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Ethical Dilemma of Terminal Prenatal Diagnosis

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Laura Shimel

on 2 March 2014

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Transcript of Ethical Dilemma of Terminal Prenatal Diagnosis

Principles & Provisions
Beneficence-"to do good."
Nonmalifience-"to no harm."
Fidelity-"faithfulness or honoring one's commitments or promises."
Autonomy-"individual has right to determine their own actions and the freedom to make their own decisions."

1.1 and 1.4- it is the nurses professional duty to respect the patients' human dignity and right for autonomous self-determination to decide with the “moral and legal right…what will be done with their own person." (ANA, 2001, p. 11).
1.3- tied with the ethical principle and duty of beneficence and nonmaleficence, delivering “dignified and humane care” (ANA, 2001, p. 12).
2.1- concerned with the nurse’s commitment to the recipient of nursing and healthcare service, states that “the nurse’s commitment remains to the identified patient." (ANA, 2001, p. 14).
3.5- when the “healthcare delivery system threaten[s] the welfare of the patient” the nurse should and can take appropriate action to notify appropriate authority (ANA, 2001, p. 19).

Consequences & Assumptions

If mother terminated pregnancy, or placed Baby K on palliative care, she may have suffered spiritual anguish.
The cost of medical care was $1450 per day for six months in the PICU, totaling roughly $260,000; plus $100 per day in a nursing home.
Baby K only had vital body functions, no brain function.
Baby K had no quality of life, had 2.5 years of suffering severe respiratory problems.

That the mother will want MORE that strictly comfort measures.
That the mother is the deciding factor in the child’s fate (MD oath)?
That the mother understands the magnitude and severity of anencephaly (EDUCATION

Arguments for Full Medical Care
Provisions 1.1, 1.4- respect the patients' human dignity and right for autonomous self-determination, mother is legal guardian and legal decision maker (ANA, 2001, p. 11-13).
Humane care is the nurse’s commitment to the ethical obligations of the nursing profession, supports ethical principle of fidelity and ANA provision 2.1 (ANA, 2001, p. 14).
Respecting mother’s religious views that all life is precious and needs to be protected that only God should decide how long the baby lives.
Due to the ethical principles and ethical provisions the nurse is ultimately responsible for advocating for the infant and providing care and educating the mother about her child and her child’s medical condition and procedures.
American Medical Association. (2014).
American medical

American Nurses Association. (2001).
Code of ethics for

Chitty, K., K., Black, B., P. (2011).
Professional nursing

Paul, R., Elder, L. (2011).
Understanding the foundations of

Romesberg, T., L. (2003). Futile care and the neonate.

The Dilemma
Baby K born in 1992 with anencephaly that was discovered prenatally.
Untreatable, infants typically survive only a couple of weeks with palliative care.
Mother carried the baby to term and had infant placed on ventilator at birth.
Physicians and ethics committee recommended the mother sign a DNR, but she refused.
Baby K readmitted to several times for respiratory distress and apnea.
At 6 months, Baby K admitted to hospital where tracheostomy was performed
Case taken to court.
Mother would not place Baby K on palliative care based on religious beliefs
Spent many months in the PICU and nursing home-covered by private medical insurance and Medicaid.
Baby K died in 1995 at 2.5 years old of cardiac arrest.

Key Players & Stakeholers
Ethical Dilemma of Prenatal Terminal Diagnosis
Christie Silberman

Debbie Nover

Laura Shimel

Marielle Elizabeth Massey

Shelby Nelson

Shamila Powar

Olympic College

Nursing Ethics II


Dawnette Johnson, RN, MSN

March 3, 2014

Advances in Neonatal Care, 3
(5). Retrieved from: http://www.medscape.com/viewarticle/464018_4.
ethical reasoning
(3rd ed). Tomales, CA: Foundation for Critical Thinking.
nurses with interpretive statements
. Silver Spring, MD: Nursebooks.org.
association policy on end-of-life care
. Retrieved from: http://www.ama-assn.org//ama/pub/physician-resources/medical- ethics/about-ethics-group/ethics-resource-center/end-of-life-care/ama-policy-end-of-life- care.page.
(Chitty & Black, 2011, p. 108-109).
Arguments Against Futile Care
Can be difficult on caregivers, may see themselves as forced to act against the best interests of the patient.
Baby K will not experience anywhere remotely close to a good quality of life, withholding care means less suffering.
Child will eventually pass, making him/her comfortable is ethical
Beneficence, non-maleficence.
Physician oath to deny treatment when medically futile per AMA Code of Ethics.
Expenditure of resources and finances in futile care.
Conflicting with principles of justice.
Provision 1.3- nurses are advocates and leaders in delivering “dignified and humane care” that minimizes unjustifiable treatment and patient suffering (ANA, 2001, p. 11).
As professionals, medicine and nursing uphold certain standards and values as their own. Continuing futile treatment to Baby K undermines the integrity and goals of the health care team.
(Romesberg, 2011).
concepts and challenges (6th ed). Maryland Heights, MO: Saunders Elsevier.
(Romesberg, 2011).
Full transcript