Mr. W. is a 67-year-old patient in the coronary care unit who has severe heart failure and chronic obstructive pulmonary disease. Mr. W. has been in and out of the hospital for 3 years and requires...

Mr. W. is a 67-year-old patient in the coronary care unit who has severe heart failure and chronic obstructive pulmonary disease. Mr. W. has been in and out of the hospital for 3 years and requires oxygen therapy at night. He has severe, chronic chest pain and dyspnea. He had a respiratory arrest and was put on the ventilator last night. He awakens after the resuscitation and communicates that the breathing tube be removed and that he be allowed to die. He is tired of the pain and dyspnea. He asks for medication to make him comfortable after the tube is removed. His family agrees with the plan of care.

Mr. W.’s wishes are followed. He is extubated and is given morphine for sedation and comfort. Mr. W.’s family members all remain at the bedside, taking turns holding his hand and talking to him.

Questions

1. Apply the ethical decision-making model discussed in this chapter to this case. What are the relevant ethical principles? Are there other areas that must be assessed before proceeding?

2. As the critical care nurse caring for Mr. W., what are your priorities at this point? On what ethical principles are these priorities based?

3. Suppose that you have strong religious beliefs about withdrawal of life support. If you were assigned to Mr. W., what actions should you take?