My sisters keeper - Grade: B PDF

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essay on the movie and it pertained to the four ethical principles of nursing ...

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Running head: MY SISTER’S KEEPER

My Sister’s Keeper

My Sister’s Keeper

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MY SISTER’S KEEPER My Sister’s Keeper is a fictional drama film released in 2009. It is based on individual perspectives of a family dealing with a deadly illness with one of its members. From this family of five, Kate Fitzgerald is the eldest daughter who was diagnosed with acute pro-myelocytic

leukemia at 2 years old. In an attempt to save Kate’s life, Anna Fitzgerald her youngest sister was created as a designer baby using chromosomes that matched Kate. Anna became Kate’s primary donor to save her life. Kate was diagnosed with renal failure in both kidneys and needed one kidney to survive. After eight surgical procedures at just eleven years old, Anna Fitzgerald decided she wanted to stop being Kate’s primary donor by signing an Emancipation of Rights. This document would guarantee Anna to live independently of her sister and to be able to make her own decisions regarding her body. Blinded by Anna’s decisions, Sara Fitzgerald (Anna and Kate’s mother) decided to fight the document in court stating that at just eleven years old, Anna does not and should not have the right to make her own decisions because she does not understand the choices she is making. It came to light in court that Kate did not want to live anymore. She was tired of the treatments that made her depressed and sick. She convinced Anna to sign the Emancipation of rights. Kate knew that her time on earth was ending, she just wanted her mother to come to the realization that keeping her alive was causing more harm than good. Introduction Often times family members accompany patients to a physician visit to help them obtain and understand information relevant to treatment decisions (Shin et al., 2015). Patients and family members may hold different perspectives on treatment decisions, and these differences may exacerbate family discord and threaten patient autonomy (Shin et al., 2015). “There also

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may be disagreements on the level of family involvement in cancer treatment decision making (TDM)” (Shin et al., 2015, para. 2). “Studies suggested that family involvement sometimes made treatment plan communication more difficult, especially when family members requested the physician not disclose a poor prognosis to a patient” (Shin et al., 2015, para. 2). The purpose of this paper is to identify and explain the four ethical principles of autonomy, non-maleficence, beneficence, and justice relating to the film “My Sister’s Keeper”. Autonomy Autonomy refers to the right or condition of self-government (Carter, 2017). “Autonomous individuals act intentionally, with awareness, and without being controlled by outside influences” (Carter, 2017, para. 20). In the film my sister’s keeper, Anna Fitzgerald believed she never had autonomy when it came to her body. Once her older sister Kate needed a donor, it was mandatory that Anna underwent procedure. Anna wanted to be in complete control of making her own decisions, even if it meant to stop being Kate’s primary donor. She felt as though she could never be a normal kid because at any moment she could go to surgery to save her sister’s life without her consent. Sarah Fitzgerald never considered how Anna felt because she knew the decisions that she made were in the best interest of the family. Sarah also felt as though Anna was too young and did not know how to make the best decisions at eleven years old. Adolescents “The respect that is owed to pediatric patients as participants in the medical decisionmaking process is dependent on several factors, including cognitive abilities, maturity of judgment, and the respect owed to a moral agent” (Katz & Webb, 2016, para. 34). It is also stated that even though the child or adolescent should be recognized as a moral being with all of the

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MY SISTER’S KEEPER appropriate dignity and rights, they are more vulnerable decision-makers than adults, in part because of both inexperience with decision-making and the slow process of maturation of judgment (Katz & Webb, 2016). According to Carter (2017), Parents or legal guardians have the legal and moral authority to make medical decisions on behalf of their children. Health care providers may presume parents care about their children and know their unique needs. Health care providers should seek to override a parent’s wishes only when those views clearly conflict with the best interest of the child. The health care team must obtain procedural consents before any procedure is done to a child (Carter, 2017). “There are many questions for which surgical team members must have answers

before the plan of care is initiated” (Carter, 2017, para.23). The perioperative nurse should verify that the plan is in place and that all essential team members are present before implementation. (Carter, 2017). Non-Maleficence Non-maleficence is the principle that involves “non-harming or inflicting the least harm possible to reach a beneficial outcome” (Pope, Hough, & Chase, 2016). The benefits must outweigh the pain and suffering that the patient will undergo or have undergone. (Carter, 2017). In the late stages of leukemia, Kate developed renal failure which required a kidney from her sister Anna in order for her to live. The physician advised Sarah and her husband that Anna donating her kidney would cause Anna temporary pain but Kate will live which is the beneficial outcome.

