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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