Nursing Ethics

Question

Ms. A. is brought into the hospital following an intentional overdose of a variety of prescription drugs. She is intubated, placed on a ventilator, and transferred to the intensive care. The following morning she is weaned from the ventilator. She is awake and angry that health care providers interfered with her decision to end her life. She is being held for observation with the plan to transfer her to a psychiatric facility within the next 48 hours. Prior to her transfer she spikes a temperature and begins to suffer from respiratory distress. Diagnostic testing reveals ventilator acquired nosocomial pneumonia which has a mortality rate of >50% even with appropriate treatment. Upon hearing her diagnosis and prognosis, Ms. A. smiles and refuses treatment. What is the appropriate legal and ethical action in this case? Please use an ethical decision making framework (page 167 of text book) rather than just your opinion.

Answer 1

This will be a sticky one that will require her medical team, ethics, and legal to be involved.

She was clearly a danger to herself when she was admitted. She also has the right to refuse treatment if she is mentally competent.

I would ask for a psychiatric evaluation to be done. While this is being done, ethics and legal consults should be started to determine the hospital's and the law's limitations.