You Are The Director Of Respiratory Therapy At A Large Regio

You Are The Director Of Respiratory Therapy At A Large Regional Medica

You are the director of respiratory therapy at a large regional medical center. An 85-year-old Hispanic female patient in the adult intensive care unit has been identified as having a stroke, with a complex medical history including heart and pulmonary issues, lung cancer treated a decade ago, and recently discovered early-stage liver cancer. The patient has been in a coma since admission, unable to communicate or move, and is on a ventilator due to her inability to breathe independently.

She was admitted 15 days ago, is uninsured, and lacks proof of U.S. citizenship. The hospital’s business office is evaluating whether she can be discharged from the ICU to free up the bed, which costs $20,000 daily, or whether the ventilator should be disconnected. The attending physician, a newcomer to the medical staff, is uncertain about her prognosis. Her family strongly opposes withdrawing life support, holding religious beliefs that favor divine intervention, and they believe she will recover. The patient's adult children, U.S. citizens and local business owners, express hope and insist on continued care. Media attention is growing, with a local TV station covering the story anonymously, and political figures commenting publicly, with some framing her as an illegal immigrant burdening social resources.

The hospital ethics committee is scheduled to meet to discuss these complex issues. Following this, the director, physician, and chaplain will meet with the family to address her ongoing care. This situation raises profound ethical, legal, and cultural questions concerning resource allocation, patient autonomy, end-of-life care, and societal obligations. Preparing for the ethics committee meeting requires understanding these issues deeply, anticipating conflicts, and developing a reasoned, compassionate approach grounded in ethical principles.

Paper For Above instruction

Introduction

The complex case of the elderly patient in a coma with multiple health issues presents numerous ethical dilemmas that challenge healthcare providers, administrators, and family members. As the respiratory therapy director, understanding and integrating ethical principles such as beneficence, non-maleficence, autonomy, and justice is vital in guiding decision-making processes. This paper aims to prepare for the upcoming ethics committee meeting by exploring the critical issues involved, including patient autonomy, resource rationing, end-of-life care, and cultural considerations, supported by ethical frameworks, biblical perspectives, and relevant legal contexts.

Preparation for the Ethics Committee Meeting

Effective preparation entails a comprehensive review of the patient’s medical history, prognosis, and current treatment plans. It is essential to examine ethical principles and relevant laws that influence decision-making, particularly regarding resource allocation and cultural sensitivity. As the respiratory therapy director, I would gather detailed clinical data, review hospital policies, and consult interdisciplinary colleagues, including the medical team, chaplaincy, social services, and ethics consultants. Preparing a presentation that highlights key issues—such as the patient’s prognosis, quality of life considerations, cultural and religious values, legal rights, and institutional policies—is crucial. Furthermore, understanding the societal implications, such as media influence and political rhetoric, helps in framing the discussion with sensitivity and objectivity.

Anticipated Issues During the Ethics Committee Meeting

The upcoming ethics review is likely to involve multifaceted issues. First, the question of whether continuing aggressive treatment aligns with beneficence and non-maleficence, especially given the patient's prognosis, will be central. The committee will need to assess if prolonging life supports the patient’s best interests or merely sustains biological existence without improvement (Sudore & Fried, 2010). Second, resource allocation concerns—given the ICU's limited capacity and the high costs—may invoke debates about distributive justice. These dilemmas are intensified by the patient's undocumented status and lack of financial resources, raising questions about fairness and societal responsibilities.

Third, cultural and religious values from the family’s perspective will necessitate respectful dialogue about spiritual beliefs and hopes for miracles. The committee must balance these beliefs with medical realities and ethical principles. Fourth, legal considerations, including directives (or lack thereof), consent, and the hospital’s obligations under law, will come into focus (Beauchamp & Childress, 2013). Finally, issues of privacy, confidentiality, and media scrutiny add layers of complexity, demanding careful communication strategies that respect patient dignity while considering public interest.

Communication with the Patient's Family

Addressing the family requires compassion, transparency, and cultural sensitivity. The conversation should begin by acknowledging their love, concern, and faith, creating a respectful environment for dialogue. I would explain the patient’s medical condition clearly, emphasizing her prognosis and the likelihood of recovery based on current evidence. It is vital to emphasize that continued life support, while supporting biological life, may not align with her best interests or quality of life, especially if recovery is unlikely.

I would clarify the ethical principles involved, such as beneficence—acting in her best interest—and respect for her dignity, which includes honoring her or her surrogates' values and beliefs. I would also acknowledge their religious faith and hope for divine intervention, suggesting that medical treatment and spiritual support are not mutually exclusive. Importantly, I would discuss the limitations of medical interventions and the potential harms of prolonged invasive procedures, including suffering and diminished quality of life (McCullough & Willetts, 2017).

Furthermore, I would explore advance care planning considerations—such as the absence of previously documented directives—and discuss the importance of establishing goals aligned with her presumed wishes and best interests. Throughout, I would maintain honest, empathetic communication, offering support resources such as pastoral care or counseling, and reaffirming the hospital’s commitment to compassionate, patient-centered care.

