- 18 Mar, 2021
- 0 Comments
- 4 Mins Read
Options for the End-of-Life-Options Act
Instructions
you will be writing a “Case Analysis Report” on one of the Bioethics Cases that were chosen for the 2019 National Bioethics Bowl competition. Your report will be 3-5 pp. in length (750-1250 words) and should address the questions attached to the case you have chosen. Additionally, 5 or more scholarly and varied sources of information should be selected, used effectively, and cited appropriately (e.g. Chicago, MLA, or APA style–a “Works Cited” page may be used for providing your source information).
Options for the End-of-Life-Options Act
Wait, you’re telling me they can do that here? That it’s legal in a hospital? That our policy supports it? Holy smokes. But what if a nurse doesn’t want to be involved?”
Ms. Shirley Green, the charge nurse for the hematology-oncology ward, called for an ethics consultation on behalf of her nursing staff, asking for help with confusion over institutional policy and significant moral distress.
The confusion and distress began the day before when their patient, Ms. Jennifer Peterson, who had been admitted for respiratory distress in the setting of stage IV metastatic lung cancer, told her oncologist that she was tired of suffering and wanted to use the California End of Life Option Act (EoLOA). The oncologist and the palliative care physician were willing to begin the process with her, explaining the timing involved and the required documentation, as well as the logistics of procuring and ingesting the medication. Ms. Peterson voiced her understanding, and her certainty that this choice was the right one for her. After the physicians left, Ms. Peterson told her bedside nurse, Ms. Allie Wagner, that she was planning to take the lethal dose of medications in the hospital, with the nurses and doctors to help take care of her, and that she was so grateful this option existed, even if it meant she had to be in the hospital for a while.
Allie came to Shirley in the breakroom, upset and near tears: “I heard the doctor describing it – that she would have to take the medicine herself – even if others help her prepare it. Did he mean us? I can’t help her kill herself! If I help, even to give her the medicine, even if she takes it herself – I’m part of it – it would feel like murder!” Two other nurses, overhearing the conversation, chimed in with different opinions, increasing the tension and distress. “For sure! At my church, we actively protested the law – and assisted-suicide is wrong – no matter what they try to call it. I could never do that either! No self-respecting nurses and doctor could, We’re supposed to save lives, not take them.” Marco nodded emphatically and put his arm around Allie’s shoulders. Rachelle looked around the room and spoke softly, “I don’t know – I’ve seen some pretty awful deaths on this unit, some people in bad shape. I can imagine why some might want to go with some dignity and peace. Maybe that’s part of what we can do to help them – when we can’t save a life, maybe we can preserve their dignity. Let them have a choice.” When she saw Marco and Allie bristle up to start arguing with Rachelle, Shirley asked them to hold off until she could call the ethics consultant to help sort out what the policies were and what they were supposed to do, as nurses, especially since people seemed to have strong opinions about the law.
With respect to the rights of individual health care providers, the law states, “Participation in activities authorized pursuant to this part shall be voluntary. Notwithstanding Sections 442 to 442.7, inclusive, a person or entity that elects, for reasons of conscience, morality, or ethics, not to engage in activities authorized pursuant to this part is not required to take any action in support of an individual’s decision under this part.” Here the law seems to indicate that there is no legal requirement to participate.
Questions:
1.Should the hospital impose any (nonlegal) penalties on employees that refuse to participate in the activities permitted by EoLOA to ensure that they have enough employees to provide the services the hospital says it offers? The law does specify what an institutional provider that prohibits these activities may do with employees that violate their prohibition policy, but it does not say what those institutions providing the care permitted by the EoLOA can do with employees that do not comply with the hospital policies. Should the law explicitly address this issue? If so, how?
2. What elements of situation appear to be generating moral distress among the nurses and how would you respond to or address those elements and/or the distress as an ethics consultant?
3. The EoLOA was challenged in the California courts in May, when a judge issued a temporary ruling that the law was invalid. The law was reinstated in June in the appeals court, and the judge directed that the prior ruling be nullified. Imagine that Ms. Peterson made her request in May after the law had been challenged but before it had been reinstated; what should the hospital have done?
Options for the End-of-Life-Options Act
Wait, you’re telling me they can do that here? That it’s legal in a hospital? That our policy supports it? Holy smokes. But what if a nurse doesn’t want to be involved?”
Ms. Shirley Green, the charge nurse for the hematology-oncology ward, called for an ethics consultation on behalf of her nursing staff, asking for help with confusion over institutional policy and significant moral distress.
The confusion and distress began the day before when their patient, Ms. Jennifer Peterson, who had been admitted for respiratory distress in the setting of stage IV metastatic lung cancer, told her oncologist that she was tired of suffering and wanted to use the California End of Life Option Act (EoLOA). The oncologist and the palliative care physician were willing to begin the process with her, explaining the timing involved and the required documentation, as well as the logistics of procuring and ingesting the medication. Ms. Peterson voiced her understanding, and her certainty that this choice was the right one for her. After the physicians left, Ms. Peterson told her bedside nurse, Ms. Allie Wagner, that she was planning to take the lethal dose of medications in the hospital, with the nurses and doctors to help take care of her, and that she was so grateful this option existed, even if it meant she had to be in the hospital for a while.
Allie came to Shirley in the breakroom, upset and near tears: “I heard the doctor describing it – that she would have to take the medicine herself – even if others help her prepare it. Did he mean us? I can’t help her kill herself! If I help, even to give her the medicine, even if she takes it herself – I’m part of it – it would feel like murder!” Two other nurses, overhearing the conversation, chimed in with different opinions, increasing the tension and distress. “For sure! At my church, we actively protested the law – and assisted-suicide is wrong – no matter what they try to call it. I could never do that either! No self-respecting nurses and doctor could, We’re supposed to save lives, not take them.” Marco nodded emphatically and put his arm around Allie’s shoulders. Rachelle looked around the room and spoke softly, “I don’t know – I’ve seen some pretty awful deaths on this unit, some people in bad shape. I can imagine why some might want to go with some dignity and peace. Maybe that’s part of what we can do to help them – when we can’t save a life, maybe we can preserve their dignity. Let them have a choice.” When she saw Marco and Allie bristle up to start arguing with Rachelle, Shirley asked them to hold off until she could call the ethics consultant to help sort out what the policies were and what they were supposed to do, as nurses, especially since people seemed to have strong opinions about the law.
With respect to the rights of individual health care providers, the law states, “Participation in activities authorized pursuant to this part shall be voluntary. Notwithstanding Sections 442 to 442.7, inclusive, a person or entity that elects, for reasons of conscience, morality, or ethics, not to engage in activities authorized pursuant to this part is not required to take any action in support of an individual’s decision under this part.” Here the law seems to indicate that there is no legal requirement to participate.
Questions:
1.Should the hospital impose any (nonlegal) penalties on employees that refuse to participate in the activities permitted by EoLOA to ensure that they have enough employees to provide the services the hospital says it offers? The law does specify what an institutional provider that prohibits these activities may do with employees that violate their prohibition policy, but it does not say what those institutions providing the care permitted by the EoLOA can do with employees that do not comply with the hospital policies. Should the law explicitly address this issue? If so, how?
2. What elements of situation appear to be generating moral distress among the nurses and how would you respond to or address those elements and/or the distress as an ethics consultant?
3. The EoLOA was challenged in the California courts in May, when a judge issued a temporary ruling that the law was invalid. The law was reinstated in June in the appeals court, and the judge directed that the prior ruling be nullified. Imagine that Ms. Peterson made her request in May after the law had been challenged but before it had been reinstated; what should the hospital have done?