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Extracorporeal membrane oxygenation (ECMO) According to Carter (2017), One such advancement in the care of children with congenital heart disease is extracorporeal membrane oxygenation (ECMO). The ECMO procedure allows a machine to take over the work of the heart and lungs by pumping oxygenated blood throughout the body. This mechanical support makes it possible to keep a patient alive while allowing the heart to recover (para. 1). “Most ECMO survivors have normal to mild neurodevelopmental disability, and a significant portion show neurodevelopmental improvement during follow-up appointments” (Carter, 2017, para.17). The impact of this ethical issue is that it challenges perioperative nurses to maintain competency on ventricular assist devices, heart cannulas, and other specialized equipment essential to their practice. They are obligated to ensure that proper equipment is available and that it is applied so as to not harm the child (Carter, 2017). Beneficence This is defined as the “obligation to provide care that improves the patient’s health or outcome” (Carter, 2017). A principle of beneficence in the healthcare setting is to maximize benefit and minimize harm to patients (Ethics in community nursing, para 6.). Once it was documented that Anna no longer wanted to be a donor to Kate, hospice options were introduced to Sara for Kate. The physician knew that there was nothing more the healthcare team could do and this was the best option for Kate. He advised Sara to take Kate home where she would feel more comfortable and surrounded by the people that loved her most. Nurse’s Role According to Carter (2017),

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MY SISTER’S KEEPER When caring for the child with a congenital heart defect, perioperative nurses are involved with assessing the need for ECMO, advocating for the child, and assessing the outcomes of ECMO after ECMO is finished or when the child arrives for his or her next surgery (para.13). “Perioperative nurse may be involved with the child multiple times for open-chest washouts as

the number of complications rise, and each encounter involves a physical assessment of the child before surgery (Carter, 2017, para.15). These nurses work to meet the obligation of beneficence by continually validating and improving their skills and knowledge through yearly competencies, continuing education, and certification (Carter, 2017). “Perioperative nurses should use their knowledge base to examine the question, “Are we helping the child or simply delaying death?” (Carter, 2017, para.13). Justice This ethical principle intertwines with societal values (Carter, 2017). In the end, Sara found out that Katie no longer wanted to live in pain and suffering. She was tired of the treatments that made her very sick. She now wanted to be in peace and came to terms with dying. She wanted justice for her younger sister Anna who she believed she let down. Kate felt as though, she never protected Anna from harm instead she made her go through every procedure that was needed to save her life. Kate realized there was no need to put Anna through anymore harm, to waste thousands of dollars on a kidney transplant she did not want to do. Limited Resources Health care providers are challenged to use health care resources they provide responsibly and wisely and to act with the best utility (Carter, 2017). “They must explore each family’s circumstances individually to ensure the best recovery for the child” (Carter, 2017, para.24).

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“The child requiring ECMO will undergo many radiological procedures, echocardiograms, laboratory tests, and surgical and nonsurgical therapies and will need a considerable amount of blood products” (Carter, 2017, para.25). One societal concern is hospital resources, they are limited and these resources should be distributed thoughtfully (Carter, 2017). According to (Carter 2017), In 2015, Ryan estimated the median patient charge for a course of emergent ECMO, not including hospital charges, to be $310,824. Total hospital costs for a survivor of ECMO are approximately $519,450, which are higher than those for other intensive treatments such as bone marrow transplantation ($207,212), liver transplantation ($231,755), or kidney transplantation ($482,000).7 This cost comparison emphasizes the need for fiscal responsibility and the importance of carefully selecting appropriate candidates for ECMO (para.25). It is the duty of the perioperative nurse to be aware of the overall costs of ECMO without compromising patient care. They should also consider costs when allocating OR supplies (Carter, 2017). “The perioperative nurse should be aware of the costs of suture, cannulas, and specialty equipment and recognize that specialty items are often scarce. An up-to-date surgical preference card is essential to avoiding waste” (Carter, 2017, para.26). Conclusion My Sister’s Keeper displayed many underlying issues that occurs with an underage child dealing with a terminal illness. Many decisions that were made excluded Anna even though she had the mental competency to comprehend the circumstances. Examining the ethical concepts of beneficence, non-maleficence, autonomy, and justice is a useful starting point for discussions that are intended to improve the care and outcomes of children undergoing any complex

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procedures (Carter, 2017). “Each nurse has a responsibility to promote health and safety, advance professional ethical standards, and integrate the principles of social justice into nursing” (Carter, 2017, para. 56).

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Carter, M.A. (2017). Ethical Considerations for Care of the Child Undergoing Extracorporeal Membrane Oxygenation. AORN Journal: The Official Voice of Perioperative Nursing, 105(2), 149-154. Katz, A.L., & Webb, A.S. (2016). Informed Consent in Decision-Making in Pediatric Practice. The American Academy of Pediatrics, 138(2), e7. Pope, B., Hough, M.C., & Chase, S. (2016). Ethics in community nursing. Online Journal of Health Ethics, 12(2), 770-771. Shin, D.W., Cho, J., Roter., D.L., So, Y.K., Yang, H.K., Park, K., Kim, H.J., Shin, H.Y., Kwon, T.G., Park, J.H. (2015). Attitudes Toward Family Involvement in Cancer Treatment Decision Making: The Perspectives of Patients, Family Caregivers, and Their Oncologists....