path for Harry
Determining the best path for Harry
Now view two different pathways that can be taken with Harry.
In progressing through each pathway, you can reflect upon the care decisions made, how you would feel if you were involved in this care, and how the care decisions impact upon Harry and his daughter.
Pathway 1
Finish your shift and go home
Pathway 2
Escalate the situation
Pathway 1
Finish your shift and go home
neurosurgical doctors.
to keep everything as it is until the team review Harry in the morning.
arrest by the nursing staff, and a Code Blue is called.
and administer adrenaline.
when the code blue team decides to “call it”.
neurosurgical doctors.
to keep everything as it is until the team review Harry in the morning.
arrest by the nursing staff, and a Code Blue is called.
and administer adrenaline.
when the code blue team decides to “call it”.
You feel you have done all you can, and the responsibility rests with the neurosurgical doctors. Harry is handed over to the night staff, and it is conveyed that the registrar said to keep everything as it is until the team review Harry in the morning. You write in the medical file and leave the ward.
In the early hours of the morning, Harry is found pulseless in cardiorespiratory arrest by the nursing staff, and a Code Blue is called. The ward staff commence CPR and the Code Blue Team arrive to continue resuscitation and administer adrenaline. The nurse in charge is unable to reach Harry’s daughter by phone, and Harry is declared dead approximately 20 minutes later, when the code blue team decides to “call it”.
Which of these best represents your reactions to this outcome?
These things happen. There is nothing else that could have been done
We can’t always prevent harms that happen to the people in our care. We work in a system characterised by risks and uncertainties, power differentials, and a strong and pervading hierarchical culture. Consequently, we may feel powerless in light of these structures. However, we are all moral agents, and we are collectively responsible for the patients under our care. It is always worth remembering there may be another way to understand the situation, and consider other alternatives – Explore the other option
Uneasy about this outcome. It feels like something different should have been done, but I’m not sure what
This unease has a fundamental ethical dimension. While Harry’s outcome is now determinative, this unease is an important trigger for ethical reflection about what else potentially could or should have been done. Even if this is uncertain, the process of critical reflection helps guide decision-making next time – Explore the other option
Pathway 2
Escalate the situation.
is best for Harry.
explain the situation from your perspective.
neurosurgical registrar
and a focus on quality of life and comfort...
life medications for comfort measures.
in attendance.
is best for Harry.
explain the situation from your perspective.
neurosurgical registrar
and a focus on quality of life and comfort...
life medications for comfort measures.
in attendance.
A phone call is then made to Harry’s daughter to discuss his deterioration, and a focus on quality of life and comfort given his previously expressed wish to “call it quits” if “things are looking bad”. Harry’s daughter agrees with this palliative approach. Lines are removed and unnecessary medication is ceased. As needed pain relief and anxiolytics are charted, along with other end of life medications for comfort measures. Harry dies peacefully in the early hours of the morning, with his daughter in attendance.
In the following three video’s, experts explore the healthcare professional’s responsibilities, ethical considerations, and options regarding how to proceed, where staff believe that patients might be harmed by the healthcare decisions being made.
Prof Ian Kerridge
“What ethical responsibilities do healthcare professionals have if they believe patients are being harmed?”
Prof Ian Kerridge
“Where healthcare staff have concerns about patients being harmed, what should they do?”
Dr Jan Maree Davis
“What should healthcare staff do if they think a shift to the palliative approach is needed for a patient?”