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Introduction
Monica Gerrek’s paper titled “Getting Past Dax,” published in the AMA Journal of Ethics, will be analyzed in this paper. This article describes burn injuries, care, and recovery of a 25-year-old patient Dax Cowart. The story of Andrea Rubin, another person who has survived severe burns, is presented in this article as an additional voice for discussion (Gerrek, 2018). The narrative of Dax tells the tale of a person with severe, excruciating, and life-altering injuries in which the healthcare team’s decision to continue treatment contradicted the actual wish of the patient. Doctors claim that individuals with high-degree burns are not realistic about their current state and potential recovery (Gerrek, 2018). Although hospitals’ decisions were not aligned with patients’ will in both situations, the outcome was positive since treatment improved their condition and the nursing staff elevated their quality of life with appropriate support.
Nurse’s Role in Supporting the Patient’s Wishes and Risks Involved
A nurse offers patients and their families expert care, empathy, and comfort, which makes them feel supported. Indeed, the nursing staff spent more time with Dax and Andrea than with doctors, allowing them to become true advocates for these patients (Gerrek, 2018). Nurses serve as the patients’ and their families’ liaisons, communicators, and contacts (Fowler, 2015). To ensure their patients are as relaxed as possible, the nurse must be proficient in pain management (Bell, 2015). However, in helping patients, nurses may be at risk of a shortage of resources, lack of competence, burnout, and anguish in the workplace.
The nurse should always be informed of the proper course of action, but one may be constrained by the circumstances or policies. For instance, if one of Dax’s nurses hypothetically supported his wish to discontinue therapy, that healthcare worker still lacked the authority to do so. Notably, Gerrek (2018) did not mention such cases, indicating that all clinicians usually agree on defending their patients’ best interests and following the four ethical principles of beneficence, non-maleficence, autonomy, and justice. Although autonomy was ignored in the case of Dax, it was done based on the other three principles as well as the evidence about burn patients’ unrealistic pessimistic view of their potential improvement.
The Social and Economic Consequences of Reversing This Decision
If a patient is proven to have a mental capacity to make decisions about one’s treatment, healthcare practitioners should strongly consider that individual’s end goal. In Dax’s situation, clinicians reversed his decision, which might have negative economic consequences for the hospital but tremendous social benefits. Indeed, when doctors make choices, it builds trust between society and the healthcare system because these cases reveal the decency, accountability, justice, and compassion that physicians and nurses possess (Sauro et al., 2021). Conversely, if the team had agreed not to treat Dax, the patient could have died, destroying the trust between the community and the hospital. Supporting this man’s decision would be appropriate if he had a terminal illness when doctors knew there was no benefit in giving any treatment (Rosenwohl-Mack et al., 2020).
On the other hand, Cowart had a chance of a significant improvement with the proposed care; hence, the advantage of saving this person’s life outweighed the economic losses that the hospital had. Moreover, considering Dax’s occupation, he likely had medical insurance that should have covered all the expenses associated with the treatment.
Lessons to Be Learned for Similar Future Situations
From the article analyzed, nurses and doctors should strive to make rational decisions based on the evidence and consider patients’ wishes. Individuals and their families are certainly the primary decision-makers regarding the choice of therapy or lack of it; however, they may feel emotionally overwhelmed, choosing unreasonable options (Akdeniz et al., 2021). Therefore, it is vital for healthcare workers to be able to explain with empathy and patience all possible outcomes. In fact, Dax’s case was an example of how crucial it is to provide life-saving treatment. In this situation, the only possible mistake of clinicians was that they did not elaborate appropriately to the patient that his condition might improve tremendously in the future. Thus, the main lesson for similar cases is extensive and effective communication between patients, families, and health practitioners.
Effects on the Nurse and Future Practice
The nurse-patient connection influences patients’ decision-making; therefore, it is essential for nursing professionals to be fully equipped with knowledge and skills to be able to explain options to people. For example, Andrea could appreciate the caregiver’s decisions through good connections with her healthcare team. Indeed, nurses influenced Andrea to appreciate the physician’s decision to treat her despite her friends’ suggestions. Although nurses play an essential role in patient care, they are often limited by doctors’ recommendations (Li & Chapman, 2020). Still, their opinions are crucial for physicians who understand that a nurse may know the patient’s wishes better since one spends more time with that person. Hence, in the future, nurses will be more motivated to encourage patients to follow physicians’ suggestions. Furthermore, it will positively impact future practice since more nurses will be motivated in their role and thus perform better in the workplace.
Conclusion
Therapeutic decisions regarding patients who cannot make decisions may arise in a clinical setting. Confusion, ambivalence, and heavy emotional and moral load are sometimes caused by contradictions between an individual’s expressed desires and what is deemed to be the best interest. However, despite being against the patient’s wishes, the physician’s decisions led to positive outcomes in the cases analyzed. The only lesson for nurses and doctors in a similar situation is to communicate more effectively with hospitalized individuals who lost hope but still have a chance to live with dignity.
References
Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care. SAGE Open Medicine, 9, 1 – 9. Web.
Bell, L. (2015). Code of ethics for nurses with interpretive statements. Critical Care Nurse. Web.
Fowler, M. D. M. (2015). Code of ethics with interpretive statements [eBook edition]. American Nurses Association. Web.
Gerrek, M. (2018). Getting past Dax. AMA Journal of Ethics, 20(6), 581–588. Web.
Li, M., & Chapman, G. B. (2020). Medical decision making. The Wiley Encyclopedia of Health Psychology, pp. 347–353. Web.
Rosenwohl-Mack, S., Dohan, D., Matthews, T., Batten, J. N., & Dzeng, E. (2020). Understanding experiences of moral distress in end-of-life care among US and UK physician trainees: A comparative qualitative study. Journal of General Internal Medicine, 36(7), 1890–1897. Web.
Sauro, K. M., Machan, M., Whalen-Browne, L., Owen, V., Wu, G., & Stelfox, H. T. (2021). Evolving factors in hospital safety: A systematic review and meta-analysis of hospital adverse events. Journal of Patient Safety, 17(8), 1285-1295. Web.
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