Moral Duty of Care

Topics: Pneumonia, Health care proxy, Medical ethics Pages: 6 (2134 words) Published: August 28, 2013
Moral Duty of Care 1


Moral Duty of Care 2
There are so many challenges when dealing with a sick loved one. But it can even more difficult when they are unable to speak for themselves, uninsured and an illegal immigrant. In this paper we will determine the best possible solution to this ethical dilemma by applying the model for making moral decisions we will explain the moral duty of the hospital.

As the director of respiratory care I will review the case by gathering all the facts that relate to this patient diagnosis as well as prognosis with consideration of her other comorbidities so that the family and other members of the meeting will get a clear understanding of what challenges we are facing in this situation. But we must also take into consideration some of the risks, by looking at the whole patient. Therefore, by beginning with the end result in mind we will be able to count our costs (Matthew 7:24-25). I will present to the family a plan of care for the patient based on the whole patient not just the diagnosis. Some things to consider when deciding plan of care would be, the age of the patient, his or her education level, economic status, race and mental status.

Given the diversity of ethnic and religious beliefs it is clear that we are facing an ethical dilemma by wanting to move an 85 year old Hispanic patient in the AICU (adult intensive care unit) to the stroke unit on another floor. Other than being comatose, on a ventilator and with a recent diagnosis of early stage of liver cancer the patient is stable.

The first thing we must consider is that the patient is on a ventilator and when patients stay on a ventilator for more than 48 hours they run the risk of contracting VAP (ventilator associated pneumonia). VAP is the leading cause and most common type of hospital acquired infection that leads to death among patients in the Intensive Care Unit (ICU) (Sadeghi, S., Barzi, Moral Duty of Care 3 A., Mikhail, O., & Shabot, M., 2013). VAP occurs in 10-20% of patients receiving mechanical ventilation and is associated with substantial morbidity, mortality, and excess in health care costs (Damschroder, L., Forman, J., Kaufman, S. R., Kowalski, C.P., Krein, S.L., & Saint, S., 2008). It is a major threat to patients admitted to the ICU and receiving mechanical ventilation. The main risk and causes of VAP is intubation due to aspiration of colonized pathogenic microorganisms on the oropharynx and the gastrointestinal tract this is the main route for the development of VAP (Alp & Voss, 2006). Secondly we must address the issue of the diagnosis of early stage liver cancer. Studies have shown that liver resection remains the only curative therapy and it is more anticipated and carried out in older patients. Surgery for elderly patients over 70 is still reluctant due to suggested age-related co-morbidity (Kulik, Framke, Grosshenming, Cevlan, Bektas, Klempnauer & Lehner, 2011). Clearly the patient is in no condition to undergo this type of surgery especially with her other history of lung cancer and heart condition and this is also a very costly surgery and the patient is uninsured.

It is understandable that the family wants the best for their mother and their faith in God is evident based on the fact that they believe the patient is going to wake up and speak of her wishes. We must look at the other facts that the patient does not have any written directive concerning life support measures or any other treatment measures set in place. Based on the findings in the case of...

References: Alp, E., and Voss, A. (2006). Ventilator-associated pneumonia and infection control. Annals of
Clinical Microbiology and Antimicrobials, 57.
Dam Schroder, L., Forman, J., Kaufman, S. R., Kowalski, C.P., Krein, S.L., & Saint, S. (2008).
Illingworth, P., & Parmet, W. (2006). Ethical health care. Upper Saddle River, NJ: Pearson.
Kulik, U., Framke, T., Grosshenning, A., Cevlan, A., Bektas, H., Klempnauer, J., & Lehner, F.
Surgery, 35(9), 2063-2072.
Rae, S. (2009). Moral choices, an introduction to ethics. (3rd ed.) Grand Rapids, MI: Zondervan.
Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. (2013). Integrating Quality and Strategy in
Health Care Organizations
Shaw, D. (2012). A direct advance on advance directives. Bioethics, 26(5), 267-274.
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