NUR-6521 Fordham University – Ethical and Legal Implications in the Management of a Stroke Patient: A Case Study

QUESTION

AC is a 72-year-old male who is admitted to your ICU after suffering a massive stroke that has left him unresponsive and unable to communicate.  He is currently on a ventilator.  His wife of 48 years is available along with their one adult daughter.  The wife informs you that they don’t have any advanced directives, but she is “pretty sure her husband would not want to live like this.”  However, their daughter is adamant her dad would want to be kept alive in case there is any chance to come out of this.

Write a  3-page paper (1050 words) that addresses ALL the following: APA & format

• Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state (Texas)
• Explain two strategies that you, as an advanced practice nurse, would use to guide your decision-making in this scenario, including whether you would disclose your errors. Be sure to justify your explanation. The case does not present a specific medication error but an ethical dilemma; please include a detailed explanation of two strategies that you would use as an advanced practice nurse to guide your decision-making in this scenario. How would you handle this ethical dilemma? Be sure to justify your explanation.
• Explain the process of writing prescriptions, including strategies to minimize medication errors.

ANSWER

Ethical and Legal Implications in the Management of a Stroke Patient: A Case Study

Introduction

This paper explores the ethical and legal implications surrounding the management of a 72-year-old male stroke patient, AC, who is unresponsive and on a ventilator. The wife and daughter hold divergent views on AC’s treatment, creating a challenging ethical dilemma. This paper will address the impact of the scenario on all stakeholders involved, strategies for disclosure and nondisclosure, decision-making as an advanced practice nurse, and the process of writing prescriptions to minimize medication errors.

Ethical and Legal Implications on Stakeholders

1. Prescriber: The prescriber, in this case, faces the ethical responsibility of making treatment decisions in the patient’s best interest while considering the legal obligations. The prescriber must navigate conflicting views from the patient’s family, the wife’s belief that AC would not want to live in this condition, and the daughter’s desire to keep him alive.
2. Pharmacist: The pharmacist plays a crucial role in medication management. They must ensure that prescriptions align with the patient’s condition, legal requirements, and ethical considerations. In this case, the pharmacist may encounter challenges in fulfilling medication requests due to the unresolved ethical dilemma.
3. Patient: AC, being unresponsive and unable to communicate, cannot provide direct input regarding his treatment preferences. However, it is essential to respect his autonomy by considering his prior wishes, if any, and acting in his best interest.
4. Patient’s Family: The wife and daughter are emotionally invested stakeholders. The wife’s belief about AC’s wishes not to live in this condition contrasts with the daughter’s desire to explore any potential for recovery. The ethical dilemma places significant emotional strain on the family.

Strategies for Disclosure and Nondisclosure

In Texas, disclosure and nondisclosure are guided by the Texas Medical Records Privacy Act (TMRPA) and the Health Insurance Portability and Accountability Act (HIPAA). In this scenario, the following strategies can be employed:

1. Facilitate Open Communication: Engage in sensitive and empathetic discussions with the wife and daughter, providing clear and honest information about AC’s condition, prognosis, and treatment options. Encourage family meetings to foster dialogue and shared decision-making.
2. Mediation and Ethics Consultation: If disagreements persist, involve an ethics committee or consultant to facilitate discussions and provide guidance. Mediation can help reconcile the differing perspectives and identify potential compromises that respect AC’s best interests.

Strategies for Decision-Making as an Advanced Practice Nurse

1. Ethical Principles: Utilize ethical principles such as autonomy, beneficence, non-maleficence, and justice to guide decision-making. Respect AC’s autonomy by considering his prior expressed wishes and values. Weigh the potential benefits and harms of continued treatment, focusing on promoting his overall well-being.
2. Collaborative Approach: Engage in interdisciplinary collaboration to gain diverse perspectives and insights. Consultation with healthcare professionals, ethics committees, and family meetings can provide valuable input and help arrive at a well-rounded decision.

Handling the Ethical Dilemma

In this scenario, my primary responsibility as an advanced practice nurse is to advocate for AC’s best interests while respecting his autonomy and considering the family’s input. I would:

1. Facilitate Family Discussions: Initiate a family meeting with a skilled mediator or ethics consultant to foster understanding, emotional support, and shared decision-making. Encourage the wife and daughter to express their perspectives, concerns, and hopes.
2. Utilize the Best Interest Standard: Evaluate AC’s condition and prognosis, considering medical evidence, quality of life, and potential benefits and burdens of treatment. If the patient’s wishes are unknown, prioritize a course of action that aligns with his presumed preferences and best interests.

The Process of Writing Prescriptions and Minimizing Medication Errors

To minimize medication errors, the following strategies should be implemented:

1. Accurate Patient Information: Obtain complete and up-to-date patient information, including allergies, comorbidities, and current medications. Utilize electronic health records (EHRs) to enhance accuracy and access to patient data.
2. Clear and Legible Prescriptions: Ensure that prescriptions are written in a legible manner, using standardized abbreviations and avoiding ambiguous instructions. Use computerized physician order entry (CPOE) systems whenever possible to reduce errors caused by illegible handwriting.
3. Double-Check Prescriptions: Implement a double-check system, where a second healthcare professional verifies the accuracy of the prescription before dispensing. This process minimizes errors and ensures patient safety.

Conclusion

The case of AC presents a challenging ethical dilemma involving the treatment decisions for an unresponsive stroke patient. Addressing the ethical and legal implications on stakeholders, employing strategies for disclosure and nondisclosure, utilizing decision-making approaches as an advanced practice nurse, and implementing prescription-writing strategies to minimize errors are essential in providing optimal care to patients while respecting their autonomy and considering their best interests. By promoting open communication, collaboration, and ethical decision-making, healthcare professionals can navigate complex scenarios like this one with compassion and integrity.

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