Draft an Ethics Policy on Health Care Decision-Making

This is a culmination of what you have learned this week. You will explore patient directed decision making, substituted judgment standards, and best interest standards, when each standard might apply, and how they can be operationalized in a health care organization.

You are the nurse coordinator of the Neurology ICU at Metropolitan Hospital. Last week, a homeless patient was admitted after he was found unresponsive outside of the hospital emergency room. He had experienced a stroke and was in need of non-emergency surgery to stop the bleeding. The doctors performed the surgery and the patient was improving, but the patient had a long road of recovery ahead and the doctors did not know whether the patient had any support system available or whether they had done the right thing by operating. The following week, a pediatric patient underwent a risky procedure that doctors didn’t think was advisable, but it was at the request of the child’s parents. The child is in the ICU, and has not been responsive since the surgery. Doctors on the unit are upset about both situations and would like more guidance on how your ICU is going to handle such events in the future.

They would like you to give a presentation to the Neuro ICU that addresses the following scenarios where an incompetent patient requires non-emergency neurologic surgery. Assume that the providers in your ICU know absolutely nothing about the ethics of decision-making.

Using what you have read this week, craft a brief PowerPoint presentation (no more than 500 words total, 10-15 slides) providing step-by-step instructions for dealing with decision-making in the following cases:

1. A homeless patient without a surrogate, living will, or family members who is unable to express his preferences about surgery, and
2. A pediatric patient undergoing care in which the team is divided about its medical appropriateness but the child’s parents are demanding it.

In each of these cases, who ultimately should decide what type of care the patient gets? What standard is being used: best interests or substituted judgement? Does the severity of the condition or length of recovery matter? Are there limits in each case in terms of whether we can know, for certain, that we are respecting the wishes of the patient?

In scenario 1, particularly, who do you recommend to make this decision? What should he/she/they consider in doing so? Are there other alternative decision-makers?