200 word response wth 2 references
Throughout my healthcare career, I have experienced various healthcare roles, as I transitioned from a certified nursing assistant to a registered nurse over 7 years. During my time as a Neonatal Intensive Care (NICU) technician, I witnessed an ethical dilemma, that remains on my mind even after all these years. The ethical dilemma involved a term infant of 37 weeks, delivered via c-section due to tight nuchal cord around the neck syndrome (tCAN syndrome). This infant sustained hypoxic-ischemic encephalopathy (HIE), which is characterized as impaired cerebral blood flow and oxygen delivery to the brain with resulting primary and secondary energy failure (Allan et. al., 2011). Due to this hypoxic injury, the infant never experienced a first cry, was immediately intubated at the delivery, inserted multiple access lines, and began his month-long journey in the highest level of the NICU. As the medical workup began, the imaging of the brain and EEG gave a poor prognosis.
The ethical dilemma began when the patient’s mother failed to visit the patient in the NICU. As social workers would discover, the patient’s mother was discharged from the labor and delivery unit home and did not stop by the NICU. Now, weeks began passing and the mother of the patient would only consent verbally over the telephone and did not visit in person. The infant required certain procedural consents to be well understood by the parent, as the procedures had risks, such as infection, paralysis, hemorrhage, disability, and death. The NICU team and social workers utilized local law enforcement to summon the mother to the NICU to finally see her child in person after a months-long stay while being intubated. As the weeks passed, the patient displayed signs of decompensation, as he was on vasopressors to raise blood pressure, maxed out on all antibiotics, on albumin to keep intracellular fluid from seeping, and became a popular one among the NICU nurses. His primary nurses would buy him clothes, bathe him, give him nicknames, watch movies with him, and spend time in his room to keep him company. During an event of decompensation, the medical team aggressively worked to stabilize the patient and suggested a “do not resuscitate” order (DNR), where one would consider his quality of life and palliative measures. Potential conflicts can occur between the parental opinion of what is in the best interests of the child, the healthcare professional’s view of what is in the best interests of the child, the parental authority to make decisions for their children, the child’s future autonomy, and the parent’s view of what is in their own best interests (Eichinger et. al., 2021). The parents refused a DNR and opted to transfer, once stable and with enough weight. Now, those the parents of the minor were absent, it was rumored that the family was able to collect a disability benefit income from the patient, which seemed to be supported as he was transferred to a pediatric/infant assisted living facility with a tracheostomy and feeding tube. Word from another children’s hospital made it back to the NICU and it was said that he experienced a decompensation episode in the assisted living facility and passed after 6 months of life.