Chapter 2

Suggestions for Though

Case Presentation

Nursing Students Face an Ethical Dilemma

Tonya and Lydia are two senior nursing students assigned to work in the intensive care unit with a critically ill patient. The patient, Mr. Dunn, is an 87-year-old retired ironworker. He lives alone in an old two-story frame house. Mr. Dunn is diabetic. He is nearly blind and has moderately advanced prostate cancer and Alzheimer’s disease. Mr. Dunn was admitted to the intensive care unit after he was discovered unconscious in his home by a neighbor. At that time, he was ketoacidotic and had a very severe necrotic wound on his left leg. The surgeon plans to amputate Mr. Dunn’s left leg but has been unable to get consent from either Mr. Dunn or his next of kin, a niece who lives out of town.

Tonya is proud of her efficiency as a nursing student. She makes rapid decisions. As they discuss the case, Tonya insists that Mr. Dunn must have the amputation. She boldly suggests to the physician that he have a surrogate appointed for Mr. Dunn so that the surgery can proceed. The course is clear to her. Lydia, on the other hand, is not certain of the correct course of action. She talks to Mr. Dunn and his niece about his condition. She wonders if the amputation is the best solution to his problem. She thinks about what his quality of life will be after the surgery. She worries about his ability to care for himself and about his state of mind should he be forced to live in a nursing home. She thinks about what she would want for her own father if he were in the same situation. Lydia falls asleep at night pondering these thoughts. She does not know how to go about solving the problem. Tonya is impatient with Lydia. She thinks that Lydia wastes her time and energy worrying about this problem when the solution is apparent to her.

Think About It

Facing Ethical Dilemmas

Consider your own response to the case. Elements of the case likely make you feel uncomfortable……

This question calls for personal reflection. We would hope that you take difficult ethical decisions seriously and dedicate thought to the best possible solution.

As you move through the textbook, you will learn more about ethical decision making and nurses’ roles as members of decision-making teams. Consider how you would thoughtfully examine your own position on the decision-making team and contribute appropriately.

• With which qualities of each nurse do you identify?Again, this question calls for your personal thoughts.