Lise Nursing Case Scenario
Lise is a new nurse on a medical unit. She graduated and accepted the position but finds she is unprepared for some situations. She is very distressed by the case of a young female patient, Caroline, a paraplegic who had a stroke and needs a ventilator. One day, Caroline asks that her ventilator be removed. She says that she would pull it out herself if she could. She is assessed and found to be capable of making this decision. Her wish is persistent, and her family confirms that the request is in keeping with her values and long-held beliefs. The physician and nurses agree that Caroline’s wishes should be respected, though Lise feels unsure. Caroline calmly says goodbye to her family. She is given hypnotics, and when she is sedated, the ventilator is removed, and she dies peacefully. Lise observes the event and thinks about it for days afterward. She consults the hospital’s ethicist, who explains that Caroline’s wish had to be respected. She had the right to ask that her treatment be halted. “But isn’t what we did considered euthanasia?” asks Lise. The ethicist tells her, “No, not at all. A capable person can say no to treatment.” The ethicist gives Lise material to read about her professional and legal obligations to respect patients’ wishes, yet Lise ultimately decides that she cannot agree. From her perspective, the removal of a ventilator is euthanasia.
QUESTIONS
- In this practice setting, Lise has a conflict of values. Elaborate on this conflict.
- Which side do you agree with?
- Do you think Lise’s discomfort with the removal of Caroline’s ventilator is an example of objecting on the basis of conscience? Why or why not?
- Should Lise’s objection be accommodated in the Intensive Care Unit? If so, can she still remain an effective team member?
- If her objection cannot be accommodated, how would you explain to Lise that she has a duty to respect patients’ informed and freely made wishes to refuse treatment, and that she cannot be a conscientious objector?