Moral Dillemas in Health Care

Preparation, Preparedness & Prevention Emergency First-Aid
1

There seems to be a pretty good knowledge base pertaining to health care and first responding and although this question doesn’t necessarily pertain to first aid, I feel like the the level of experience here warrants my question.

I am currently a student nurse and in one class we are currently discussing ethics and morality in the health care setting. So, I was just wondering if anyone here has had to deal with a moral dilemma while giving health care and how you dealt with that particular situation. Also, feel free to share any other difficult situation you had to deal with and how you overcame it. I’m just trying to formulate how professionals think and act when faced with such issues so I can be better prepared for my career.

Actually, as I’m finishing typing this I am realizing answering me could be a HIPPA violation due to the patient confidentiality deal but I’m not really sure. I guess if you leave out names and locations it would be ok. If it is a violation, just ignore my question. I’ll try to see if it is.

Thanks.

2

I was really trying to figure out if this was going to contribute to the emergency aid discussion… but the third paragraph just throws it too far off topic. Let’s see what happens, but I don’t give it long.

3

Its at your discretion. I’ll just delete that paragraph since it doesn’t contribute much.

4

Not quite sure what you’re looking for but will stake a stab at it!

The moral dilemmas that I have faced have been in the ICU as an RN (currently SRNA). These have largely been facing medical team vs. family/patient decisions about dying. It always seems that the patient or family wants to let go and the team wants to keep pushing on, although there have been a few cases of the opposite where I worked. We have done surgery for those who have been poor surgical candidates as research and comorbidities predicted a dark outcome and some have surprised us but more have had the other result.

I have been involved with balls to the wall “codes” that have run for 10-11 hours trying to save a patient’s life and still have lost the battle. These times are tough because you are dripping with sweat and mentally and emotionally exhausted but for the most part you feel like you have done all that you can do and tried all the options. There have been one or two that I feel like we could have saved but the comorbidities were so stacked against the patient it was better to stop and let them go than to put them through the hell of the long course of treatment just to die anyway.

How do you deal with it. I am not too sure…everyone deals in their own way. I talk to my wife and rant about some of it (she is a NICU RN) and some of it I just work through in my head, on the range by myself, at my desk in the shop working on guns. You find your own way of dealing with it.

When I was 28 (36 now), I had a stage 3 colon cancer. I have a unique perspective on death and the finality of life but was able to get that “2nd chance”. I appreciate things that I do for my patients and their families more and I take pleasure in walking down the “window hall” of our OR and seeing the sky on a beautiful day and knowing that I am doing what I supposed to be doing and that really is enough…it gives me peace.

What the guys on this forum have said is that you become like a machine…and you do…your training takes over and you become hyperfocused. I have always called this thinking about the process and NOT the outcome. If you are focused on the PROCESS of taking care of the patient, the OUTCOME will take care of itself.

I can’t tell you how to cope, you will certainly find your own way. Each situation is different and each patient is different. Combat and trauma is a little different so there are usually not those who have numerous comorbidities and have lingered way too long so death is more shocking or stunning.

To all you guys who are combat medics and TRUE first responders…thanks for all you do! We could not have the success that we have in trauma without you! As for combat, that takes special people and y’all are great…THANKS FOR YOR SERVICE!

Hope some of this ramble helped!

Sparky

5

I’m a huge proponent of natural selection and sometimes that aspect of emergency medicine bothers me. People who attempt suicide multiple times, people who drink/drug and hurt other people, people with no regard for their own well being. We are morally obligated to treat these people but man…sometimes it’s a stretch.

Theres also the more tenuous situations such as in patients with end stage diseases who acutely deteriorate and have no advanced directives. We have encountered and successfully resuscitated people in this situation several times to what end? The person gets to live the rest of their life on life support at significant cost to their family. Hard to high five after those ones.

6

Not a privacy problem until you include individually identifiable health information (as defined). Might be an agency policy violation though. Scenarios, theoreticals, and incident summaries devoid of personal info are fine.

7

I was fortunate enough to be given this advice early on, and it has helped me avoid most of the dilemmas that matter.

" No matter what, do what is right for the patient"

In general,if you heed those words, you will not run afoul of admin bs or legal problems or find yourself regretting something that you did, or should have done.

But you won’t be popular with a certain type of co-worker.

Eventually, you will violate rules or regs, or deviate from accepted protocol, but, if you have developed the reputation as a good guy and not a shitbird, you will be ok. Luckily I work for a medical director and have a chain of command that cuts me a lot of slack in re: to rigid adherence to rules/protocol as long as I can articulate why I did what I did, and that I did it for the good of a patient.

You will be faced with this, follow the rules, or be influenced by coworkers and do less than what you should for someone, or break the rules to do what is right. There are too many examples of this to give you a specific one like you asked for. The theme is more important.

Do good guys occasionally get jammed up? Yep, but it’s rare, and if you work in that environment, change employers.

To sum up the rule dilemma:

“Rules are for the guidance of wise men, and the blind obedience of fools”

Medicine is science, but there is a lot of intangible ‘human’ factor that requires a whole helluva lot of discretion.

Since you are in school, I’ll add one more piece of advice that speaks to your question about morality. Don’t listen to the reprobates that say things like “75% still equals RN (or emt-p or whatever)” Meaning all you need to do is pass and thats good enough. It isn’t. Learn everything you can and try to be the type of caregiver that you would want taking care of your loved one in an ICU ( or in the middle of no where). Believe me you will run across a bunch of mediocre people that get by doing the minimum, If you are working in a critical patient care setting, your actions and knowledge will be all that stands between life and death for people under your care. Prepare yourself accordingly.