An 80-year-old female patient with congestive heart failure and moderate dementia requires elective knee replacement surgery. Surgeon (Dr. Omar) and anesthesiologist (Dr. Hasan), however, considered her to be too high of a risk for surgery. Later in the week, surgeon (Dr. Mahmood), who practices with surgeon (Dr. Omar), has a different anesthesiologist approve the patient for surgery even though the patient’s family doctor expresses extreme concern regarding the patient.
On the morning of surgery, the patient suffers cardiac arrythmias, which the nurse in the preoperative waiting area notes in the chart. The Nurse spoke with Her Husband on the bedside and she realizes that he is unaware of the conflict between the surgeons involved with the case. Surgeon (Dr. Mahmood) is scheduled to go for a vacation next week, and he is on a hurry to perform the surgery before leaving. The nurse discusses the patient’s unstable cardiac status with the (Dr. Mahmood) who listened to her but proceeded with the surgery anyway.
The patient suffers a cardiac arrest during surgery. She is resuscitated and transferred to the intensive care unit, but she dies two days later.
What are some of the ethical issues in this case?
Did the Nurse Do the right thing? what would you have done??
Answers
Answer:
Cardiopulmonary arrest is a common event in hospitals, occurring most frequently in emergency departments (EDs)and intensive care units (ICUs). They always cause a great deal of stress on physicians, nurses, and others who are nearby, and they require an immediate sequence of actions designed to reverse the adverse conditions to prevent death. Resuscitations are usually well-rehearsed ballets, with each successive intervention planned in advance, departing from the routine when circumstances demand a different pathway. Anything that distracts the mayday team from their total focus on the resuscitation may pose a danger to the patient. A distraught family member in the room during a cardiopulmonary resuscitation (CPR) imposes just such a distraction. Or so most physicians have believed in the past.
Some institutions have policies that encourage family presence (FP) during CPR in EDs and ICUs. The implications and results of such policies have been studied and reported in the medical literature over more than 20 years, often concluding that the benefits of the practice outweigh the harms. Despite this evidence, most surgeons believe that allowing family members to be present during CPR is a bad idea. The following hypothetical case was the focus of the debate that follows.