According to Johnson & Westphal (2018), neurological or what is commonly known as brain death was officially accepted as a standard way to determine and declare death in hospitals in 1968. In this case, functions of the brain such as the brain stem cease to functions. In the case of brain death, breathing and the heartbeat are usually sustained by use of a machine.
Although it is widely accepted as a legal and ethical means to declaring death, neurologic standards may sometime not be acceptable to some people or may even confuse others. This is due to the fact that the body is still warm, the heart of a deceased is still beating, and the respiratory system working by mechanical ventilation. It is therefore paramount that care nurses must understand and consider beliefs of the family of the dead especially those that do not support neurologic procedure as a criterion in the declaration of death. This paper will endeavor to address the concerns of handling opposition to brain death diagnosis due to both cultural and religious beliefs of the affected parties. According to Johnson & Westphal (2018), the need for medical practitioners to understand and take into consideration cultural and religious beliefs in brain death diagnosis is well brought out. In their article, a case study is given of Mr. R who despite being diagnosed with brain death, his family is torn between accepting that he is indeed dead due to religious beliefs held by some of his family members. His father and brothers hold the view that as a Muslim, one can only be declared dead when he or she stops breathing and his body is cold, while his wife embraces the idea of determining the declaration of death by means of neurological criteria. This is despite the fact that both sides acknowledge to fully understand the explanation given by a competent health practitioner on the matter of brain death.
The family insists that Mr. R being a Muslim should not be declared dead and that as long as his body is still and is still breathing by the help of mechanical ventilation, he should not be declared as dead. They further insist that he be medically taken care of until such a time when all indicators of life such as heartbeat are no longer noticeable according to their Islamic traditions. In handling such a sensitive matter, it is expected that all medical workers follow certain ethical principles. As outlined by the American Nurses Association (ANA) all nurses in America should operate within certain set ethical codes of conduct. When dealing with matters such brain death diagnosis, nurses should understand that they have a heavy responsibility in ensuring that these ethical codes of conduct are strictly followed.
They include practicing with compassion and respect of the dignity of the individual taking to consideration special attributes of every single person. Most importantly to note in the case of Mr. R, is the ANA provision that nurses have the responsibility to work with other health practitioners and the public to promote cooperation through health diplomacy hence reducing health disparities (American Nurses Association, 2015). According to ANA’s ethical codes, it should be the view of the medics to acknowledge that they have the responsibility to respect and uphold the dignity of all individuals and cooperate with everyone in minimizing health disparities. In the case of Mr. R, the health professionals need to cooperate with the family by respecting their beliefs and should, therefore, give health care to Mr. R up to the point when it is mutually acceptable to withdraw life support from him as provided for by the law. This will ensure that the cultural beliefs of the family are protected while showing them compassion and respect.
According to Stokes, F. (2017, it is of great importance that nurses get to understand and appreciate divergent views as an important step towards the provision of both ethically and culturally congruent medical care to not only the patients and their families but also to the communities they serve. Ethical considerations in determining what should be done in case of an objection by family members to neurologic criteria are important especially due to the legal considerations on how to go about it. In taking ethical consideration in such cases as presented by Mr. R, policy guidelines need to well evaluated and taken into account. As brought out by Johnson & Wesphal (2018), various policies such as the New York statutes provide that a notification is issued by the hospital in cases where a family objects to neurologic criteria. It also provides interventions in terms of intensive care for an agreeable period of time. Medical practitioners also need to offer support as well as to work with family members who object to brain death diagnosis regardless of their reasons.
On the other hand, principles such as nonmaleficence and also the principle of justice in regard to how a deceased body should be treated with respect, avoiding family distress while utilizing available and scarce amenities optimally may require medical intervention when and if death has been proved by a qualified medical doctor. In the case of Mr. R, the most applicable principle would be to provide for intensive care to Mr. R while trying to understand the Islamic beliefs of the family. This should also give time for more consultation and negotiation with the family on the most appropriate course of action. This would go a long way in showing compassion and support to the family while still helping them to fulfill their religious obligations. The family should, however, be well informed of the situation at hand, the legal provisions and what they should expect. This is supported by the fact that ethically, medical professionals are required to work with and offer support to families whose faith and culture do not support neurological criteria ( Johnson & Wesphal, 2018) In brain death diagnosis, legal considerations should be factored. In deciding the response to religious and cultural beliefs that object to the neurological standard of determining death, a countries legal provisions and requirements should be taken into account.
The first should be to create awareness among the concerned party of the existing legal requirements. According to Johnson & Wesphal (2018), all 50 states that make up the US recognize neurologic standards. This is shown by their adoption of the Uniform Determination of Death Act. The Act provides for the diagnosis of brain death and concludes that it should be done within the acceptable medical standards. Additionally, states such as New York, New Jersey, and California have included more provision to deter the use of neurologic standards in determining the declaration of death when an objection to doing so is made due to personal cultural and religious beliefs. In this case, the law encourages negotiations on how to proceed in such a case.
According to Langley G. et al, (2015), it is widely accepted that moral distress would be experienced by health professionals when it comes to making serious decisions. These are decisions that may conflict with the views of other parties involved such as family members and colleagues. In the case of Mr. R, moral distress may occur due to the fact that some of the family members defer with neurologic standards due to their beliefs. This may put the health practitioners in a dilemma on following the right cause of action. Moral distress may be manifested in both physical and emotional forms. Since most clinical decisions such as the end of life are made by medical doctors, an emphasis of cure is more encouraged to that nursing and caring.
On the other hand, nurses provide care to patients while factoring the sensitivity of their service to both the patient and the family especially in situations where they have critically ill or dying patients under their care. In this case, just as in the case of Mr. R, ethical deliberations have to be made that may bring conflict and in some cases contested by other associated individuals. It is, therefore, no doubt that in the case Mr. R moral distress among the medical practitioners may exist. In making an ethical decision in the case of Mr. R, the first consideration would be to give in to the wishes of the family. As Johnson & Wesphal (2018) points out, appreciation of the cultural beliefs is a good strategy in dealing with members of the family whose opinion is against brain death diagnosis due to cultural and religious differences. The family members have the right to be treated with dignity and their beliefs accorded maximum respect (Cheraghi, M. A. , 2015).
In this case, it is quite clear that an assessment of family preferences are not in favor of any interventions and therefore no need to disrespect their Islamic beliefs and faith on the matter of when should a person be declared dead. This is supported by the rationale that in health cultural preservation should be acknowledged especially in dealing with matters which need not be changed as changing them would have no much significant. (Johnson & Wesphal, 2018)In responding to the case study, it is of common interest that all parties get involved in reaching a conclusive conclusion. This should be done ethically and in accordance with the legal provisions under the law. The medical practitioners should also show compassion and respect to the family by making sure that their demands are well met while giving truthful information to the family to allow them to make decisions (Cheraghi, M. A. , 2015).
In conclusion, it is of the essence to note that determining death by way of neurologic criteria is widely accepted and legally agreeable procedure. The medical practitioners have a duty to familiarize themselves with all ethical and legal standards so as to be able to articulate issues to the highest ethical standards as provided by their institution. It should also be noted that patients and their family members should be handled with care and should be given all the support required. The views of all affected parties in medical disparities should be well considered and respected in critical decisions such as in the case of brain death diagnosis.
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