430 Chapter 17 Death and DyingCase 17-1 When Parents Refuse to Give Up1Nine-year-old Yusef Camp began experiencing symptoms soon after eating a pickle bought from a street vendor. He felt dizzy and fell down, he could not use his legs, and he began to scream. By 10:00 p.m., he was hallucinating and was transported to the DC General Hospital by ambulance. He went into convulsions. His stomach was pumped, and they found traces of marijuana and possibly PCP. He soon stopped breathing, and by the next morning, brain scans showed no activity.Four months later, Yusef’s condition had not changed. The physicians believed his brain was not functioning and wanted to pronounce him dead based on brain criteria. Several difficulties were encountered, however. First, there was some disagreement among the medical personnel over whether his brain function had ceased completely. Second, at that time the District of Columbia had no law authorizing death pronouncement based on brain criteria. It was not clear that physicians could use death as grounds for stopping treatment. Most important, Ronald Camp, the boy’s father, protested vigorously any sug- gestion that treatment be stopped. A devout Muslim, he said, “I could walk up and say unplug him; but for the rest of my life I would be thinking, was I too hasty? Could he have recovered if I had given it another 6 months or a year? I’m leaving it in Almighty God’s hand to let it take whatever flow it will.”The nurses involved in Yusef’s care faced several problems. Maggots were found growing in Yusef’s lungs and nasal passages. His right foot and ankle became gangre- nous. He showed no response to noises or painful stimuli. The nurses had the responsi- bility not only for maintaining the respiratory tract and the gangrenous limb, but also for providing the intensive nursing care needed to maintain Yusef in debilitated condition on life support systems. Had the aggressive care been serving any purpose, they would have been willing to provide it no matter how repulsive the boy’s condition was and in spite of there being many other patients desperately needing their attention. However, some of the nurses caring for Yusef were convinced that they were doing no good what- soever for the boy. They believed they were only consuming enormous amounts of time and hospital resources in what appeared to be a futile effort. In the process, other patients were not getting as much care as would certainly be of benefit to them. Could the nurses or the physicians argue that care should be stopped because he was dead? Could they overrule the parents’ judgment about the usefulness of the treatment even if he were not dead? Could they legitimately take into account the welfare of the other patients and the enormous costs involved when deciding whether to limit their atten- tion to Yusef?1Weiser, B. (1980, September 5). Boy, 9, may not be “brain dead,” new medical examiner shows. Washington Post, p. B1. Weiser, B. (1980, September 12). Second doctor finds life in “brain dead” DC boy. Washington Post, p. B10. Sager, M. (1980, September 17). Nine-year-old dies after four months in coma. Washington Post, p. B6.TitleCopyrightContentsList of CasesPrefaceIntroductionWhat Makes Right Acts Right?What Kinds of Acts Are Right?How Do Rules Apply to Specific Situations?What Ought to Be Done in Specific Cases?Two Additional Questions of EthicsWhat Kind of Person Ought I to Be?What Does This Relationship Demand of Me?EndnotesPart I Ethics and Values in NursingChapter 1 Values in Health and IllnessIdentifying Evaluations in NursingIdentifying Ethical ConflictsThe Rights of the Patient vs the Welfare of the PatientMoral Rules and the Nurse’s ConscienceLimits on Rights and RulesChapter 2 The Nurse and Moral AuthorityThe Authority of the ProfessionThe Authority of the PhysicianThe Authority of the InstitutionThe Authority of the Health InsurerThe Authority of SocietyThe Authority of the PatientChapter 3 Moral Integrity andMoral DistressWhy Does Moral Agency Matter?Moral DistressCreating and Sustaining Healthy and Ethical Work EnvironmentsEthics Environment AssessmentsResources for Establishing and Sustaining Healthy EnvironmentsChange Theory ModelsResources for Resolving Moral DistressPart II Ethical Issuesin NursingChapter 4 Benefiting the Patient and Others: The Duty to Produce Good and Avoid HarmBenefit to the PatientUncertainty About What Is Actually Beneficial to a PatientHealth Benefits vs Overall BenefitsBenefiting vs Avoiding HarmBenefit to the InstitutionBenefit to SocietyBenefit to Identified NonclientsBenefit to the ProfessionBenefit to Oneself and One’s FamilyChapter 5 Justice: The Allocation of Health ResourcesThe Ethics of Allocating ResourcesJustice in Public PolicyJustice and Other Ethical PrinciplesChapter 6 RespectIgnoring a Person as a Person and Focusing Only on the Pathology or “Task” to be PerformedArrogant Decision MakingHumiliating OthersChapter 7 The Principle of AutonomyInternal Constraints on AutonomyExternal Constraints on AutonomyOverriding AutonomyChapter 8 VeracityThe Condition of DoubtDuties and Consequences in Truth TellingComplications in Truth TellingChapter 9 FidelityPromise KeepingConfidentialityChapter 10 The Sanctity of Human LifeActions and OmissionsCriteria for Justifiable OmissionWithholding and WithdrawingDirect and Indirect KillingVoluntary and Involuntary KillingIs Withholding Food and Water Killing?Part III Special Problem Areas in Nursing PracticeChapter 11 Abortion, Contraception, and SterilizationAbortionContraceptionSterilizationChapter 12 Genetics, Birth, and the Biologic RevolutionGenetic CounselingIn Vitro Fertilization and Artificial InseminationGenetic EngineeringChapter 13 Psychiatry and the Control of Human BehaviorPsychotherapyOther Behavior-Controlling TherapiesChapter 14 HIV/AIDS CareConflicts Between Rights and DutiesConflicts Involving the Cost of Treatmentand Allocation of ResourcesResearch on HIVChapter 15 Experimentation on Human BeingsCalculating Risks and BenefitsCommentaryProtecting PrivacyEquity in ResearchInformed Consent in ResearchChapter 16 Consent and the Right to Refuse TreatmentThe Right to Refuse TreatmentThe Elements and Standards of DisclosureComprehension and VoluntarinessConsent for Patients Who Lack Decision CapacityChapter 17 Death and DyingThe Definition of DeathCompetent and Formerly Competent PatientsNever-Competent Patients and Those Who Have Never Expressed Their WishesFutile CareLimits Based on the Interests of Other PartiesAppendix Ethics Resources on the Web Bioethics Research Library at Georgetown UniversityGlossaryIndex
