Week 11: Ethical Concerns
Scenario 1: The parents of a 5-year-old boy have accompanied their son for his required
physical examination before starting kindergarten. His parents are opposed to him receiving any
vaccines.
All 50 states have requirements for vaccination of children prior to entering into public
school, private school, and daycare. 47 states allow exemptions for religious reasons, and 18
states allow for personal and philosophical reasons (National Conference of State Legislatures
website, 2017). According to the CDC, vaccines have prevented more than 21 million
hospitalizations and 732,000 child deaths in the United States over the past 20 years (Centers for
Disease Control and Prevention website, 2016). High immunization rates helps to create
immunity among large numbers of individuals, both vaccinated and those that are unable to
receive immunizations due to immune system disorders.
It would be important to ask the parents about why they are opposed to vaccinating their
son. Perhaps they have religious beliefs or personal reasons for not vaccinating their son. At
times, parents have misinformation regarding the risks of immunizations, they may not
understand the purpose of immunizations, or they have religious or cultural reasons that don’t
allow for vaccinations (Sullivan, 2012). The practitioner is ethically obligated to inform parents
of their right to refusal but to also inform them of benefits of vaccines and risks of withholding
them. The practitioner will need clarification from the parents as to the reasons they don’t want
to vaccinate their son. They can then be educated on the benefits of immunizations and potential
side effects to expect. The parents can then make an educated decision. A helpful website to
provide to the parents is The National Vaccine Information Center which can be found at
This study source was downloaded by 100000845811670 from CourseHero.com on 05-15-2022 06:03:21 GMT -05:00
https://www.coursehero.com/file/29106705/Week11MainPostdocx/
, http://www.nvic.org. This website provides information regarding vaccines and state laws and
allows for parents to make educated decisions.
Scenario 2: A 49-year-old woman with advanced stage cancer has been admitted to the
emergency room with cardiac arrest. Her husband and one of her children accompanied the
ambulance.
For the sake of this scenario, I will focus on New Jersey state laws since this is where I
live and plan to practice as an advanced practice nurse. Without much information in the
scenario, upon arrival to the emergency department, the ED staff would want to know if the
patient has a POLST. POLST stands for Practitioner Orders for Life-Sustaining Treatment. It is
created on a standardized green form that is easily recognizable by medical staff state-wide. This
document, created and signed by the patient, doctor, APN, patient surrogate, spells out what type
of medical treatment the patient wishes to receive toward the end of life. It helps to avoid
unwanted and medically ineffective treatment, and to abide by the patient’s wishes (State of New
Jersey website, n.d.). POLST does not mean, “Do not treat”, as it allows for a variety of options
such as CPR, airway management, and comfort measures to be taken. The patient would ideally
complete this document prior to actually needing it. Medical professionals are legally and
ethically obligated to honor the document.
This scenario can be difficult to manage not knowing the status of the patient upon
arrival to the ED. I have witnessed patients arriving to the ED status post a cardiac arrest who
are awake and alert with a cardiac rhythm compatible with life. Evidence suggests, this patient
with advanced stage cancer would not fare as well as a healthy individual suffering cardiac
arrest.
One study shows that cardiac arrest of cancer patients in-hospital results in a “poor” outcome and
low survival rate, and cardiac arrest in cancer patients out of the hospital proves an even worse
This study source was downloaded by 100000845811670 from CourseHero.com on 05-15-2022 06:03:21 GMT -05:00
https://www.coursehero.com/file/29106705/Week11MainPostdocx/
Scenario 1: The parents of a 5-year-old boy have accompanied their son for his required
physical examination before starting kindergarten. His parents are opposed to him receiving any
vaccines.
All 50 states have requirements for vaccination of children prior to entering into public
school, private school, and daycare. 47 states allow exemptions for religious reasons, and 18
states allow for personal and philosophical reasons (National Conference of State Legislatures
website, 2017). According to the CDC, vaccines have prevented more than 21 million
hospitalizations and 732,000 child deaths in the United States over the past 20 years (Centers for
Disease Control and Prevention website, 2016). High immunization rates helps to create
immunity among large numbers of individuals, both vaccinated and those that are unable to
receive immunizations due to immune system disorders.
It would be important to ask the parents about why they are opposed to vaccinating their
son. Perhaps they have religious beliefs or personal reasons for not vaccinating their son. At
times, parents have misinformation regarding the risks of immunizations, they may not
understand the purpose of immunizations, or they have religious or cultural reasons that don’t
allow for vaccinations (Sullivan, 2012). The practitioner is ethically obligated to inform parents
of their right to refusal but to also inform them of benefits of vaccines and risks of withholding
them. The practitioner will need clarification from the parents as to the reasons they don’t want
to vaccinate their son. They can then be educated on the benefits of immunizations and potential
side effects to expect. The parents can then make an educated decision. A helpful website to
provide to the parents is The National Vaccine Information Center which can be found at
This study source was downloaded by 100000845811670 from CourseHero.com on 05-15-2022 06:03:21 GMT -05:00
https://www.coursehero.com/file/29106705/Week11MainPostdocx/
, http://www.nvic.org. This website provides information regarding vaccines and state laws and
allows for parents to make educated decisions.
Scenario 2: A 49-year-old woman with advanced stage cancer has been admitted to the
emergency room with cardiac arrest. Her husband and one of her children accompanied the
ambulance.
For the sake of this scenario, I will focus on New Jersey state laws since this is where I
live and plan to practice as an advanced practice nurse. Without much information in the
scenario, upon arrival to the emergency department, the ED staff would want to know if the
patient has a POLST. POLST stands for Practitioner Orders for Life-Sustaining Treatment. It is
created on a standardized green form that is easily recognizable by medical staff state-wide. This
document, created and signed by the patient, doctor, APN, patient surrogate, spells out what type
of medical treatment the patient wishes to receive toward the end of life. It helps to avoid
unwanted and medically ineffective treatment, and to abide by the patient’s wishes (State of New
Jersey website, n.d.). POLST does not mean, “Do not treat”, as it allows for a variety of options
such as CPR, airway management, and comfort measures to be taken. The patient would ideally
complete this document prior to actually needing it. Medical professionals are legally and
ethically obligated to honor the document.
This scenario can be difficult to manage not knowing the status of the patient upon
arrival to the ED. I have witnessed patients arriving to the ED status post a cardiac arrest who
are awake and alert with a cardiac rhythm compatible with life. Evidence suggests, this patient
with advanced stage cancer would not fare as well as a healthy individual suffering cardiac
arrest.
One study shows that cardiac arrest of cancer patients in-hospital results in a “poor” outcome and
low survival rate, and cardiac arrest in cancer patients out of the hospital proves an even worse
This study source was downloaded by 100000845811670 from CourseHero.com on 05-15-2022 06:03:21 GMT -05:00
https://www.coursehero.com/file/29106705/Week11MainPostdocx/
