Instructions; Comment on at one of your peers’ posts that focus on cases other than the one you chose.

Instructions; Comment on at one of your peers’ posts that focus on cases other than the one you chose.

Follow the RISE Model for Meaningful Feedback (PDF) when writing your response posts to peer(s).

This discussion will be graded using the Discussion Initial Post and Reply rubric from your syllabus.
Discussion #1 Using the RISE model respond to the discussion question below. 1/2 page 2 references

Model ethical principles are crucial when practicing in any clinical setting during ethical decision-making. The MORAL model application will help make sure that the decision one is about to make will bring the best solution to the issue or the ethical dispute. Implementation of the first three steps of the MORAL model in the article “The Feeding Tube Dilemma” includes (M) massaging the dilemma, (O) investigating the options, and (R) resolving the dilemma (Guido, 2014).

The first step is to summarize the medical problem and plan of care. The clinicians are required to collect enough information about the benefits and burdens of inserting a feeding tube into a patient. Here, the clinicians should analyze in-depth the intentions of inserting the feeding tube to a patient. This includes thinking about the primary and secondary stakeholders in a dilemma—the impact of a feeding tube on the life of a patient and those around the patient and finally considering people involved in this case, which includes patients getting the treatment, families, and clinicians.

The second step, which is to analyze the options, requires unbiased thinking and reflection. One should carefully establish whether the advantages outweigh the disadvantages. Someone should ask some serious questions like; how will this decision affect the life of the patient? Is there another better way of handling this issue? Is this the best standard of care? The article states that most clinicians will decide to insert a feeding tube in a situation where a reversible process is applicable. In the same way, very few medical professionals recommend the use of feeding tubes in cases where the situation cannot be reversed, for example, esophageal blockage due to untreatable cancer (Dunlop, 2006). One should also consider the ethical and moral reasons for inserting the feeding tube. For example, the need for a feeding tube for those who can swallow but cannot feed themselves (Dunlop, 2006).

The third step includes identifying moral criteria to resolve a dilemma. A stepwise plan should be initiated by patients and family consulting. An option that will help to produce the most effective outcomes and do the least harm to the patient should be considered in this step. A feeding tube might not be a good option for those who can swallow but cannot feed themselves. “A feeding tube may be an easy way out, but this is not acceptable” (Dunlop, 2006).

Sometimes the insertion of feeding tubes will cause diarrhea, which might result in skin breakdown and skin irritation, leading to bedsores for those who lack continuous nursing care (Dunlop, 2006). If a feeding tube is the only option for these patients, then an alternative way, such as constant care, should be given to the patient to reduces other risks. Similarly, for a dying patient, a feeding tube increases the risk of fluid overload due to the weakening of the heart functions; in such a case, a feeding tube should not be considered an option (Dunlop, 2006). While resolving a dilemma, all the options, such as patient autonomy, the common good, and beneficence, should be considered carefully.

References

Dunlop, J. T. (2006, January 27). The Feeding Tube Dilemma: Key Questions. The Center for Bioethics & Human Dignity. https://cbhd.org/content/feeding-tube-dilemma-key-questions

Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Boston, MA: Pearson

Instructions; Comment on at one of your peers’ posts that focus on cases other than the one you chose.

Follow the RISE Model for Meaningful Feedback (PDF) when writing your response posts to peer(s).

This discussion will be graded using the Discussion Initial Post and Reply rubric from your syllabus.

Discussion #2 Using the RISE model respond to the discussion question below. 1/2 page 2 references

MORAL Model: Terri Schiavo

The first step in the MORAL decision making model is to assess the dilemma by identifying the main issues, all key actors, and their probable or stated opinions (Guido, 2014). In the case of Terri Schiavo, the main issue is that she was a relatively young woman who suffered a heart attack caused by years of anorexia. This cardiac arrest resulted in anoxic encephalopathy, which led to significant brain damage and caused her to be in a persistent vegetative state (Weijer, 2005). After multiple years of unsuccessful therapies, Terri’s husband wanted to remove life sustaining measures, claiming that this was in line with Terri’s wishes. However, Terri’s parents did not want these measures discontinued and proceeded with litigation to block the cessation of services. Arguably, the most significant issue is that Terri herself never expressed her wishes in writing regarding the possibility for the use of life sustaining maintenance in a persistent vegetative (Weijer, 2005).

The second step in the MORAL process is to outline the possible options. In this case, the choice was to either continue or discontinue life saving measures for Terri. The main benefit of continuing her care is that Terri remained alive. When her care was ultimately discontinued, Terri died. Alternatively, it was argued that Terri was not really living due to her persistent vegetative state and her husband claimed to have had conversations with Terri in which she expressed that she would not want to continue in a vegetative state once it became clear that she would not recover (Grant, 2015).

The third step in the MORAL process is to resolve the problem. Although this case went through litigation for seven years, the ultimate resolution in the case of Terri Schiavo was that life sustaining measures were discontinued and Ms. Schiavo died (Grant, 2015).

References

Grant, E. R. (2015, June 11). Cruzan at 25, Schiavo at 10: Legal fictions it is time to outgrow. Retrieved from https://cbhd.org/content/cruzan-25-schiavo-10-legal-fictions-it-time-outgrow

Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Boston, MA: Pearson.

Weijer C. (2005). A death in the family: Reflections on the Terri Schiavo case. Canadian Medical Association Journal, 172(9), 1197–1198. https://doi.org/10.1503/cmaj.050348

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