Ethics Presentation

NURS 362
Lisa Chee
Melanie Goo
Grace Kim
Chelsey Miyake
Amber Suzuki

Ethical Dilemma Case 3

Infant is born with anencephaly but has brainstem
function and is breathing on his own
Child has no higher brain function and will likely die in a
few days
Parents decide to donate their child's organs
Medical team suggest that they can keep the infant
alive in order to allow more time for the growth of
organs and to match potential organ recipients

Ethical Dilemma Case 3

Parents agree to medical teams decision
Infant is intubated, placed on a ventilator, and GT for
nutrition & fluids
Nurse disagrees with parents decision to keep infant
alive to harvest organs. The nurse states, "This creeps
me out. This is so wrong and not why I became a nurse.
This reminds me of that movie, "Coma!"
Local news station reports this case through an
anonymous source and it spreads nationwide

Ethical Decision-Making Model

1.
2.
3.
4.

Identify the ethical issues & problems

Identify & analyze available alternatives for action
Select one alternative
Justify the selection

Ethical Analysis
Problem 1 - Issue of organ transplantation
Keeping infant alive simply for harvesting organs
Avoiding life support
Problem 2 - Issue of nurses actions
Respecting parents wishes
Expressing disapproval

Problem 1
Keeping infant alive simply for harvesting organs
Ethical principle
o Autonomy: personal freedom & right to make
choices (Cherry & Jacob, 2011, p. 190)
o Utilitarianism: best decision is the one that brings
about the greatest good for the greatest number of
people (Cherry & Jacob, 2011, p. 191)

Evidence-Based
Autonomy - Most parents choose to abort upon diagnosis;
nevertheless, some do choose to carry the baby to full term
in hopes of donating its organs (Gilman, 2013).
Utilitarianism - Solid organs from one donor can be used
for up to nine recipients (Wilkinson & Savulescu, 2012).
Anencephaly can be detected very early in pregnancy, so a
woman who is pregnant with such a fetus may choose to
have a therapeutic abortion.

Problem 2
Respecting parents wishes
Ethical Principles
o Beneficence: one should do good & prevent or
avoid doing harm (Cherry & Jacob, 2011, p. 190).
o Fidelity: loyalty, fairness, truthfulness, advocacy, &
dedication to patients; agreement to keep promises
(Ethics Resource Center, 2009, p. 2).

Evidence-Based
Donation can play a role in the grief process. It may be a
consolation that the death is not entirely meaningless.
When the patients concerned are those who lived for
others, donation can be seen as an expression of who
these persons really were (Dierckx de Casterl, et al., 2011).

Evidence-Based
RNs Right to Refuse Care
Federal Health Care Provider Conscience Protection Laws (Church
Amendments, Section 245 of the Public Health Service Act and the
Weldon Amendment) prohibit patients receiving financial
assistance from discriminating against certain healthcare providers
based on their refusal to treat the patient due to moral and religious
beliefs (U.S. Department of Health & Human Services, 2012)

Evidence-Based: Cultural Competency

1st page of search engines (e.g. Google) affects family members decision to
donate organs in the context of brain death (Bresnahan and Mahler, 2010).
Buddhism: Buddhists believe that organ donation is a matter of individual
conscience & place high value on acts of compassion. Buddhist belief honors
people who donate their organs for the advancement of science & saving lives
Hinduism: Donation of organs is an individual decision for Hindus
Judaism: All branches of Judaism support & encourage [organ] donations.
Islam: The religion of Islam believes in the principle of saving human lives
permitted organ transplant as a necessity to procure that noble end.
Catholicism: Catholics view organ & tissue donation as an act of charity & love.
Transplants are morally & ethically acceptable.

Our Decision
Support parents decision and right to choose
o Utilitarianism
o Autonomy
Nurses actions were unprofessional
o Comments
o Breach in confidentiality (alerting the media)
o Cultural competence

References
Bresnahan, M., and Mahler, K. (2010). Ethical debate over organ donation in the context of brain death. Bioethics, 24(2): 54-60.
Brierley, J. (2013). Current status of potential organ donation in cases of lethal fetal anomaly. Obstetrician & Gynaecologist, 15(3), 184-188.
doi:10.1111/tog.12027
Cherry, B. & Jacob, S. (2011). Contemporary nursing: Issues, Trends and Management (6th ed).
St. Louis: Elsevier.
Erlen, J. A. (1990). In My Opinion... Anencephalic Infants as a Source of Organs: The Need for Caution. Children's Health Care, 19(3), 187.
Ethics Resource Center. (May 29, 2009). Definition of values. Retrieved from http://www.ethics.org/resource/definitions-values
Dierckx de Casterl, B., Verhaeghe, S. T., Kars, M. C., Coolbrandt, A., Stevens, M., Stubbe, M., & ... Grypdonck, M. (2011). Researching lived
experience in health care: Significance for care ethics. Nursing Ethics, 18(2), 232-242. doi:10.1177/0969733010389253
Gilman, S. (2012). The use of anencephalic infants as an organ source: An on-going question. Elon Law Review, 4(1), 71-92. Retrieved
November 5, 2014, from http://www.elon.edu/docs/e-web/law/law_review/Issues/Elon_Law_Review_V4_No1_Gilman.pdf
U.S. Department of Health & Human Services. (May 2012). Overview of federal statutory health care provider conscience protections. Retrieved
from http://www.hhs.gov/ocr/civilrights/faq/providerconsciencefaq.html
Wilkinson, D., & Savulescu, J. (2012). Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of
organs for transplantation. Bioethics, 26(1), 32-48. doi:10.1111/j.1467-8519.2010.01811.x