently communicates to Roger and his family the reality of the progressive nature of Roger’s disease.  She tries to put aside her own emotions during the discussion.  Jessica asks open ended questions and empathetically listens to his responses, giving him positive, affirming non-verbal feedback.  In doing this, she is gathering information to help her navigate this ethical dilemma.   This end-of-life discussion was carried out subtly, tactfully, and at length over multiple visits to the patient in his own home. 

These home visits are themselves an example of the NP as a disruptive innovator.  Traditional medicine as practiced today takes place in a clinical setting or a tertiary care center (Hamric, Hanson, Tracy, O’Grady, 2014).  Jessica provides a service that is outside of the status quo by delivering superb patient-centered primary care in the patient’s own home.

I feel I would handle this situation in the same manner.  I believe that it is a fundamental right for people facing terminal illness to decide their own fate.  However, I also believe that fear of death and the unknown that follows too often drives these decisions.  I believe my role is to reassure, encourage, and help relieve this fear so the patient can feel at peace with a decision that reflects the reality of their situation.

Hamric, A., Hanson, C., Tracy, M.F., O’Grady, E. (2014). Advanced Practice Nursing:

An Integrative Approach, Fifth Edition. St. Louis, Missouri: Elsevier Sanders.