NSG 426 University of Phoenix Week 4 Legal and Ethical Responsibility Paper

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nsg 426

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Assignment Content

1.

Read the following case study from the Center for Practical Bioethics:

oOur Pregnant Daughter Didn't Want This...

Complete the Questions for Discussion following the case.

Summarize the case, explaining the legal and ethical aspects of it.

Research and explain any laws that pertain to the situation.

Define and explain the ethical principles that pertain to this case.

Determine if the legal and ethical responsibilities are in alignment with each other.

Explain how you would recommend this care team resolve the situation by answering the following questions:

oWhat specific details of the case require resolution?

oWhat specific actions should the organization or nurse take to ensure an appropriate outcome?

oWhat resources and dependencies exist for your recommendation?

Format your assignment as an 875- to 1,050-word paper.

Cite at least 3 peer-reviewed sources published within the last 5 years.

Note: At least 1 of the sources should provide evidence for your resolution recommendation or plan of action.

Include an APA-formatted reference list.

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NSG/426: Integrity In Practice: Ethic And Legal Considerations Wk 4 - Signature Assignment: Legal and Ethical Responsibilities [due Mon] Assignment Content 1. o Read the following case study from the Center for Practical Bioethics: Our Pregnant Daughter Didn't Want This... Complete the Questions for Discussion following the case. Summarize the case, explaining the legal and ethical aspects of it. Research and explain any laws that pertain to the situation. Define and explain the ethical principles that pertain to this case. Determine if the legal and ethical responsibilities are in alignment with each other. o o o Explain how you would recommend this care team resolve the situation by answering the following questions: What specific details of the case require resolution? What specific actions should the organization or nurse take to ensure an appropriate outcome? What resources and dependencies exist for your recommendation? Format your assignment as an 875- to 1,050-word paper. Cite at least 3 peer-reviewed sources published within the last 5 years. Note: At least 1 of the sources should provide evidence for your resolution recommendation or plan of action. Include an APA-formatted reference list. Submit your assignment. Case Studies: Our Pregnant Daughter Didn’t Want This... By Tarris Rosell, PhD, DMin Twenty-nine year old Janet and her husband Jack were driving home from her ob-gyn appointment when tragedy struck. Another driver, elderly and distracted by an incoming text message, ran a red light and T-boned Janet and Jack’s Mini-Cooper. Both young people sustained severe injuries. Jack died enroute to the hospital. Janet survives, having escaped injury except to her head; but that was unfortunately massive. Her physicians now say, a month after the accident, that the prognosis is grim. The best one could hope for—or perhaps the worst—is continuation for some time in a persistent vegetative state. Just before leaving the doctor’s office, Janet had sent a jubilant text message to her parents. “Guess what?! We’re pregnant!!! ” So Janet was pregnant—and prescient. Unlike most young adults, Janet had thought about mortality in advance of this accident. She is, or was, a nurse. She had gone to continuing education workshops about end of life care and advance care planning. Janet then had completed her own advance directives some months ago, naming Jack as her primary agent and durable power of attorney for healthcare decisions. She named her parents as secondary agents. Janet also had completed, with notarized signature, a healthcare treatment directive. Among her directives was a clear, handwritten statement about life prolongation if she were, somehow, “to end up in anything like PVS, from which I am not apt to recover.” Janet had written that, in such a condition, “I do NOT want my life to be extended by means of medically assisted nutrition and hydration, ventilator, or other life support.” And then it happened. With Jack gone, treatment decisions are left up to Janet’s parents. They both are thoughtful people, healthcare professionals also, who take very seriously their difficult responsibility of acting as surrogates on Janet’s behalf. After consulting her physicians, other family members, and even their priest, a decision is made to stop everything except palliative care. Janet’s parents had received a copy of their daughter’s advance directives, and they have determined that this is what she would have wanted, what in fact she had conveyed with such tragic prescience. Plans are made to transfer Janet to a hospice unit in another part of the hospital. It would take place the following day. That evening, a resident physician notices in the patient’s chart that Janet is pregnant. Probably about nine weeks, it appears. He wonders if this matters, legally or ethically or religiously, for his patient’s transfer to hospice, especially when Janet is not imminently dying otherwise. The resident does a bit of online research and learns that in the State of Kansas, a woman’s healthcare directives about “withholding or withdrawal of life-sustaining procedures in a terminal condition” may not legally be in effect while pregnant. “The declaration of a qualified patient diagnosed as pregnant by the attending physician shall have no effect during the course of the qualified patient’s pregnancy” (KSA 65-28, 103, (4)B). A note in the patient’s medical record the next morning references this statute, with a question about how it potentially impacts the impending transfer to hospice care. When the attending physician reads the note, she calls Janet’s parents and says hesitatingly, “We have a bit of a problem here. It appears we may need some legal assistance, perhaps an ethics consultation, and must postpone Janet’s transfer of care.” The doctor explains further what her young resident colleague had discovered, and questioned. The parents had spent a sleepless night anticipating today. It would be the hardest thing they’ve ever done, and yet the right thing in keeping with their daughter’s wishes. Now they can’t believe what they’re hearing. Postpone? Ineffective advance directives? Continued life support? Did the doctor really say that? That there may even need to be surgery for a feeding tube and a tracheostomy while this legal glitch is being discussed and gets clarified? Almost in unison, Janet’s mother and father protest, “But, Doctor, our daughter didn’t want this!” Questions for discussion 1. What should be done now for Janet and her parents, and on what grounds? 2. What values underlie the statute making a pregnant woman’s healthcare treatment declarations of “no effect” while pregnant? 3. Do you agree or disagree with this statute, and on what grounds? 4. What decision would you be making as Janet’s parental surrogate, and why? 5. Ought someone to be a surrogate for Janet’s fetus, or not? And why or why not?
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Explanation & Answer

