N520 Module 1 assignment: ethical issues case responses: MORAL model, wrongful birth and life, stem cells, a full sample

When Care Appears Medically Inappropriate: The MORAL Model, the Three Wrongful Actions, and the Stem Cell Debate

Student Name

Master of Science in Nursing Program, Aspen University

N520: Legal and Ethical Issues in Health Care

Instructor Name

Month Day, Year

When Care Appears Medically Inappropriate: The MORAL Model, the Three Wrongful Actions, and the Stem Cell Debate

This paper answers the Module 1 prompts in three parts. Part 1 applies Guido's MORAL model to a composite case in which a family demands treatment the team believes will not help. Part 2 distinguishes wrongful birth, wrongful life, and wrongful conception. Part 3 summarizes the controversy over stem cell research and where it stands today.

Part 1: The MORAL Model Applied

The composite case: Mr. W., 84, has been in the intensive care unit for three weeks with septic shock, kidney failure requiring dialysis, and respiratory failure. He has no advance directive. His condition has worsened despite maximal therapy, and the team believes that cardiopulmonary resuscitation would not restore him to any condition he would value. His two sons insist that "everything" be done, including resuscitation, and say their father "never gave up on anything." The nurses caring for him are distressed by what they describe as prolonging his dying.

Guido's MORAL model provides five steps for ethical decision-making (Guido, 2020).

M: Massage the Dilemma

The dilemma sets respect for the patient's presumed wishes, expressed through his sons as surrogates, against the clinicians' duty not to impose burdensome treatment without benefit. The principles in tension are autonomy, beneficence, and nonmaleficence (Beauchamp & Childress, 2019). The stakeholders are Mr. W., whose own values are the ethical center of the case; his sons; the physicians and nurses; and the institution. The key question is not what the team prefers, but what Mr. W. would want and what treatment can realistically achieve.

O: Outline the Options

The options are to continue all treatment including resuscitation as the sons request; to have the attending physician enter a do-not-resuscitate order unilaterally; to continue current treatment while seeking agreement through structured communication; or to follow a formal process for potentially inappropriate treatment. Each option carries consequences for Mr. W.'s comfort, the family's trust, staff moral distress, and the institution's legal exposure.

R: Resolve the Dilemma

A multisociety policy statement recommends reserving the word futile for interventions that cannot accomplish their intended physiologic goal and using potentially inappropriate for treatments that have some chance of an effect but that clinicians believe are not justified by competing ethical considerations (Bosslet et al., 2015). Because resuscitation might briefly restore circulation, it falls into the potentially inappropriate category, and the statement recommends a fair process rather than a unilateral decision: expert consultation, a second medical opinion, review by an interdisciplinary committee, an offer to transfer care to another clinician or institution, and notice to surrogates of their right to seek outside review.

The resolution is therefore procedural: the team neither yields to the demand nor overrides it alone, but follows a process that protects both the patient and the family's standing. I would first pursue a family meeting with palliative care to explore what "never giving up" meant to Mr. W. and what he would say about his present condition.

A: Act by Applying the Chosen Option

The nurse's actions include requesting the family meeting and a palliative care consultation, attending the meeting to share observations about Mr. W.'s comfort, documenting the discussion, and requesting an ethics consultation if disagreement continues. Throughout, the nurse continues full nursing care and supports the sons, whose grief may be driving their demands.

L: Look Back and Evaluate

The final step asks whether the outcome respected Mr. W.'s values and whether the process was fair. The team should review whether earlier conversations about goals of care might have prevented the conflict, and nurses who experienced moral distress should be offered a debriefing. Lessons learned can inform a unit protocol for early goals-of-care discussions.

Part 2: Wrongful Birth, Wrongful Life, and Wrongful Conception

These three actions arise when negligence is alleged in reproductive care, and they differ in who sues and what injury is claimed (Guido, 2020). Wrongful birth is brought by parents who allege that a provider's negligence, such as failing to offer or correctly interpret prenatal genetic testing, deprived them of the information they needed to decide whether to continue a pregnancy, and that a child was born with a serious condition as a result. Many states recognize this claim, usually allowing recovery of the extraordinary costs of caring for the child.

Wrongful life is brought on behalf of the child, who claims that but for the negligence they would not have been born. Most courts reject these claims because they would require comparing life with a disability to never having existed, although a few states allow recovery of special damages such as medical expenses. Wrongful conception, also called wrongful pregnancy, is brought by parents after a negligent sterilization or contraceptive failure leads to an unplanned pregnancy, usually of a healthy child; damages are typically limited to the costs of the pregnancy and the failed procedure.

Part 3: The Stem Cell Research Controversy

The controversy centers on embryonic stem cells, which can become any cell type and therefore hold promise for treating diseases such as diabetes, spinal cord injury, and Parkinson's disease. Obtaining them destroys the embryo, so the debate turns on the moral status of the embryo. Those who hold that an embryo has the moral status of a person oppose the research as the taking of a human life; supporters argue that early embryos, particularly those left over from in vitro fertilization and otherwise discarded, do not have that status and that the potential to relieve suffering justifies their use.

Federal policy has shifted with these arguments, with funding limited to existing embryonic stem cell lines in 2001 and expanded in 2009. The development of induced pluripotent stem cells, adult cells reprogrammed to an embryonic-like state, has reduced but not eliminated the controversy, since these cells avoid embryo destruction but remain less understood. For nurses, the ethical skill is to understand both positions well enough to support patients whose religious or moral views shape their decisions about research participation or treatment.

Conclusion

The MORAL model turns a painful conflict into a structured process that respects the patient's values, the family's role, and the clinicians' integrity. The three wrongful actions show how negligence in reproductive care is defined by who is harmed and how, and the stem cell debate shows how moral disagreement shapes science and policy. In each case, the nurse's task is to reason clearly, respect differing values, and act within professional and legal duties.

References

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Bosslet, G. T., Pope, T. M., Rubenfeld, G. D., Lo, B., Truog, R. D., Rushton, C. H., Curtis, J. R., Ford, D. W., Osborne, M., Misak, C., Au, D. H., Azoulay, E., Brody, B., Fahy, B. G., Hall, J. B., Kesecioglu, J., Kon, A. A., Lindell, K. O., & White, D. B. (2015). An official ATS/AACN/ACCP/ESICM/SCCM policy statement: Responding to requests for potentially inappropriate treatments in intensive care units. American Journal of Respiratory and Critical Care Medicine, 191(11), 1318-1330. https://doi.org/10.1164/rccm.201505-0924ST

Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Pearson.