ETHICAL Dilemma: Code Status/Patient Autonomy



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Clinical Dilemmas are a new series of clinical reasoning case studies that emphasize the “art” of nursing. Each study has an emphasis that integrates aspects of caring, spiritual care, nurse engagement/presence, and ethical decision making and its relevance to nursing practice.

These case studies can be used in the classroom as an active learning tool to develop the ethical comportment of nurses as well as in post-conference in the clinical setting. Students will also develop clinical reasoning as they identify relevant clinical data, determine the nursing priority and resultant nursing interventions.

Overview of Dilemma

This clinical dilemma highlights the current code status of Mabel who has severe dementia and was recently extubated. She expressed to her husband years ago that she would not want to be kept alive long-term on a ventilator. Because of end-stage COPD, her primary care providers have communicated that if she required intubation for any reason in the future, she would likely remain on a ventilator the rest of her life. Her husband has not yet taken the initiative to honor Mabel’s stated wishes and she remains a full code.

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