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Ethical Dilemma Essay

1866 words - 8 pages

Do Not Resuscitate Orders in Pediatric Patients
Ethical Issues in Healthcare

Abstract
Children with terminal illnesses frequently have do not resuscitate orders. Dealing with dying children, and letting them die without major intervention can be hard issues for nursing and other health care professionals to cope with, and can cause an internal ethical dilemma. The seven nursing ethical principles are discussed in regards to do not resuscitate orders, and ethical theory is applied. The ethical dilemma faced by nurses with do not resuscitate order is discussed, and how to resolve it.

Do Not Resuscitate Orders in Pediatric Patients
Children throughout the United States are ...view middle of the document...

Beneficence and Nonmaleficence
One of the main nursing ethical principles is beneficence. Beneficence means to act in the best interest of the patient (Burkhardt & Nathaniel, 2002). With a do not resuscitate order, it is a common misperception that care is withheld from the patient. In actuality, the patient still receives appropriate medical and nursing interventions. While the goals for the patient may change after a do not resuscitate order initiation, life-prolonging measures still can be utilized (Baker et al., 2010). If the patient is at the end stage of life, the care goals for the child have shifted towards an aim for a better quality versus quantity of life. This entails making the patient comfortable and happy, versus subjecting them to more procedures that will not prolong their life. The beneficence principle can indeed be applied to a child with a do not resuscitate order, because in certain situations, such as a child who is in pain and has been suffering, the act of not resuscitating can be very much in the best interest of the child. Another nursing ethical principle is nonmaleficence, which means to do no harm (Burkhardt & Nathaniel, 2002). When a child has had all life prolonging treatments stopped, it is because the child will not benefit from those measures. Decisions to limit interventions at end of life are based on relieving suffering, and optimizing the quality of life the child has remaining (Lyon et al., 2008). If the child is dying, resuscitation may not conform to the goal of a quality end of life, thus having a do not resuscitate order can be considered a nonmaleficient act.
Autonomy and Justice
Autonomy is the ethical principle giving the patient the right to choose or deny care (Burkhardt & Nathaniel, 2002). When a patient and family decide on a do not resuscitate order, nurses need to understand that do not resuscitate is not the plan of care (Murphy & Price, 2007). A do not resuscitate order only addresses whether or not to start cardiopulmonary resuscitation. The patient and/or family have decided that being resuscitated is not in the best interest of the child, but many other interventions are still available to the patient. Nurses and other staff members have to respect the autonomous decision of the patient and family. The nursing ethical principle of justice involves giving fair and equal care to all patients (Burkhardt & Nathaniel, 2002). A child with a do not resuscitate order should be cared for comparatively like other children on the unit who are a full code. Therapies, activities, and other nursing measures apply to the child with a do not resuscitate order the same as a full code child (Wright, Forbat, Knighting, & Kearney, 2008).
Confidentiality, Veracity, and Fidelity
Whether a child has a do not resuscitate order or not, confidentiality is given to every patient. It is not only an ethical principle nurses must adhere to; it is also a violation of...

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