Read the article below. Identify at least THREE ethical issues found in this case. Research, explore, and present them addressing related ethical, legal, psychological, financial, societal, and financial concerns. Address any pros and cons, benefits and potential detriments aligned with facts in the article. Have there been similar cases? Be specific.

Avoid the first-person use. Follow the rules for written papers.

Nurse Refuses To Give CPR, Senior Dies: Ethical Problem Or Legal Issue?

Carolyn Rosenblatt, RN

A licensed nurse refuses to give CPR to an 87-year-old woman who collapses in the senior residence where she works because of “company policy.”  It shocks us because nurses not only know what to do in emergencies like this, they are supposed to care enough to do it.  We don’t expect to see them on the phone with the 911 dispatcher refusing to even hand the phone to a passerby so the dispatcher can instruct anyone else to administer CPR.

As a nurse and attorney, it just felt awful to read about this.

I was not surprised to learn that there was “company policy” about a nurse in an independent seniors’ residence not giving nursing care. The law does not actually allow what we think of as hands-on nursing to be given to residents who are not in a skilled nursing facility (nursing home).  Neither the state nor federal departments of health license or regulate independent living or assisted living homes.  However, the horrible image of a nurse standing by refusing to permit anyone else there to get emergency instructions from the 911 dispatcher is most disturbing, no matter what kind of a home this was.

I believe there should be exceptions in non-health care residences for emergencies like the one involving this senior, Lorraine Bayless.  A nurse who is on scene should be able to do what any trained lay person can do:  administer CPR when someone stops breathing.  If the nurse was precluded from giving CPR, what was she doing there in the first place?

The press reports that there was no Do Not Resuscitate (DNR) direction in place.  It’s a good thing for the facility’s owner Brookdale Senior Living that Ms. Bayliss’s family believed that she wanted “to die naturally and without any kind of life prolonging intervention” as they told the Associated Press.  Brookdale’s policy about what the nurse should do in an emergency was sufficiently unclear that Brookdale’s public statement was to the effect that the nurse had “misinterpreted the company’s guidelines.”  That sounds like “CYA” in case a family member later changes his or her mind and wants to blame Brookdale for not doing CPR.

We have legal documents that allow anyone to make quite clear what they want in an emergency such as stopping breathing.  There is a DNR statement or order. There is an advance health care directive to guide others if the person in no longer conscious or competent.  There is a newer document called Physician’s Orders for Life Sustaining Treatment (POLST) in some states, also called Medical Orders for Life Sustaining Treatment (MOLST).  A doctor signs it and it’s posted appropriately. It allows others to be comfortable following the person’s wishes, even if the wishes say don’t keep me alive.

This uncomfortable, ethically questionable, confusing scene over Ms. Bayliss’ end of life did not have to happen the way it did.  If you don’t want to be in that kind of situation, you need to be responsible for deciding what you want and communicating it to those who will have to act on your behalf.

Either you want emergency intervention or you don’t. If you are very clear that you do not want to be resuscitated when you stop breathing, let the people where you live know what you want and put it in writing. Post it in a prominent place and give it to the administrator of any seniors residence you choose as your home. If you have clear statement that you don’t want resuscitation and you stop breathing, no one should call 911.  Paramedics will attempt CPR every time. CPR is definitely life prolonging intervention.  The legal documents mentioned above allow you to spell out under what circumstances you want to be kept alive. It is not always so straightforward as stopping breathing, or a sudden event.

Why doesn’t everyone have a Do Not Resuscitate order or statement?  Why don’t more people fill out an advance healthcare directive or get the doctor to sign off on a POLST or MOLST form? We’re in a society that is generally rather phobic about death, much more than many other cultures in the world. Death in many other places is accepted as the natural end of life and people don’t spend as much time avoiding the very idea.  In our culture, we seem to think it’s optional.  We don’t like the idea of planning for the end.

Perhaps Lorraine Bayless has left us all with an important wake up call.  Independent and assisted living senior residences need clear written policies about resuscitation of residents. If nurses happen to be working there, they should not be frozen in place when a resident collapses and CPR can be administered by someone, including themselves.  Residents should be required to spell out their end of life wishes and emergency instructions and these should be available to those in charge.  And each of us needs to face the reality that no one gets out of here alive.  We need to think it out, write it out, and do our loved ones and those who help us the decency of making our wishes clear to them.  If a person wants no resuscitation, we have to accept the idea that we don’t have to “do something” if they stop breathing.

As I’m in the elder and family consulting business, I made sure my husband and kids know about my own wishes.  I’m pretty sure that when it’s my time to kick the bucket, they’ll let me kick it and get out of the way.  It’s not so bad to exit the way Lorraine did, fast, and probably without pain.  Her family says she had it her way.  What would your way look like?

Submit written papers that clearly and concisely answers the question(s) in the assignment.

You should include:

A cover page
A purpose statement
Introduction
Section headers
Conclusion
A minimum of four external references
Include a Works Cited/References Page
Your work should:

Be written professionally, be grammatically correct, and cited appropriately.
Reflect a logical process, flow, transitions, structure, and appropriate content.
Cohesively, clearly, and comprehensively explain ethical issues relating to healthcare today.
Have proper paragraph development, transitions, and academic tone.
General Guidelines:

Avoid use of I, you, we
12-point Times New Roman
1-in margins
Left aligned
Double spaced
Spell words out first time used, then abbreviations are acceptable
Use complete sentences in the active voice
Do not use contractions
Cite appropriately