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Zeena John
EthicalDilemma.docx
Summary 1311 Words
Running head: ETHICAL DILEMMA 1
ETHICAL DILEMMA 2
Et hical Dilemma
St udent ’s Name: Zeena John
Course: HLT 520
Inst ruct or: Dr. Wendy Whit ner, PhD, MPH
Dat e: 04-06-18
Almost every healt hcare professional encount ers et hical dilemmas in t heir careers. In
t his case, a pat ient was brought t o t he emergency room and had a t at t oo on his
chest t hat read, “Do Not Resuscit at e.” The discovery of t he t at t oo t riggered a
debat e among professional physicians. There was no way t o consult t he pat ient since
he was unconscious, and t here were no known relat ives during t he incident . There was
no t ime t o locat e t he next of kin as t he pat ient ’s healt h was quickly det eriorat ing.
This art icle discusses t he et hics t hat apply in a case such as t his t hat creat es an
et hical dilemma among t he doct ors, pot ent ial organizat ional policies relat ed t o t his
case, and finally t he four primary healt h care et hical principles and t he process of
moral making formula on assist ing t he clinical st aff.
The et hical dilemma present ed by t his case has t wo dimensions; t o ignore t he t at t oo
or t o obey it . The pat ient was bat t ling for his life, and any delay t o save his life risked
his deat h. Pat ient ’s pulse slowed t o a rat e t hat was worrying; t he decision had t o be
made fast . A t at t oo is not ident ified as a legally binding do not resuscit at e orders.
Nat alie Rahhal (2017) st at es t hat a legal DNR order t hat has t o be honored by t he
emergency medical t echnicians and paramedics should t o be on yellow paper. The
medical privacy laws prot ect DNR orders, and t he order has t o be signed by bot h t he
pat ient and t he doct or. The individuals who want DNR should fill st andard forms wit h
t he doct ors, and a writ t en DNR order on t he medical chart s. These wishes t o have a
DNR are also reit erat ed in a will, and t he pat ient s are issued wit h wallet cards and
bracelet s t hat indicat e t heir DNR st at us.
Grammatical problem: Instructor
assist, assistance (help): assisting help
Web Content: https://www.dailymail.co.uk/health/article…
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According t o Vearrier (2018), t here are t wo advance care planning document s: AD
(advance direct ives) and physician orders for life-sust aining t reat ment (POLST).
Advance direct ives are complet ed by t he person in t he presence of a wit ness, while
POLST is a physician order for t he end of life. Legally, t he t at t oo was not binding; t his
is because it is neit her an advance direct ive nor a physician order for life-sust aining
t reat ment . The DNR t at t oo had no wit ness or a not e t hat complet es t he legal
document at ion. The t at t oo does not also inform sufficient ly in whet her t here are any
specific int ervent ions required. There was also no evidence t hat t he pat ient was fully
aware of what t he DNR t at t oo meant , and t herefore t he st aff could not presume an
informed decision making (Vearrier, 2018).
The et hics t eam, on t he ot her hand, could have a different argument . The t at t oo
could be an expression of t he aut hent ic preference of t he pat ient . The law could fail
t o be nimble enough in support ing healt h care t hat is pat ient -cent ered and in respect
of t he best int erest s of t he pat ient . The t at t oo could also have a foundat ion on
unclear beliefs of t he pat ient , and t he pat ient could have had it t at t ooed on him
based on his int erest s. Holt et al. (2017) share t he case of t he senior man who had a
hist ory of chronic obst ruct ive pulmonary disease, at rial fibrillat ion, and diabet es
mellit us. He was rushed int o an emergency room and found t o have a high blood
alcohol level, and had a t at t oo on his ant erior chest reading ‘Do Not Resuscit at e.’ The
et hical depart ment of Florida hospit al decided t o respect t he DNR t at t oo on t he
pat ient . Anot her perspect ive would be t hat t he t at t oo is a permanent direct ive,
unlike carrying around writ t en document s. The pat ient could have had his wish inked
on him, in an at t empt of t rying t o avoid some unknown fat e.
