Morality

As a nurse, I have plenty of situations that I can recall where I've felt a sort of "moral dilemma." I can remember a specific patient, around 19 years old, with a hypoxic brain injury, that spent months on our unit. The acuity level of this patient was such that, often times, as a charge nurse, I’d be afraid to leave the patient alone for safety reasons. He was in constant movement, compromising his safety, but his movements were not purposeful. He could not communicate effectively, however, he would cry out in, what seemed to be desperation and would only minimally make eye contact. He was incontinent and becoming contracted. He could not participate in therapy. We had this patient in rehab for months with basically no signs of progress despite intense therapy. This was, by far, one of the most disturbing, devastating, brain injury cases I had seen on over 5 years.

            In this case it became increasing hard not be “broken down” on a daily basis. I began having nightmares during the time I was caring for this patient. I can also distinctly remember standing by this patient’s bed, on my own, holding him to keep him safe as he was perspiring from spiking yet another temperature over 102, he was yelling and crying out, and I was crying. This was not a normal occurrence for me. I knew we would be sending him to ER again, where nothing new would ever be determined, and all that would happen was that he was going to be caused distress. This patient’s mother did not accept her son was not expected to recover back to a level of independent function.  None of us believed this patient should be repeatedly hospitalized, or given any measures to preserve life as, it was felt that, there was simply no quality. However, his mother was in charge of his advanced directives, and thought otherwise.  All of the healthcare team felt that, to live in this manner, was simply inhumane. However, day in and day out, we were faced with this mother’s despair and the patient’s suffering. 

I don't feel like there's any perfect answer in this situation. What is right and wrong? I think you go with the basic "wellbeing" of the person, like Sam Harris speaks to (Harris, 2010). However, navigating this in healthcare is not easy. And again, sometimes we find ourselves in these "teams" that we form with others and can't figure out how to get out....or beg to differ with another's opinion.