April 2020

430 Chapter 17 Death and Dying Case 17-1 When Parents Refuse to Give Up1 Nine-year-old Yusef Camp began experiencing symptoms soon after eating a pickle bought from a street vendor. He felt dizzy and fell down, he could not use his legs, and he began to scream. By 10:00 p.m., he was hallucinating and was transported to the DC General Hospital by ambulance. He went into convulsions. His stomach was pumped, and they found traces of marijuana and possibly PCP. He soon stopped breathing, and by the next morning, brain scans showed no activity. Four months later, Yusef’s condition had not changed. The physicians believed his brain was not functioning and wanted to pronounce him dead based on brain criteria. Several difficulties were encountered, however. First, there was some disagreement among the medical personnel over whether his brain function had ceased completely. Second, at that time the District of Columbia had no law authorizing death pronouncement based on brain criteria. It was not clear that physicians could use death as grounds for stopping treatment. Most important, Ronald Camp, the boy’s father, protested vigorously any sug- gestion that treatment be stopped. A devout Muslim, he said, “I could walk up and say unplug him; but for the rest of my life I would be thinking, was I too hasty? Could he have recovered if I had given it another 6 months or a year? I’m leaving it in Almighty God’s hand to let it take whatever flow it will.” The nurses involved in Yusef’s care faced several problems. Maggots were found growing in Yusef’s lungs and nasal passages. His right foot and ankle became gangre- nous. He showed no response to noises or painful stimuli. The nurses had the responsi- bility not only for maintaining the respiratory tract and the gangrenous limb, but also for providing the intensive nursing care needed to maintain Yusef in debilitated condition on life support systems. Had the aggressive care been serving any purpose, they would have been willing to provide it no matter how repulsive the boy’s condition was and in spite of there being many other patients desperately needing their attention. However, some of the nurses caring for Yusef were convinced that they were doing no good what- soever for the boy. They believed they were only consuming enormous amounts of time and hospital resources in what appeared to be a futile effort. In the process, other patients were not getting as much care as would certainly be of benefit to them. Could the nurses or the physicians argue that care should be stopped because he was dead? Could they overrule the parents’ judgment about the usefulness of the treatment even if he were not dead? Could they legitimately take into account the welfare of the other patients and the enormous costs involved when deciding whether to limit their atten- tion to Yusef? 1Weiser, B. (1980, September 5). Boy, 9, may not be “brain dead,” new medical examiner shows. Washington Post, p. B1. Weiser, B. (1980, September 12). Second doctor finds life in “brain dead” DC boy. Washington Post, p. B10. Sager, M. (1980, September 17). Nine-year-old dies after four months in coma. Washington Post, p. B6. Title Copyright Contents List of Cases Preface Introduction What Makes Right Acts Right? What Kinds of Acts Are Right? How Do Rules Apply to Specific Situations? What Ought to Be Done in Specific Cases? Two Additional Questions of Ethics What Kind of Person Ought I to Be? What Does This Relationship Demand of Me? Endnotes Part I Ethics and Values in Nursing Chapter 1 Values in Health and Illness Identifying Evaluations in Nursing Identifying Ethical Conflicts The Rights of the Patient vs the Welfare of the Patient Moral Rules and the Nurse’s Conscience Limits on Rights and Rules Chapter 2 The Nurse and Moral Authority The Authority of the Profession The Authority of the Physician The Authority of the Institution The Authority of the Health Insurer The Authority of Society The Authority of the Patient Chapter 3 Moral Integrity andMoral Distress Why Does Moral Agency Matter? Moral Distress Creating and Sustaining Healthy and Ethical Work Environments Ethics Environment Assessments Resources for Establishing and Sustaining Healthy Environments Change Theory Models Resources for Resolving Moral Distress Part II Ethical Issuesin Nursing Chapter 4 Benefiting the Patient and Others: The Duty to Produce Good and Avoid Harm Benefit to the Patient Uncertainty About What Is Actually Beneficial to a Patient Health Benefits vs Overall Benefits Benefiting vs Avoiding Harm Benefit to the Institution Benefit to Society Benefit to Identified Nonclients Benefit to the Profession Benefit to Oneself and One’s Family Chapter 5 Justice: The Allocation of Health Resources The Ethics of Allocating Resources Justice in Public Policy Justice and Other Ethical Principles Chapter 6 Respect Ignoring a Person as a Person and Focusing Only on the Pathology or “Task” to be Performed Arrogant Decision Making Humiliating Others Chapter 7 The Principle of Autonomy Internal Constraints on Autonomy External Constraints on Autonomy Overriding Autonomy Chapter 8 Veracity The Condition of Doubt Duties and Consequences in Truth Telling Complications in Truth Telling Chapter 9 Fidelity Promise Keeping Confidentiality Chapter 10 The Sanctity of Human Life Actions and Omissions Criteria for Justifiable Omission Withholding and Withdrawing Direct and Indirect Killing Voluntary and Involuntary Killing Is Withholding Food and Water Killing? Part III Special Problem Areas in Nursing Practice Chapter 11 Abortion, Contraception, and Sterilization Abortion Contraception Sterilization Chapter 12 Genetics, Birth, and the Biologic Revolution Genetic Counseling In Vitro Fertilization and Artificial Insemination Genetic Engineering Chapter 13 Psychiatry and the Control of Human Behavior Psychotherapy Other Behavior-Controlling Therapies Chapter 14 HIV/AIDS Care Conflicts Between Rights and Duties Conflicts Involving the Cost of Treatmentand Allocation of Resources Research on HIV Chapter 15 Experimentation on Human Beings Calculating Risks and Benefits Commentary Protecting Privacy Equity in Research Informed Consent in Research Chapter 16 Consent and the Right to Refuse Treatment The Right to Refuse Treatment The Elements and Standards of Disclosure Comprehension and Voluntariness Consent for Patients Who Lack Decision Capacity Chapter 17 Death and Dying The Definition of Death Competent and Formerly Competent Patients Never-Competent Patients and Those Who Have Never Expressed Their Wishes Futile Care Limits Based on the Interests of Other Parties Appendix Ethics Resources on the Web Bioethics Research Library at Georgetown University Glossary Index

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Case study, download and read the attached case study. Once completed, answer the three questions at the end of the