Imagine that the nurse described in the scenario come to you for advice on how to handle the situation with Ms. Lykes in the most ethical way. Please provide an
ethical analysis of the pertinent issues and your recommendation.
scenario
Mrs. Almena Lykes is 24 years old and was diagnosed with amyotrophic lateral sclerosis (ALS) about 18 months ago. When she was admitted to the hospital with severe
pneumonia and shortness of breath she had some movement in her arms and could not get around the wheelchair. Despite the physical occupational and repertory therapy
and good nursing care she became weaker since she being hospitalized. Test results indicates that her pneumonia probably develop because of weakness of the swallowing
muscle. She is discouraged knowing that her condition is going to get progressively worse and that she will eventually die. She is also believes that her husband is
not willing to care for her at home any longer a fact her staff cannot confirm he has not called or appeared since she was admitted.
After a 2-week course Almenas condition takes decisive turn for the worse. Dr. Jarda Roubal her physician believes that she is not going to be able to bounce back
from this pneumonia even with vigorous treatment with antibiotics and respiratory therapy because of rapid deterioration of her swallowing and breathing muscles. Dr.
Roubal discusses the seriousness of her prognosis and the options open to her intervention regarding to pneumonia and predicts she is near to the time when she will
has to make a decision whether or not she wishes to place on ventilator permanently. He answers all question directly about the seriousness of her prognosis. He ask
her nurse Roy Moser to place a respirator in her room for quick initiation of ventilator support should it be needed.
Yesterday evening Mrs. Lykes and asked Roy to sit down with her by her bed tearfully she told him that she really was ready to die. She requested that that her
treatment in physical occupational and respiratory therapy be discontinued and that she not be placed on a respirator unless it would mean she would suffer less
while she was dying. She said she had seen a movie in which a woman was given morphine to speed up the dying process and make it painless and explained that was she
wanted. She is also requested a DOT NOT Resuscitate (DNR) status. Dr. Roubal means well but he will make a vegetable out of me she says breaking down. Roy said he
would be sure to talk to Dr. Roubal about her wishes but that the final decision would be made by her and the team caring for her. Then Roy documented the conversation
in her clinical record.
That evening when Dr. Roubal came through to check on the patients Roy Moser took him aside and conveyed the whole conversation as best he could recall it. Dr. Roubal
said What do think? I think we should do what she suggests. She isnt going to get better. After a moment Dr. Roubal said well you are right about her not
getting better but I think she is depressed and once she still has a lot of life in her Dr. Roubal then went to visit Almena. He said to her The nurse has told me
about your concerns. I would like you to think it over. There is still a lot we can do for you.
Later that evening Roy went back to Almena Lykess room. Almena looked extremely sad and alone her eyes puffy from crying. Now she was dry eyed and made an attempt
to lift her limp hand. I dont know what to do she said.
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