ANA Code of Ethics as a Tool to Solve an Ethical Dilemma

As little kids, we were instilled the value of knowing right from wrong. If you saw a child on the playground push down another one, you would automatically see it as something wrong. With this being said, the way someone was raised will have a lot to play out in how they think or feel. The way they feel about a given situation may differ from what another person feels. These may lead to arguments when one side is trying to get their points and views across while the other side opposes and tries to back up their beliefs. As a result of this, when a choice is made neither party is contempt. This situation can be seen as an ethical dilemma. This paper will seek to describe how an ethical dilemma arose, identify principles of ethics, and relate them to the American Nurses Associations (ANA) code of ethics.

Last year, I became aware of a situation involving a lovely couple from my church. The wife had just given birth to their newest edition. While she was 37 weeks along, she had an unexpected delivery in her home. When the baby was born, he had no heart beat and his brain did not receive oxygen for ten minutes resulting brain death. According to (Hockenberry, M., Wilson, D. 2015), “Brain death is the total cessation of brainstem and cortical brain function that results from any condition that causes irreversible widespread brain injury.” The ethical dilemma happens when the Doctors pronounce the baby brain dead. In order to be pronounced brain dead, there must be an absence of the gag, sucking, rooting reflex, there must be flaccid tones along with absence of movements and two electroencephalogram tests should show lack of activity. The parents were told that prognosis was very poor, but being that the parents were very religious people, they believed that God can do a miracle to reverse the baby’s condition. The hospital on the other hand wanted to discuss end-of-life care since baby would not be able to function to his fullest capabilities and to possibly take him off of the ventilator. The parents did not want to discuss about end of life care and wanted to keep the baby on the ventilator until he would wake up. With the hospital not wanting the baby to suffer, they decided to take the case to the courts to see what decision can be made that will be best for the baby.

The American Nurses Association have put together five key principles of ethics which are Autonomy, Beneficence, Nonmaleficience, Justice and Veracity. I will deliberate on three of them and they are autonomy, beneficence, and nonmaleficence. Beneficence addresses the idea that the nurse’s actions should be what will be best for the patient. For example, according to (Yan, E. G., & Munir, K. M. 2004), it is important that the benefits outweigh the risks. Nonmaleficence is do no harm to the patient and lastly autonomy is giving someone the freedom in making choices they feel will be best for them and their health. In this case, both the parents thought that leaving the baby on the ventilator is what is best for him because they have faith. They think that disconnecting him would be a harm to him and they would feel guilty. The hospital feels that it is doing harm to the baby by keeping him alive when they know that he will not be able to function independently and taking him off the ventilator would be best for him.

Looking at this situation, it is hard to say who is right and who is wrong because we have the parents that think they know what is best for the child and then the hospital uses factual objective data such as diagnostic testing to prove their point. With the last principle of Autonomy and examining the ethical dilemma, the parents wanted to make that final decision for their child who could not make it himself and that is to still keep him alive through the machine. The ANA Code of Ethics provision one is the nurse practices with compassion and respect for inherent dignity, worth and unique attributes of every person (American Nurses Association, 2001). With this being said, the fundamental principle about being a nurse is to have respect, understand and offer support to families in times like this. It is important to build trust, stay biased and offer correct information even when it may be hard to do so. Even though the hospital has its best intentions for the baby, the important to respect the wishes of the parents. This is one way that provision one may not be altered. Moving on, even though the parents knew that nothing can be done to save their baby, the claims to be holding onto faith and prayers, they even got social media involved and their story for a miracle went viral. They were told that the ventilator can only support a person for a period time and that it was not going to sustain the baby for his whole life.

For the two months that the baby had been kept on life support, ethics communities, organ donation and the chaplain were used to aid this family in making the difficult decision. The parents demanded that additional tests be done so the committee provided that, it was not until after 2 months of no progress that they finally decided to take the baby off of the life support machine and allow him to pass. This was one of the most difficult decision they ever had to make and it broke them. They were able to be in the room when they disconnected the baby. They even decided to donate the baby’s organs which were still viable. The baby would have been 1-year-old in January. Even though this was a hard time for the parents, something good came out of it because I heard that the heart of the baby saved another little newborn and they were happy to be a part of that.

As I look back at their case, I feel like this was a very difficult situation that I do not wish upon anyone. All resources were provided to them, but they just were still in the stage of denial and they were not ready to let go. It was until the very end that they decided to disconnect the life support because the tests that they inquired showed that nothing more could be done. They even joined a support group with parents who have gone through similar situations. Therefore, resources pertaining to their case were used. I do not feel like anything else could have been used.

In summation, when dealing with an ethical dilemma, it is important to see that there is not a win-win or win-lose situation. It is all about delivering the facts even though it may be hard. The purpose of the ANA code of ethics is to help in times like this where it may be hard to make a decision. It is also the role of the nurse in this situation to act out on the provisions in which they agreed to do so. Although the ending of the situation was hard, there is still joy today as the parents are able to be in contact with the other little baby that received their infants heart.