Recently while on a visit to a nursing home caring for the elderly, I happened to witness a case where a nurse refused to offer CPR to an elderly woman who had collapsed. The patient was an 87 year old lady resident at the nursing home. She did not only refuse to offer CPR, but also prevented anyone else from providing CPR to the patient. Apparently the policy of the organization restricted nurses and other medical practitioners from providing resuscitation to the patient. As a professional nurse, I would not expect to see a medical practitioner, nurses included refusing to offer help to a patient who has collapsed. Instead of the nurse offering help to the patient, she went ahead to call for the emergency services. It is ironical that the first thing the paramedics would do when they arrive is offering CPR to the patient, which the nurse could have done as the first respondent in the case. This raises the issue of ethical and legal dilemmas that professional nurses encounter while discharging their duties.
I later got information from the resident nurse that the patient had not signed an advance directive, to stipulate that she was not to be resuscitated in the event her medical condition required it. The patient had not categorically expressed her desire to die a natural death. In this modern society advance directives are a common feature in the health care system. Patients are required to fill legal documents, which define their health care preferences. This legal document provides a description of the patients desires in relation to the end-of-life requirements prior to their death. This legal document is also referred to as a living will (Finkelman & Kenner, 2010). Patients have a legal right of establishing a plan, and medical practitioners including nurses are obligated to follow these instructions. The legal provisions provided in the living will include: “use of life-sustaining equipment such as a ventilator, respirator, or dialysis; artificial hydration and nutrition; do-not-resuscitate’ (DNR) or allow-a-natural-death’ (AND); and organ or tissue transplant” (Finkelman & Kenner, 2010, p. 212).
In this case, the nurse was acting on the policy of the health care institution, which later released a press statement claiming that the nurse had misinterpreted their policy statement. This appears to be a CYA in the event that a family member was to sue the institution for denying the patient CPR. This case was questionable and raised a lot of ethical issues.
This case raised a lot of ethical and legal issues affecting the nursing profession. The nurse was torn between the ethical principles guiding the nursing profession such as informed consent and autonomy of the patient. On the other hand, she was forced to abide by the policy of the institution, which dictated that the patient should not be resuscitated. However, based on the ethical principles, the nurse was wrong not to offer CPR because the patient had not signed any legal document to suggest that she should not be resuscitated. The nurse should have disregarded the institutional policy and resuscitate the patient. The law does not allow health care institutions to make such decisions on behalf of the patient, only close family members may be allowed.
To avoid such scenarios, patients should be advised to make their wishes and preferences known through legal advance directives. Before making this decision they should consult their physicians, but the ultimate decision has to be made by the patient. If the patient decides not to be resuscitated, the medical practitioners are obliged to respect the patient’s wishes.
Finkelman, A. W., & Kenner, C. (2010). Professional nursing concepts: Competencies for quality leadership. Sudbury, Mass: Jones and Bartlett Publishers.