How can the nurse facilitate discussions with the family about treatment goals for D.C.?

Entitlement to Treatment

Situation

D.C., a 35-yr-old English tourist, was in a hang-gliding accident while

touring the United States. She was taken to the regional trauma center

for treatment of internal injuries, blood loss, and severe pelvic

fractures. She has become septic, is now in renal failure, and has

ARDS. She has no health insurance. Despite a poor chance of

survival, her husband and parents want all possible measures to be

taken.

Ethical/Legal Points for Consideration

• Federal law requires hospitals receiving federal funds through

Medicare and Medicaid to provide emergency evaluation and

treatment to stabilize patients (Emergency Medical Treatment

and Active Labor Act [EMTALA]). Once the patient is stabilized,

they are under no obligation to continue treatment and may

transfer the patient to another facility.

• Discussions with the family must occur to clarify treatment goals

(e.g., recovery, survival, continued biologic existence,

nonabandonment of the patient) and what they mean by wanting

“everything done.” There is no legal or ethical obligation to

continue medical treatment when treatment goals cannot be met.

• Contact with the English consulate may result in collaboration to

stabilize the patient and transport her to England.

• Neither HCPs nor hospitals are required to provide medically

futile care (care that provides no benefit to the patient).

• Although her home country (England) offers universal health

care, D.C. assumed the risk when engaging in a potentially

dangerous activity and did not obtain international health

insurance coverage for her visit to a foreign country.

Discussion Questions

1. How can the nurse facilitate discussions with the family about

treatment goals for D.C.?

2. Are family members able to state D.C.’s wishes for her own care

in such a situation?

 

find the cost of your paper

set up and solve a case-study example of the light-intensity distribution in a photochemical reactor.

Photochemical reactor modeling: a case-study problem. Although radiation is important in heat transfer, an analogous model can be used in the design of photochemical reactors. The modeling of these reactors….

Write a critique on this technique of secondary-emission measurement.

Secondary-emission measurement: a case-study problem. An indirect way of measuring of secondary emission from ponds or large bodies of water used in waste treatment is to measure the concentration and….

set up a mass transfer model and evaluate the variation of the local mass transfer coefficient at various locations in the plate.

Chemical vapor deposition (CVD) on an inclined susceptor: a case-study problem. An important application of convective mass transfer theory is in CVD processes employed to coat surfaces with thin films….