Nursing Ethical Dilemma

I became aware of this medical- ethical dilemma through my clinical assignment in pediatrics. My patient was a 3 month old female who was born dead. Apparently the mother suffered Placenta Abruptio, it is unknown how long the fetus suffered with hypoxia before birth. Nurses claim this infant was born dead. CPR was performed for more than 15 minutes before the heart started. Needless to say the baby was then placed on life support. A determination was made that the infant is brain dead. The major dilemma is that the Mother never returned to the hospital and is considered missing in action. Consequently leaving the infant without a guardian or family member to speak on her behave regarding whether to withdraw the life support and possibly
donate her organs or continue life support. This case is extremely devastating as there has been no progress in any direction to obtain guardian to advocate for this infant. Thus far the professionals that are involved are the infants Doctors, Case Management, Department of child and families and the hospital. Infant was admitted back to the hospital with a diagnosis of sepsis/MRSA as she was being cared for in some state medical facility.
The ethical principles that are relevant to this case from the ANA code are two specifically.
These would be in provision 1.3, where it states, “Nurses act as advocates for the patient and family, assessing the responsibility and appropriate use of life-sustaining care in accordance with the wishes of the patient and family (Slate, 2015).” Since it has been reported there is no family involvement I would verify the attempts made so far. Furthermore this ANA code 1.3 claims, “The invaluable experience of nurses in the care at the end of life should be used to assist education, research, practice and the development of policies (Slate, 2015).” As the infants nurse advocate I would find out what policies and procedures are presently in place for this complicated case. Educating myself on what policies need to be clarified and or revised to make clearer more logical and ethical decisions in this case. Another provision in the ANA Code of ethics that applies would be 2.3, which states “Collaboration is not just cooperation (Slate, 2015).” “Collaboration is the concentrated effort of multiple members of the healthcare team in order to achieve a desired outcome (Slate, 2015).” This is relevant because this case needs a desired outcome. Another important statement in this provisions says, “Nurses should advocate for the participation of all relevant members of the health care team, and ascertain that all vital questions are asked and that necessary information for informed
decision making is provided(Slate, 2015).” This applies to this case because questions need to be asked to make certain every attempt was made to find the infants Next of Kin, educate them properly in regards to the meaning of brain death. Some of the question I would ask. Has every avenue been explored? Has the Case Manager sent police to all the address in the chart? What attempts have been made to obtain a surrogate though the court system? This applies also to educating a surrogate/or the courts for anyone to make an informed decision in regards to this infant and what the greater good would be for most people. For a better understanding of how brain death is interpreted as legally dead there is, “The Uniform Declaration of Death Act.” The UDDA offers two definitions for when a person may be declared legally dead.
“1. Irreversible cessation of circulatory and respiratory functions or 2. Irreversible cessation of all functions of the entire brain, including the brain stem ("What is the Uniform Declaration of Death Act or UDDA," 2015).” The UDDA states that 50 states recognize brain death to be legally dead. Further evidence on brain death is explained in Florida Statutes 382.009 which state “For legal and medical purposes, where respiratory and circulatory functions are maintained by artificial means of support so as to preclude a determination that these functions has ceased, the occurrence of death may be determined where there is irreversible cessation of functioning of the entire brain, including the brain stem ("Statutes & Constitution: View Statutes: Online Sunshine," 2015).” Most of the time patients have advanced directives that dictate exactly what they want done as far as medical care and more times than not, patient do not want to sustain their life if brain death has occurred. If no directives, the next of kin would make the choice, as they know what their loved one would have wanted. Sometimes the patient is kept on life support only to harvest organs for
transplant.
Unfortunately in this case of a 3 month old infant there have not been any developments in finding a family member. The desired outcome would be to try harder to locate the mother or family member, educate them to the fact brain dead means there is no recovery. If there are no religious restrictions within the family, then the family member could make an informed decision. Meanwhile in collaboration with all professionals involved there needs to be a court appointed guardian/surrogate or the courts may decide themselves as to the best course of action for this 3 month old, brain dead infant on life support.