DISCOURSE ON MEDICALLY FUTILE CARE INTERVENTIONS

DISCOURSE ON MEDICALLY FUTILE CARE INTERVENTIONS 1
The Ethical Discourse on Caring for a Medically Futile Patient
Nicole James
John Abbott College
Nursing 180-60N
Maria Lewis
1/04/2020

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The Ethical Discourse on Caring for a Medically Futile Patient
Nurses are essential providers of health care across the lifespan of individuals from many
cultural and ethnic backgrounds. At the core of John Abbott College and its conceptual
framework is the concept of caring, which charges the essence of every nurse. Providing nursing
care to a patient who is not expected to recover from their illness, can become an exhausting
ethical situation when the nurse feels that the dignity of a patient is no longer being promoted.
Further amplifying the tension is when the nurse is unable to maintain the dignity of the patient.
Medical futility is a topic with many ethical implications. The challenge is battling personal
values with the beliefs of others concerning withdrawing treatment.
The chosen topic was inspired by an interpretation of a recent clinical experience, which
caused ethical and moral trouble for the writer. In this instance, a 75-year-old woman of Asian
descent sustained a massive intracerebral bleed while at home. She was taken by ambulance to
the ER and subsequently spent over 2 weeks in the ICU until she was stabilized and transferred
to the Neuroscience floor, where she was under the writers’ care. The unilingual Cantonese
patient never regained the ability to communicate, move, swallow, or breathe without medical
aid. Only after being admitted for two weeks, did the comatose patient have a family member
willing to be the substituted consent decision maker who was unable to reply to many
fundamental questions concerning the patient’s wishes and past medical history. While under the
writer’s care, the patient developed a spike in temperature and significant episodes of
desaturation despite the maximum oxygen delivery system on the floor and had to be transferred
back to the ICU. The substitute decision maker went against the physician’s advice to changing
the patient’s level of intervention from a levels 1 to a level 4. The writer, who was a passively
present during the discussion, was left battling her own morally distressing issues while

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continuing to provide personally unethical care to the patient while being supportive to the
family’s decision.
Using reliable nursing references, the paper will explore and discuss the mismatch of
viewpoints regarding futile care and propose effective strategies to help in the resolution process.
The first stance will focus on the moral and ethical burden felt by nurses when the care provided
is no longer in the best interest of the patient. Secondly, examining the surrogate decision makers
stance in deciding to choose futile care against all medical advice. Emphasis will be on
miscommunication and the implications of culture and religion in the decision-making process.
Issues Encountered
 Holding onto ethical situations when providing treatment to a medically futile patient
 Conflicting personal ethical values and beliefs of others to withdraw treatment to such
patient
 Families prolonging a patient’s life against the physician’s advice (where further
treatment is futile)
Credibility Dissection
The primary purpose of conducting research is to gain knowledge from reliable and
credible sources to improve health care practises. Nursing care decisions are backed by research
from evidence-based nursing practice. During the data collection process, seven articles were
selected. The following article, “A Culture of Avoidance: Voices from Inside Ethically Difficult
Situations,” is an example of a credible article. The up-to-date nursing article was published
within the past five years and accessed using the professional databases CINAHL (Cumulative
Index to Nursing and Allied Health Literature). This article comes from a primary source rather
than a secondary source, as such articles may be biased (Davies & Logan, 2018, p. 36). The main

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writer of the article has the authority to speak about the topic as she is a Registered Nurse. The
article was also published in a Nursing Journal.
Another important criterion is that the article has been reviewed through an independent
peer-review process, which represents scientists, not paid editors, to judge papers that are worthy
of publication. The research used double-blind peer-review, which means that identifying
information about the authors and financial links associated with the article were removed before
the review process, giving reviewers objectivity (Davies & Logan, 2018, p. 38). The process is
critical because the research is considered balanced, purposeful, and free of commercial bias.
My Stance
In the age of Modern Medicine and medically invasive procedures, ventilators, dialysis,
feeding tubes, and other life-sustaining support measures give patients a greater chance for
survival, but to an uncertain end. Due to these treatment modalities, patients waiver of the
natural dying process in hopes of prolonging life. Caring for the physical, emotional, and
spiritual needs of patients and their families are the primary responsibilities of a nurse. The
opportunity to support, encourage, and be present for patients is a valuable part of nursing.
However, certain factors can complicate care and leave the nurse ethically and morally
distressed. Nurses are bound by the code of ethics, policies, and procedures in the hospital to
which they are employed. However, as the writer sees, there are still many grey areas. Providing
life-sustaining interventions on a medically futile patient is disheartening from the perspective of
a nurse. In some cases, Nurses can no longer act in the best interest of the patient. If nurses
continue to suffer from these conditions, moral distress can easily escalate to burnout.
According to Burkhardt, Nathaniel & Walton (2018, p. 252), medical futility can be
understood as starting a life-sustaining treatment that is seen to offer no hope or improvement