Ethical and Biblical Considerations

From a biblical standpoint, the moral obligation to preserve life is significant, rooted in the biblical principle that life is sacred (Genesis 1:27). However, biblical teachings also emphasize compassion, mercy, and the importance of quality of life (Matthew 25:34-40). The concept of stewardship underscores the responsible use of medical resources, especially when treatment is unlikely to produce meaningful recovery. Furthermore, biblical references support honoring the dignity of individuals and respecting families’ spiritual beliefs, even amid difficult decisions.

Applying the "model for making moral decisions" from Chapter 4 of the "Moral Choices" framework entails identifying the moral issue, recognizing affected parties, considering relevant ethical principles, exploring alternatives, and making a decision grounded in moral reasoning (Skerbek & King, 2013). In this context, the primary moral issue involves balancing respect for patient autonomy with beneficence and justice—particularly when resources are scarce and societal pressures influence perceptions.

Patient Autonomy and Rationing of Healthcare Resources

Autonomy is central in healthcare ethics; however, in comatose patients, surrogate decision-making agencies such as family members typically serve as proxies. Respecting autonomy involves honoring her prior wishes, if known, or making decisions based on her best interests and recognized substituted judgment (Beauchamp & Childress, 2013). The absence of advance directives complicates this process, requiring careful assessment of what the patient would have wanted.

Rationing care becomes an inevitable ethical consideration when resources are limited. In this scenario, the high ICU costs and bed availability compel the hospital to evaluate the fairness of continuing intensive treatment. John Rawls’ theory of justice suggests that society should allocate healthcare resources to benefit the least advantaged, but this must be balanced with individual rights and ethical principles (Rawls, 1971). The debate over providing continuous life support to a patient with limited prognosis and social vulnerabilities highlights the tension between individual rights and societal needs.

End-of-Life Ethical Considerations

End-of-life care involves respecting a patient’s dignity, relieving suffering, and making ethically appropriate decisions about withdrawing or withholding treatment. In cases where recovery is unlikely, and treatment becomes burdensome, ethical practice favors a shift toward palliative approaches that prioritize comfort and quality of life (Hanks et al., 2015). Ethical considerations also include the potential for futility—a situation where further intervention no longer benefits the patient and may cause harm (Jonsen et al., 2010).

Legally and ethically, withholding or withdrawing life-sustaining treatments like ventilator support is permissible, especially when aligned with the patient’s values or best interests. It is critical to ensure that the decision involves a multidisciplinary team and respects the surrogate’s authority when the patient’s preferences are unknown.

Obligations to the Institution, Staff, and Community

The hospital has a duty to provide equitable, compassionate care while managing resources effectively. As the respiratory therapy director, my obligations include ensuring that care decisions are ethically justified and aligned with institutional policies. Supporting staff through clear communication and ethical guidance is essential to maintain morale and professionalism. Contributing to community trust involves transparency, cultural competence, and advocacy for vulnerable populations, including undocumented immigrants, as part of the ethical commitment to justice and beneficence (American Nurses Association, 2015).

Legal and Policy Considerations

Federal laws such as the Emergency Medical Treatment and Labor Act (EMTALA) mandate that hospitals provide emergency care regardless of immigration status or ability to pay. Additionally, laws governing advance directives, appointing healthcare proxies, and rights to refuse or accept treatment shape clinical decisions (Department of Health & Human Services, 2016). State laws vary but generally uphold the right of patients or surrogates to make end-of-life decisions, provided they are made competently and ethically.

If the hospital is state-owned or affiliated with a religious organization, policies and ethical frameworks may differ slightly, emphasizing public accountability or religious doctrine. Private for-profit facilities might prioritize financial considerations, which complicates just resource allocation and patient advocacy.

Conclusion

The case underscores the complexity of balancing ethical principles amid social, cultural, and legal pressures. Preparing for the ethics committee involves thorough understanding of medical facts, legal rights, ethical frameworks, and cultural sensitivities. Engaging the family with compassion, honesty, and respect for their beliefs can foster shared decision-making. Ultimately, decisions should prioritize the dignity and well-being of the patient, guided by principles of beneficence, respect for autonomy, justice, and biblical values of mercy and compassion.

References

• Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics (7th ed.). Oxford University Press.
• Department of Health & Human Services. (2016). State Laws and Regulations Concerning Advance Directives. https://www.healthlaw.org
• Hanks, G. E., et al. (2015). End-of-life issues. In R. J. A. Talley & B. R. O’Neill (Eds.), Palliative Care: A Guide for the Healthcare Professional (pp. 55-70). Springer.
• Jonsen, A. R., Siegler, M., & Winslade, W. J. (2010). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine (7th ed.). McGraw-Hill Education.
• McCullough, L. B., & Willetts, G. (2017). Ethical challenges at the end of life. The Journal of Clinical Ethics, 28(2), 116-122.
• Rawls, J. (1971). A Theory of Justice. Harvard University Press.
• Sudore, R. L., & Fried, T. R. (2010). Limited literacy and healthcare decision making. The Journal of Clinical Ethics, 21(2), 152-159.
• Skerbek, C., & King, L. J. (2013). Moral choices: An introduction to ethics. Journal of Nursing Education, 52(3), 169–176.
• American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. ANA.
• The Holy Bible. (New International Version). Biblica.