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Zorluk: Çok zorEthical Practice

An older adult client with a history of early-stage Alzheimer's disease is admitted with severe pneumonia. The client's respiratory status rapidly deteriorates, resulting in an altered level of consciousness and impending respiratory failure. The client's adult child, who is the designated durable power of attorney for healthcare (DPOA-HC), is at the bedside and demands the client be intubated immediately to save their life. However, the medical record contains a legally valid living will, executed by the client two years ago when fully competent, explicitly refusing intubation and mechanical ventilation. The attending physician verbally orders the nurse to prepare the equipment for immediate intubation, citing the proxy's demand. Which of the following is the most appropriate ethical and legal action for the nurse to take?

  1. A
    Gather the intubation equipment as ordered by the physician to maintain the client's airway while requesting an emergent ethics committee consultation.
  2. B
    Instruct the adult child that their authority as proxy is permanently revoked due to their emotional state and refusal to follow the living will.
  3. C
    Administer a prescribed PRN intravenous sedative to chemically restrain the confused client and reduce their agitation while awaiting the intubation.
  4. Withhold the intubation equipment and immediately notify the physician that the client's documented living will legally supersedes the proxy's request.Cevap

Cevap

The most appropriate action is to withhold the intubation equipment and immediately inform the physician that the client's documented living will supersedes the healthcare proxy's request.
The core ethical principle of autonomy dictates that an individual's documented wishes regarding healthcare must be honored. A living will is a legally binding advance directive that provides specific instructions about life-sustaining treatments. When a client becomes incapacitated, the designated durable power of attorney for healthcare (DPOA-HC) must make decisions based on the client's known wishes (substituted judgment). The DPOA-HC does not have the legal authority to override a valid, specific living will. Furthermore, the nurse acts as a client advocate (fidelity) and must intervene when a physician's order violates the client's established legal rights. Withholding the equipment and challenging the physician's order is the necessary action to prevent medical battery and uphold ethical practice.

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1
Analyze the legal standing of the available advance directives.
The client has a valid living will refusing intubation, and a designated DPOA-HC.
Understanding the hierarchy of advance directives is essential. A living will provides specific instructions, while a DPOA-HC makes decisions based on what the client would want.
2
Evaluate the conflict between the proxy's demand and the living will.
The proxy is demanding an intervention that the client explicitly refused in writing.
A DPOA-HC is legally obligated to use substituted judgment (following the client's known wishes). They do not have the authority to override a valid, specific living will.
3
Assess the physician's order in the context of ethical principles.
The physician's order to prepare for intubation violates the ethical principle of autonomy and constitutes potential medical battery.
Healthcare providers must honor competent clients' prior refusals of care, even in life-threatening emergencies.
4
Determine the required nursing advocacy action.
The nurse must refuse to participate in preparing for the intubation and clearly communicate the legal boundary to the physician.
The principle of fidelity requires the nurse to act as a steadfast advocate for the client's rights, intervening when other team members attempt to violate those rights.

Anahtar Kavram

Hierarchy of Advance Directives and Client Advocacy
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Konular

Ethical Practice

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