Reference no: EM133527461

Case Study: Dwayne comes into the ER with complaints of cough, shortness of breath, and chest discomfort . Nadine is the nurse and starts taking the patient's history; Dwayne informs Nadine that he has been living on the streets for the last year after losing his job. He tells Nadine that he does not even know why he came to the hospital because he does not want anything done because he also has pancreatic cancer. Dwayne reports that he would have been on a transplant list, but he had no way of making the appointments due to living conditions. . He also tells her that he never wants to be a burden on society by being on a breathing machine or having a feeding tube. Nadine asks the patient if he has a living will and he informs her that he did at one time, but longer has one. He tells Nadine that he has DNR tattooed on his chest to make sure no one attempts to save his life. He asks Nadine if the hospital can give him a new living will so he can sign it in case something happens. He reports that he has no immediate family. Nadine tells him she will bring the paperwork in for him to review the living will when she finishes his health history. The patient reports that he knows he is supposed to be on blood pressure medications, but he cannot afford the medications and he has no safe place to keep them. Nadine finishes the history and leaves the room. Within a minute of Nadine leaving the room, Dwayne's EKG shows ventricular fibrillation. A code is called and when Nadine arrives in the room, the physician is directing the code, Nadine tells the physician that the patient is homeless, has no family, and requested to be a DNR, but he coded before she could get him the paperwork to sign. After 30 minutes, the physician stops the code due to futility and pronounces Dwayne's time of death.

Questions:

1. Applying the principle of autonomy to Dwayne, has his freedom to make the decision to be a DNR been violated?
2. Apply the principle of beneficence to Nadine and the ER physician. Is it right that all life-saving techniques are being performed on Dwayne when he goes into ventricular fibrillation?
3. What is meant by "the code is stopped due to futility?"
4. On what basis should someone receive a transplant? What are the ethical issues regarding transplantation?