The pot ent ial organizat ional policies t hat could be referred t o when a similar case
arises are t he legal and et hical policies. As st at ed above, t he law does not recognize
DNR t at t oos as legally binding. There are t he set legal st eps t hat should be followed
when get t ing a DNR order and a DNR t at t oo is not a known met hod. According t o
Smit h & Lo (2012), clinicians are legally and morally obligat ed t o respect pat ient ’s
preferences t o forego t reat ment t hat is life sust ained. In t his case, however, it is
impossible t o know what t he will of t he pat ient is, as t here is neit her wit ness nor
paperwork, and t he pat ient is unconscious. Clinicians in healt h care and emergency
responders are under no obligat ion t o respect a DNR t at t oo. When t he pat ient is
unresponsive, a document t hat is legally binding on t he DNR sit uat ion, for example,
POLST or AD could be searched for if t here is t ime. However, during a case of
cardiopulmonary arrest , in t he absence of t he legally binding document s, t he
responding clinician or t he emergency provider should go ahead wit h at t empt ed
resuscit at ion (Smit h & Lo, 2012). If t he emergency personnel can choose t o wit hhold a
resuscit at ion at t empt , t hey could be legally liable for int erpret ing t he t at t oo
erroneously. The medical pract it ioners should not rely on t at t oos in making decisions
on emergency cases. The pract it ioners should be aware of st at e laws t hat pert ain t o
DNRs, and most import ant ly what validat es a DNR.
Sokol et al. (2011) ident ify t he four quadrant s met hod t hat can be applied in solving
an et hical dilemma case and illust rat es how et hics can be pract iced across medical
specialt ies of a wide range. These quadrant s are; medical indicat ions, preferences of
t he pat ient , life’s qualit y, and cont ext ual feat ures. This approach is compat ible wit h
t he widely applied four principles of medical et hics (beneficence, aut onomy, just ice,
and non-maleficence). Medical indicat ions consist of reviewing t he medical sit uat ion,
ident ifying t he complicat ions, and det ermining t he measures t o benefit t he pat ient
and cause minimum harm medically. In t he above case, t his is deciding on t he best
resuscit at ion met hod t o apply.
The second st ep is respect for aut onomy or t he pat ient ’s preferences. The DNR
t at t oo does not represent t he pat ient ’s wish, at least not in t he sense of formalit y.
The validit y of t he informat ion on t he t at t oo was uncert ain. Here, t here are no known
preferences of t he pat ient .
Beneficence is t he act of doing well t o ot hers wit h t he inclusion of a moral obligat ion.
Considerat ion of t he impact s of t he int ervent ion program is essent ial. The t reat ment
Web Content: https://www.acepnow.com/article/do-not…
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should improve t he qualit y of life of t he pat ient , not just prolong it . The int ervent ion
should ensure t hat t he pat ient will be grat eful in receiving anot her chance t o live and
not get devast at ed by what he could perceive as a gross infringement on her
aut onomy. The medical t eam should t herefore proceed wit h resuscit at ing t he pat ient
using t he most suit able int ervent ion form. In seeking t o do good and not evil, and
avoiding any int ent ional harm, t he t eam demonst rat es non-maleficence.
The final principle is just ice or cont ext ual fact ors. It considers cult ural, legal, religious,
familial, economic, and ot her fact ors t hat could have been missed in t he ot her t hree
principles. If t he best int erest s of t he pat ient are not clear, t he hospit al’s legal t eam
could be consult ed if t he t ime allows. The DNR t at t oo is not legally binding, and it did
not verify when it should be applied, and t herefore t he best solut ion would be
at t empt ing resuscit at ion.
In conclusion, t he cases t hat result in an et hical dilemma should be approached using
t he four renowned principles. These principles are beneficence, just ice, non-
maleficence, and aut onomy. The DNR t at t oo should not be seen as legally binding, as
t here are t he legal document s t hat should be used. The pat ient should be
resuscit at ed t o avoid legal complicat ions because t here is no proof of t he validit y of
t he t at t oo.
References
Rahhal N. (2017). Hospit al t hrown int o panic over unconscious man’s ‘do not
resuscit at e’ t at t oo across his chest . Daily Mail.
ht t ps://www.dailymail.co.uk/healt h/art icle- 5134609/Hospit al-panic-pat ient s-not -
resuscit at e-t at t oo.ht ml
Holt G. E., Sarment o B., Ket t D., & Goodman K. W. (2017). An unconscious pat ient wit h
a DNR t at t oo. The New England Journal of Medicine. 377:2192-2193.
ht t ps://doi:10.1056/nejmc1713344
Smit h A. K. & Lo B. (2012). The problem wit h act ually t at t ooing DNR across your chest .
US Nat ional Library of Medicine, Nat ional Inst it ut es of Healt h; Journal of General Int ernal
Medicine. Ret rieved from ht t ps://dx.doi.org/10.1007%2Fs11606-012-2134-1
Vearrier L. (2018) Do-Not -Resuscit at e Tat t oos: Are They Valid? ACEPNOW, Wiley.
ht t ps://www.acepnow.com/art icle/do-not -resuscit at e-t at t oos-are-t hey-valid/
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