Attached.

Running head: LEGAL AND ETHICAL RESPONSIBILITY

Legal and Ethical Responsibility
Name
Institutional Affiliation

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LEGAL AND ETHICAL RESPONSIBILITY

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Discussion Questions
Q1. Legal justice needs to be sought for Janet and her parents. This can be achieved by advising
the parents to seek legal justice. From the case, it is seen that there is a development of a new tier
requiring new interpretation altogether. Evidently, there is a special law that prevents Janet from
seeking hospice care following the fact that she is pregnant. This law needs to be redone and a
proper preventive measure realized. It has been shown that patients need at least surrogate
involvement (Torke et al., 2014). For the case of Janet, the husband who would have supported
her is already dead from the accident, and so it is the parents who need to offer the necessary
support. The parents will be actively involved in making decisions once the special law has been
interpreted.
Q2. The health care issues determine the underlying values of the healthcare of a woman during
pregnancy. In this case, the underlying value is that keeping the pregnancy should be prioritized
and that other contingent services are declared of “no effect” (DeMartino et al., 2017). Such
interpretations are always overlooked, making most people unaware of them. As a result, there is
always a myriad of health complications thereby interfering with the wishes of the patient.
Q3. This statute is agreeable. This is based on the ground that this statute prioritizes the life of
the patient even in the condition of pregnancy. Evidently, patients have the right to chose to stay
in a vegetative state in case this will cause more suffering to the family as well as the life of the
unborn. The statute also offers a chance to reconsider the law for the benefit of both the patient
and the family (Torke et al., 2014). Therefore, the statute holds for the case of Janet.
Q4. As Janet’s parental surrogate, I would decide that she should be kept in a condition that is
comfortable while minimizing pain as well as suffering. This can be achieved by advising Janet

LEGAL AND ETHICAL RESPONSIBILITY

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to surrender to the care of the doctors to ensure that the unborn are kept comfortable throughout
the developmental stages until the delivery stages (Pope, 2017). Therefore, keeping the
pregnancy would be beneficial to Janet, unless the doctors have found that keeping the
pregnancy could be detrimental to the life of Janet.
Q5. The case presented here is quite sensitive making it challenging to determine the fate of the
unborn child. Therefore, only relatives or Janet’s parents should be surrogates for the child. This
choice is informed by the fact that it will allow Janet to live the plans they established with the
husband regarding the child that Janet is carrying. Apparently, having a stranger would not be
suitable to make surrogate support for the child because of the issues with attachment. The
surrogate also needs to understand the needs and wishes of Janet. Therefore, it would be good if
that is Janet’s parents who better understand her and have a close connection with her.
Summary of the Case
The case of Janet as presented is about a dilemma that arises between continuing
proposed hospice care or coming up with new decisions that...


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