When an unauthorized immigrant suffers a brain injury, who decides when treatment is withdrawn? An ethical dilemma touches on issues of clinician autonomy and justice versus patient and family autonomy.
Imagine that someone you love—a young person—suddenly collapses and is rushed to the hospital. Her heart is restarted, but it soon becomes apparent that there has been extensive anoxic brain injury. In a vegetative state, on a ventilator, no ability to follow commands, spastic extremities, an EEG showing continuous seizure activity. . . . and this person is an undocumented immigrant. And uninsured.
In this month’s AJN, Kimberly Radtke and Marianne Matzo present a fictional case (based on their real-life experience in palliative care) to illustrate the ways in which this kind of scenario might play out. The parents are overwhelmed, trying to make decisions while they are still in shock. Physicians soon express their concerns about prolonging “medically inappropriate care.” And who will pay for it?
In addition, hospitalization due to critical illness increases an unauthorized immigrant’s risk of repatriation without their consent. What must the family be feeling as they struggle to understand their daughter’s future?
The role of the ethics committee.
Radtke and Matzo discuss the many ethical dilemmas that are raised by this kind of case, and describe the role of the palliative care team and ethics committee as both clinicians and the family struggle to make the right decisions. One of the provisions of the ANA Code of Ethics is that “the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” The authors point out that ethics committees can provide a forum in which nurses help to ensure that the patient’s and family’s voices are heard.
This story makes clear that showing compassion, conveying adequate information to patients and/or their families (in this case, through an interpreter), and allowing them enough time to make an informed decision are critical contributions nurses can make as families try to come to terms with sudden and catastrophic medical events.
Read this thoughtful and informative article, “Liberty and Justice for All,” in the November issue.