Ethical Dilemma in Patient Care

This case study explores an ethical dilemma faced by healthcare professionals when a critically injured patient, who had previously signed a Do Not Resuscitate (DNR) order due to depression after his wife's death, requires surgery. The patient is unconscious and unable to give consent, while his family insists on the procedure. The case examines the conflict between respecting patient autonomy, honoring DNR wishes, and providing care based on beneficence.

1Running head: CASE STUDY
Case Study
Name of student:
Name of university:
Author note:

2
CASE STUDY
In the present case, the patient had suffered a Gun Shot Wound to the head which was
self-inflected, and his condition was critical as understood by the vital signs of HR 121, B/P
60/45, Saturation 93%. In addition, the patient had earlier expressed his lack of desire to live
after the death of his wife. Though the neurosurgeon pointed out the chances of patient
recovery was negligible given the old age of 89 years, the patient’s family members insisted
on completing the surgery. It was evident that the patient had attempted self-harm owing to
his unstable mental condition. The ethical issue, in this case, relates to the dilemma of
whether to procced with the surgery without the informed consent of the patient. While the
provision of care for patient reporting to the emergency room with the critical condition is
mandatory, the dilemma lies in whether to proceed without the informed consent. This is of
much significance since the chances for the patient to not give the consent is more as he had
attempted suicide owing to depression after his wife’s death (Baird, 2015). Patient consent
forms an important element of healthcare delivery across the globe, including the US, where
there is stringent legal regulation concerning patient consent. The law covers the legal aspect
of the right of the patient to agree or disagree with the treatment supposed to be given to him
(Tingle & Cribb, 2013).
As the patient was taken to the ER for surgery, it was brought to notice that the patient
had signed DNR order two days back. As a nurse, the ethical and legal issue faced relates to
whether to proceed with the surgery in spite of knowing that the patient had signed DNR
orders. DNR, or ‘Do Not Resuscitate’, also known as ‘allow natural death’ is a legal order
provided to withhold cardiopulmonary resuscitation (CPR) or Advanced cardiac life support
(ACLS) as per a patient’s preference to end his life. The request for DNR under normal
circumstances is made by the patient himself and entails the health care professional
entrusted with the care of the patient to respect the decision taken by the patient regarding the
end of life. It is to be noted that a DNR has no affect on any form of treatment other than

3
CASE STUDY
those requiring intubation or CPR (Griffith & Tengnah 2017). In the US, advanced cardiac
life support and CPR are not allowed to be undertaken if there is the presence of a valid
DNR. In the present case, the patient had been in intubation.
While respecting the patient’s wishes is one priority, consent of the patient’s family to
carry out the surgery cannot be ignored. The patient was not in sound mind when he signed
the DNR, as he had expressed his heartbreak after the loss of his wife. It is evident that the
patient had no desire to live and was suffering from depression. In my opinion, the
appropriate step would be to honour the wishes of his family since the patient was not in
sound mind when signing the DNR and committed suicide. According to Bartlett (2015),
ethical dilemmas are evident when a patient signing a DNR attempts to end his life by
suicide, and the treatment needs CPR or ventilation. In such a case, the principle of
beneficence gets more importance than patient autonomy, and the healthcare professional has
the right to revoke the DNR.

4
CASE STUDY
References
Baird, A. G. (2015). Patient consent and opting-out. Br J Gen Pract, 65(640), 574-574.
Bartlett, L. S. (2015). Do-not-resuscitate. Nursing2017 Critical Care, 10(3), 44-47.
Griffith, R., & Tengnah, C. (2017). Law and professional issues in nursing. Learning
Matters.
Tingle, J., & Cribb, A. (Eds.). (2013). Nursing law and ethics. John Wiley & Sons.