Introduction
As medical technology continues to advance, options to treat what were once thought to be fatal conditions continue to increase. Extracorporeal membrane oxygenation (ECMO) has been used since the 1970s and became a common therapy for newborns with respiratory failure (Rehder, Turner, & Cheifetz, 2011). Despite ECMO’s proven pediatric use, there are still ethical concerns over this therapy. There are concerns over the expense of this particular therapy in relation to results (Richards & Joubert, 2013). There are also multiple complications that can occur while using ECMO, and recently the expansion of using ECMO in adults with acute respiratory distress syndrome (ARDS), using ECMO as a bridging therapy while awaiting organ transplantation, and also using ECMO to maintain organ perfusion in organ donation have all brought up ethical considerations. Research is ongoing to further explore these issues.
The Basics of ECMO
ECMO is an external cardiopulmonary bypass circuit that serves to temporarily replace the functions of the heart and lungs. This necessitates the surgical placement of a catheter into a central vein located near the heart and a second catheter that can be placed in either a different central vein (VV ECMO), which is used for respiratory support, or placed into artery (VA ECMO), used when the patient requires cardiac and respiratory support. These catheters are connected to the ECMO machine where the blood is pumped through an oxygenator where carbon dioxide is removed and oxygen instilled (http://nyp.org/services/carf/what-is-ecmo.html).
ECMO has an established history of being used as a pediatric modality with critically ill patients as a last life-saving effort. Yet, there still is controv...
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There has been some ethical issues surrounding the development and use of technology, that would consist of some advancements, such as “when in vitro fertilization is applied in medical practice and leads to the production of spare embryos, the moral question is what to do with these embryos” (Shi & Singh, 2008, p. 182). As for ethical dilemmas that comes into play with “gene mapping of humans, genetic cloning, stem cell research, and others areas of growing interest to scientist” (Shi & Singh, 2008, p. 182). “Life support technology raises serious ethical issues, especially in medical decisions regarding continuation or cessation of mechanical support, particularly when a patient exists in a permanent vegetative state” (Shi & Singh, 2008, p. 182). Health care budgets are limited throughout this world, making it hard for advancements yet even harder to develop the advancements with restraints. Which brings us back to the “social, ethical, and legal constraints, public and private insurers face the problem deciding whether or not to cover novel treatments” 188. Similarly what was mentioned before the decisions about “new reproductive techniques such as intracytoplasmic sperm injection in vitro fertilization (ICSIIVF), new molecular genetics predictive tests for hereditary breast cancer, and the newer drugs such as sildenafil (Viagra) for sexual dysfunction” (Giacomini, 2005).
When medical care providers are forced to make decisions and these decisions “violate one of the four principles of medical ethics” so that they can adhere to another of these principles this is considered an ethical dilemma (“Medical Ethics & the Rationing of Health Care: Introduction”, n.d., p. 1). Bioethicists refer to the healthcare ethics four principles in their merits evaluation and medical procedure difficulties as transplants. Organ and or transplant allocation policies has a mixture of legal, ethical, scientific and many others, however the focus here will be to show how the four ethical principles, autonomy, beneficence, nonmaleficence and justice, applies to transplant allocation (Childress, 2001, p. 5).
There is great debate in this country and worldwide over whether or not terminally ill patients who are experiencing great suffering should have the right to choose death. A deep divide amongst the American public exists on the issue. It is extremely important to reach an ethical decision on whether or not terminally ill patients have this right to choose death, since many may be needlessly suffering, if an ethical solution exists.
In the critical care population, patients on ventilator support require nutritional supplementation. To support the metabolic processes, healthcare providers address the initiation of feedings within the plan of care (Khalid, Doshi, & DiGiovine, 2010). For therapeutic nutritional support, providers compare the risks and benefits of enteral and parenteral feedings. Following intubation, one goal is to initiate feedings within 24 to 48 hours, to provide optimal patient outcomes, and decrease the risk of ventilator-acquired pneumonia (Ridley, Dietet, & Davies, 2011).
This can be seen in the case study as ethical and legal arise in resuscitation settings, as every situation will have its differences it is essential that the paramedic has knowledge in the areas of health ethics and laws relating to providing health care. The laws can be interpreted differently and direction by state guidelines may be required. Paramedics face ethical decisions that they will be required to interpret themselves and act in a way that they believe is right. Obstacles arise such as families’ wishes for the patients’ outcome, communicating with the key stakeholders is imperative in making informed and good health practice decision. It could be argued that the paramedics in the case study acted in the best interest of the patient as there was no formal directive and they did not have enough information regarding the patients’ wishes in relation to the current situation. More consultation with the key stakeholders may have provided a better approach in reducing the stress and understanding of why the resuscitation was happening. Overall, ethically it could be argued that commencing resuscitation and terminating once appropriate information was available is the right thing to do for the
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient's failin...
There are many different thoughts and beliefs surrounding ethics. Ethic codes of conduct are in place. Ethics has always existed but has been more closely looked at over the last 40 years. There is discussion about futile care to patients in intensive care settings and do-not-resuscitate (DNR) orders for surgical patients. Guidelines and regulations need to be followed and set forth.
A do not resuscitate order for patients who have emergency surgery is an “independent risk factor for poor surgical outcome and postoperative mortality” (Kelley , 2014 pg 1 para 3) and the probability of returning patients to their previous level of functioning is higher for CPR performed during the peri-operative period (Kelley , 2014).
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Sepsis is a life threating health condition and if not treated early can lead to shock, multiple organ failure and death (Ho, 2012). The main study of which practice has been based world-wide is the Surviving Sepsis Campaign. The Surviving Sepsis Campaign was developed to create evidence-based management guidelines. The Surviving Sepsis Campaign completed this by using an educational program to implement the guidelines by integrating their recommendations into resuscitation and management bundles (Marik, 2011). The first Surviving Sepsis Campaign Guidelines were published in Critical Care Medicine in 2004 with an updated version published in 2008 with the core of the recommendation's remained largely unchanged (Ahrens, 2011).
Hess Dean R., M. N. (2012). Respiratory Care: Principles and Practice 12th Edition. Sudbury, MA: Jones and Bartlett Learning.
...ey may require aggressive treatment, such as continuous fluid drainage and use of mechanical ventilation to help the patient to breathe. Whatever the severity of it, it is important to get medical care as quickly as possible to have the best chance of full recovery.
Another huge ethical topic is the patient’s right to choose autonomy in the refusal of life-saving medicine or treatment. This issue affects a nurse’s standards of care and code of ethics. “The nurse owes the patient a duty of care and must act in accordance with this duty at all times, by respecting and supporting the patient’s right to accept or decline treatment” (Volinsky). In order for a patient to be able make these types of decisions they must first be deemed competent. While the choice of patient’s to refuse life-saving treatment may go against nursing ethical codes and beliefs to attempt and coerce them to get treatment is trespass and would conclude in legal action. “….then refusal of these interventions may be regarded as inappropriate, but in the case of a patient with capacity, the patient must have the ultimate authority to decide” (Volinsky). While my values of the worth of life and importance of action may be different than others, as a nurse I have to learn to set that aside and follow all codes of ethics whether I have a dilemma with them or not. Sometimes with ethics there is no right or wrong, but as a nurse we have to figure out where to draw the line in some cases.