Ethical Dilemma of Resource Management of a Vegetative Patient

Running head: ETHICAL DILEMMA FOR A VEGETATIVE PATIENT 1
Ethical Dilemma of Resource Management of a Vegetative Patient
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ETHICAL DELIMMA FOR A VEGETATIVE PATIENT 2
Ethical Dilemma of Resource Management of a Vegetative Patient
Introduction
The advancement of modern medical technology has led to better resuscitation and
supportive care of patients with acute brain injuries. As a result, there has been a significant rise
in the number of patients surviving with profound cognitive impairment (Wade, 2013). The
management of such patients has severe financial and emotional implications for both the
healthcare provider and the family. This has strained the existing hospital resources through the
provision of care to such vegetative patients (Willmott & White, 2018). Therefore, it is important
to make proper decisions on how to allocate the limited health resources on patients in vegetative
states. This has raised several ethical issues concerning the use of resources, sanctity and quality
of life, patient autonomy, beneficence, non-maleficence and justice that require a nurse to
conduct an ethical analysis when managing resources in a patient in persistent vegetative state
and take a position.
Ethical Dilemma and the Impact on Patients, Nursing Practice, and Research Process
The diagnosis of vegetative state occurs when a patient is unaware of self and the
environment with no prospect of future change. However, the diagnosis cannot be certain.
Additionally, there lacks a standard test for the prognosis thus creating making it difficult to
decide on the best course of action (Wade, 2013). One of the cons of using resources on a patient
in vegetative state includes the cost implications. The management of a patient in vegetative
states is expensive as far as resources are concerned. Another con includes the potential strain it
places on the health facility. This has raised concerns over the unethical upholding of continued
use of scarce resources to treat such patients who are unlikely to recover when the same
resources can be utilized on another patient with better odds of recovery (Reichlin, 2014). The
ETHICAL DELIMMA FOR A VEGETATIVE PATIENT 3
withdrawal of resources also compromises on a key ethical principle of non-maleficence as it
causes harm to the patient.
Research Question
Should nurses withdraw life sustaining care for vegetative patients to reduce social costs
and ensure financial savings that can otherwise be used on patients with a higher chance of
recovery?
Position on this Ethical Dilemma and Support by Current Literature
The management of a patient in vegetative state raises several ethical issues. These
ethical issues revolve around the use of limited resources to prolong life at the expense of
another more likely to benefit the patient. They include respect for the sanctity of life,
beneficence, non-maleficence, justice, and fairness. Nurses should use these ethical principles to
examine the pros and cons of continuing resource use in vegetative patients (Reichlin, 2014).
Following this, the priority of allocation of the limited resources should always rest on the
patient who stands to benefit more. Therefore, the priority of allocation of the limited resources
should always rest on the patient who has a higher chance of recovery and leading a quality life.
The principle of justice and fairness raises concerns over the distribution of scarce
resources in the hospital. Continued resource use on vegetative patients leads to inequalities in
access to healthcare by denying many other patients access to scarce health resources. For this
reason, it is ethically sound to redirect these limited resources to other patients with a higher
chance of recovery (Willmott & White, 2018). The continued use of resources on vegetative
patients prolongs agony to both the patients and their families. Most patients have terminal
injuries and sickness. Therefore, the use of these resources only prolongs the dying process
causing the patient unnecessary suffering (Manalo, 2013). This raises core ethical concerns on
ETHICAL DELIMMA FOR A VEGETATIVE PATIENT 4
the quality of life of patients in vegetative states. It also gives them time to accept the situation
and grieve in case of death. Doctors also have time to evaluate the patient and discover new and
better ways of treatment. The use of resources also honor’s the patient’s right to autonomy. The
decision of whether to prolong life artificially should follow the advance medical directives
given by the client. In case there are no guidelines, the patient's surrogate should make a choice.
However, the use of resources on a patient in vegetative states has several advantages.
First, it recognizes the biomedical ethical principle of the sanctity of life. The law advocates for
the protection of life at whatever cost. Therefore, nurses should be good stewards of life and
ensure its sanctity by making the right diagnosis for permanent vegetative states (Wade, 2013).
Once the diagnosis is correct, the use of resources to prolong life at the expense of another more
likely to benefit the patient is morally wrong. Therefore, due to the limitation of health resources,
it is important to prioritize the patient with a better diagnosis and prognosis for the use of the
available resources. This decision should be made in consultation with the healthcare team as
well as the patient’s significant others. In so doing, the health team adheres to the principle of
beneficence for the patient with a higher chance of survival.
The Advantages and Disadvantages Technology on this Ethical Dilemma
The continued use of resources including modern technological advancements on a
vegetative patient also increases the chances of survival. The extended time-frame of life-
sustaining interventions gives the family hope on the possibilities of recovery. There have been
cases of full recovery from vegetative states with the advanced medical interventions imaging,
ventilation, and medications. Technology also plays a crucial role in the diagnosis of vegetative
states and highlighting the chances of recovery for the patients (Manalo, 2013). Additionally, the
continued use of modern technology on patients in vegetative states also promotes organ
ETHICAL DELIMMA FOR A VEGETATIVE PATIENT 5
donation programs which prolong the lives of other patients. On the other hand, modern medical
technology has led to better resuscitation measures and supportive care of patients with acute
brain injuries (Reichlin, 2014). This has significantly increased the number of patients surviving
with profound cognitive impairment placing a strain on the existing health facilities. Modern
technological advancements also have the disadvantage of being overtly expensive which may
drain family resources by giving them false hopes.
Conclusion
In conclusion, the recent rise in the number of patients in vegetative states has raised
several ethical concerns in their management. As a result, nurses face several ethical dilemmas in
regards to the use of the scarce medical resources on these patients. This research paper
addressed the question on whether nurses should withdraw life sustaining care for vegetative
patients to reduce social costs and ensure financial savings that can otherwise be used on patients
with a higher chance of recovery? The findings reveal that the allocation of these scarce
resources should be prioritized with the distribution always resting on the patient who stands to
benefit more from the interventions. This will ensure adherence to the ethical principles of
fairness and justice, patient autonomy, beneficence, and non-maleficence while at the same time
respecting the patient’s right to sanctity and quality of life.
ETHICAL DELIMMA FOR A VEGETATIVE PATIENT 6
References
Manalo, M. (2013). End-of-Life Decisions about Withholding or Withdrawing Therapy:
Medical, Ethical, and Religio-Cultural Considerations. Palliative Care: Research and
Treatment, 7(1), 1-5. http://dx.doi.org/10.4137/pcrt.s10796
Reichlin, M. (2014). On the ethics of withholding and withdrawing medical
treatment. Multidisciplinary Respiratory Medicine, 9(1), 39.
http://dx.doi.org/10.1186/2049-6958-9-39
Wade, D. (2013). Ethical issues in diagnosis and management of patients in the permanent
vegetative state. PubMed Central (PMC). Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119582/
Willmott, L. & White, B. (2017). Persistent vegetative state and minimally conscious state:
ethical, legal and practical dilemmas. Journal of Medical Ethics. 43:425-426.

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