Table of Contents
Summary of Case Study
This case study discusses Janet and Jake in a car accident and Janet is pregnant. Jack dies and Janet is left in a vegetative state. She had advance directives that name her husband as primary and her parents as secondary power of attorney (POA). She also had notarized handwritten statement about not wanting medical means assistance with nutrition, hydration, ventilator, or other life support. Janet’s parents decide to follow her written wish for palliative hospice care. A physician reads her chart and sees she is pregnant and investigates Kansas state laws. “withholding or withdrawal of life sustaining procedures in a terminal condition” may not withstand while pregnant (Rosell). Janet is not transferred to hospice at this time. In fact, they may need to insert a tube for feeding and breathing while the situation gets straightened out.
Options
The ethical side of this case is whether to end life support as the patient wished but does it count if she is pregnant. Legally removing life support was not a choice since she was pregnant per Kansas law (Kansas Health Care 2018). It just so happens that even though Janet made her wishes know before she was pregnant, law will make it illegal to take her off life support because she is pregnant. If Janet and Jack lived in another state their option may have remained followed.
Case Study Discussion Questions Answers
Janet’s parents need a lawyer to fight for her wishes. If she is kept alive for the baby, who would then be raise the baby? There is no information on the current situation of the parents such as financial means and their health. They may not want to start over with a baby at this point in life. The unborn baby’s rights take precedence over the parents’ wishes in the legal aspect of the case. As a registered nurse I disagree with the legal aspect and tend to lean more toward the ethical side of the case. Even though it is a law in Kansas that Janet will remain on life support because she is pregnant, I feel more information is needed (Kansas Health Care 2018). The baby may have been harmed in the accident as well as her mother and father.
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I would want to take my daughter off life support but there are so many other facts that need to be considered. If the parents can care for the grandbaby and it is their choice to keep the baby, then life support would be the best option. If in the family someone cannot have children, this would be a blessing for them to raise the baby and remain in the family. The family may have religious beliefs that need to be carried out. Although it may not seem so, I am pro-choice.
Resolution
Knowing more information about the baby’s progress in the womb at present time would help this case. The more information that is given could make the decision easier although it has already been decided by law what the outcome will be for Janet on the life support. This does not ensure the fetus to grow and form into healthy baby. There unknown information such as Janet has health insurance that will pay for her to remain on life support through the entire pregnancy. Janet took the time and effort to make a will that is official, and the parents’ wishes should be the basis for the decision. As far as Janet being kept alive for the fetus to survive, the farther along the fetus from time of mother’s brain death, the better chance of viability when baby is born (Manninen 2016).
Nurses’ Responsibility
The nurse should know state laws and hospital policies. The doctor would make the call of treating or not treating Janet. Several cases regarding ethics (Courtwright, Rubin 2017) in medical situations have been discussed. These specific occurrences are opposite of the case of Janet. The family wanted to prolong the lives of their loved ones and the hospitals wanted to remove life saving treatments. Different states rule under different laws when it comes to ethical decisions.
Conclusion
Every case is different and must be judge as such (Manninen 2016). The patients wish should be respected with no life sustaining treatments. Most ethical/ legal medical issues exist when the medical staff wants to end life sustaining treatments. This case was the opposite with family wanting the ending of life sustaining treatment and doctor wanting to keep patient alive for her fetus. Who should make these life ending decisions? Perhaps more research needs to be done using case studies such as this one to show the risks and benefits of keeping the mother on life support while the fetus develops. Just as everyone is different with different opinions, legality or ethical decisions will always be hard choices.
References
- Courtwright, A., & Rubin, E. (2017). Healthcare Provider Limitation of Life-Sustaining
Treatment without Patient or Surrogate Consent. Journal of Law, Medicine & Ethics, 45(3),
442–451. https://doi.org/10.1177/1073110517737544 - Kansas Health Care. (2018). (Pen Publishing Interactive, Inc.) Retrieved from Witchita Medical
Research and Education Foundation. - Manninen, B. A. (2016). Sustaining a pregnant cadaver for the purpose of gestating a fetus: A
limited defense. Kennedy Institute of Ethics Journal, 26(4), 399-VI. Retrieved from
https://search.proquest.com/docview/1876055425?accountid=35812 - Rosell, T. Case Studies: Our Pregnant Daughter Didn’t Want This… Center for Practical Bioethics. Retrieved from: https://www.practicalbioethics.org/case-studies-our-pregnant-
daughter-didn’t-want-this
