Nursing Assignment: Ethical Analysis of a Heart Failure Case Study

This nursing assignment presents a case study of an elderly patient with heart failure, exploring the ethical issues surrounding treatment decisions. The patient, suffering from multiple health complications, experiences complications with a left ventricular assist device and wishes to discontinue treatment due to pain. The assignment highlights the conflict between the patient's autonomy, the doctor's and wife's perspectives, and ethical considerations regarding informed consent and the right to refuse treatment. The student, acting as a nurse practitioner, identifies the ethical dilemma and proposes strategies to address it, emphasizing the importance of respecting the patient's wishes and the need for informed consent. The discussion includes references to relevant literature and legal frameworks, such as the Patient Self-Determination Act, to support the ethical position. The conclusion reiterates the significance of patient autonomy in life-sustaining treatments and the role of the nurse in advocating for the patient's rights. The assignment also considers the ethical implications of withholding and withdrawing treatment, the role of surrogates, and the importance of open communication in healthcare decisions.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the student:
Name of the university:
Author note:

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NURSING ASSIGNMENT
Introduction:
Ethical consideration in the treatment of the patient is extremely essential in order to
avoid any further ethical and legal issue (Aitamaa et al., 2019). This assignment includes the case
study of an elderly patient suffering from heart complication. The ethical issue associated with
the case study is mentioned in the discussion along with the impact of that issue on the
healthcare professional. Being a nurse practitioner, it is my responsibility to evaluate strategies
that can help to overcome the ethical issue. The primary focus of the discussion is to evaluate the
ethical issue associated with the case study.
Identified issue:
The issue identified for the discussion is the case study of RM, who is an elderly patient
of age 71 years has been suffering from heart failure. The patient has a past medical history of
type 2 diabetes mellitus, ischemic cardiomyopathy and chronic kidney disease. The patient has
been collapsed at home and is admitted to the hospital. After assessing the patient, the doctor
suggested to his wife that the patient will have to take support of left ventricular assist device
which was also considered as the life sustaining or destination therapy. The patient has
experienced arterial clot after left ventricular assist made has been provided and due to which the
patient has decided to quit the treatment as he does not want to tolerate so much of pain. Hi wife
does not want him to quit the treatment and want him to live. The doctor also seems to be
confused and does not want to withdraw he treatment (Allen, 2019).
According to me, it is not ethical for his wife or the doctor to continue the treatment
without the consent of the patient. Though it is not easy for any individual to let go their closed

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ones, but for that making them tolerate the painful treatment which might increase their pain and
might make their health worse is unethical.
According to the Horner et al., (2016), the patient have the right to choose and have the
right to refuse the care if they are not happy with the treatment and its consequences. The right to
choose indicates the patient preferences to select a medical therapy among all the available
options. According to the patient Self-Determination Act, before starting any treatment, the
informed consent from the patient or the surrogate must be taken (Bennett, 2016). In this case,
the wife of the patient have given the permission to use left ventricular assist device for the
patient which is ethical, however after the patient has gained its decision making skill, he wants
to quit the treatment as it is giving him more pain, but neither the doctor nor his wife is
convinced with the patient which is non ethical.
The device which is implanted for the patient comes with other burdens and will also
have negative impact on the life style of the patient. It will remain with the patient till the end of
his life and will make his life more complicated (Rogers, et al., 2017).
As a nurse practitioner, I observed that this is an ethical issue and hence to be considered
effectively. The left ventricular assist device was implanted for the patient when the patient was
unconscious which could be avoided. As implantation of such life sustaining devices should not
be done without the prior consent of the patient. It can only be done, when the patient had
prepared a bill which will state the name of the individual that will make the decision in the
behalf of the patient if the patient will lost his decision making skill (Grady, 2015). However in
this case no such surrogates were prior made by the patient which will make the decision in his
behalf.

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In order to address the issue, I will talk with his wife and will try to make her understand
that it is unethical for her to hold the treatment of her husband is not happy with the treatment
and is getting more pain due to this. The doctor will also be informed about the ethical
consideration of withholding and withdrawing a treatment and withdrawing a life sustaining
treatment is not non ethical.
Conclusion:
From the above discussion, it is concluded that withholding and withdrawing a treatment
which is life-sustaining should not be done without the prior consent of the patient. If in the case
the patient has lost his decision making skill, the decision will be taken by the surrogate. Any
treatment and therapy is to be done by taking the informed consent of the patient. Strategy that
can be used by nurse practitioner in such situation is discussed in the assignment.

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Reference:
Aitamaa, E., Suhonen, R., Iltanen, S., Puukka, P., & Leino-Kilpi, H. (2019). Ethical problems in
nursing management: frequency and difficulty of the problems. Health care management
review.
Allen, L. (2019). How Should Physicians Respond to Requests for LVAD Removal?. Retrieved
21 July 2019, from https://journalofethics.ama-assn.org/article/how-should-physicians-
respond-requests-lvad-removal/2019-05
Bennett, M. (2016). Nursing Care at the End of Life: 25 Years After the Passage of the Patient
Self-determination Act. Journal of Hospice & Palliative Nursing, 18(6), 550-555.
Grady, C. (2015). Enduring and emerging challenges of informed consent. New England Journal
of Medicine, 372(9), 855-862.
Horner, J., Modayil, M., Chapman, L. R., & Dinh, A. (2016). Consent, refusal, and waivers in
patient-centered dysphagia care: Using law, ethics, and evidence to guide clinical
practice. American journal of speech-language pathology, 25(4), 453-469.
Rogers, J. G., Pagani, F. D., Tatooles, A. J., Bhat, G., Slaughter, M. S., Birks, E. J., ... &
Gregoric, I. D. (2017). Intrapericardial left ventricular assist device for advanced heart
failure. New England Journal of Medicine, 376(5), 451-460.