The Influence of Institutional Conceptual Frameworks on Ethical Decision-Making
One of the most troublesome and complex ethical dilemmas faced in health care involves decisions at the end of life. Based on the case study involving Tonya Archer, the hospital needs to balance respect for the family’s wishes and the application of predetermined medical and ethical standards. This paper examines the ethical, professional, and institutional aspects in continuing life support or its withdrawal in view of the diagnosis of whole-brain death: The Influence of Institutional Conceptual Frameworks on Ethical Decision-Making.
End-of-Life Issues in Health Care Ethics
The most relevant end-of-life issues in this case include the definition of death itself, patient autonomy, beneficence, non-maleficence, justice, and the appropriate use of healthcare resources.
Definition of Death
In numerous countries, brain death is considered to be medical and legal death. The Uniform Determination of Death Act (UDDA) defines death as the irreversible cessation of circulatory and respiratory functions or the cessation of all brain activity, including the brainstem (Omelianchuk et al., 2022).
In Tonya’s case, medical experts concluded that she experienced a complete brain death, which is defined as the total and permanent loss of brain function. Accordingly, recovery is out of question. Even though some bodily functions persist with mechanical help, brain death is still regarded as the end of life.
Parental Rights and Patient Autonomy
Pediatric cases, as a rule, apply the principle of parental surrogate decision-making. Nonetheless, this fundamental right is not without limitations as it must be commensurate with clinical and medical expectations and the well-being of the child. Ethical principles and medical guidelines must also be attended to in case Tonya’s parents decide to keep life support for their daughter. A hospital has the obligation of reconciling the need to honor parental preferences with the need to observe medical ethics and practice.
Beneficence and Non-Maleficence
The principle of beneficence dictates that medical actions should benefit the patient, while non-maleficence requires healthcare providers to do no harm (Haddad & Geiger, 2023). There is no medical benefit to keeping Tonya on life support with her non-functional brain. There is a possibility, however, that the continuation of these artificial measures may lead to an exacerbation of suffering or prolonging delusional hopes. In addition, extended support to a person suffering from a brain-dead state may result in a body breakdown alongside other ailments like infections and untreated organ failures.
Justice and Resource Allocation
Medical ethics demand the just distribution of scarce healthcare resources. The continuation of life support for a patient in a brain-dead state takes away resources that could be utilized for other patients who may benefit from these resources (Haddad & Geiger, 2023). Hospitals have to balance their obligations to individual patients with the needs of the larger patient population. Justice also pertains to healthcare professionals, who should not be obliged to provide futile treatments that run counter to medical and ethical standards.
The Hospital’s Ethical and Legal Considerations
The hospital needs to decide whether to follow the request of the parents or remove the life support based on medical and ethical criteria.
Ethical Principles and Moral Theories
Utilitarianism, with an emphasis on the greatest good for the greatest number, would favor the removal of life support (Driver, 2022). Resources will be utilized in keeping Tonya on life support without any good for her or other patients. According to this perspective, the ethical action would be the allowance for natural death to take its course rather than using interventions for no positive outcome.
On the other hand, deontology, which focuses on duty and moral rules, could argue for either side. Doctors have a duty to respect family wishes, but they also have a duty to follow medical standards defining brain death as the end of life. The duty to uphold truth and professional integrity may override the duty to accommodate the family’s request.
Professional Codes of Ethics and Their Application
Professional codes of ethics guide healthcare providers in making ethical decisions.
American Medical Association (AMA) Code of Ethics
The AMA Code of Ethics mandates physicians to respect life but also recognizes death when it has occurred (American Medical Association, 2016). It supports the withdrawal of life-sustaining treatment in the case of a patient being declared brain dead. Compassionate and honest communication by physicians with families is also demanded when discussing diagnosis and prognosis so that informed decisions are made.
American Nurses Association (ANA) Code of Ethics
The ANA Code of Ethics centers on caring and advocating for patients (American Nurses Association, 2020). In the case of brain death, nurses should communicate the medical information to the families while upholding their ethical and legal duties.
Both codes concur that the hospital did not breach any code since once a patient has been pronounced brain dead, it is no longer medically productive to continue treatment.
Institutional Mission and Values
A hospital has a mission, vision, and also values, which have an impact on ethical decision-making. Most hospitals have an objective of helping people and providing high-quality service that is backed by research. It is consistent with the hospital’s mission if life support is withdrawn within the context of the value of dignity and patient-centered approaches because to sustain treatment for a brain dead patient is contrary to reasonable medical practice.
In the case of Allina Health Champlin Clinic, their mission is to provide great care which includes preventing illness, restoring health, and providing comfort (Allina Health, 2025). The values for the hospital include integrity, respect, trust, compassion, and stewardship. Withdrawing the life support in the case of Tonya is consistent with these values as it achieves ethical resource use (stewardship), respects the field of medicine (integrity), and offers the family moral support which is necessary.
Allina Health also focuses on making a difference by providing excellent care which extends to making sound ethical decisions in the practice of medicine. By adhering to standard operating medical procedures, providing psychological support to the family, the hospital honors its mission and values.
The Role of Accrediting Bodies
Accrediting agencies such as The Joint Commission have set ethical guidelines for hospitals. They mandate that hospitals follow the medical and legal definitions of death (Young & Smith, 2022). Hospitals that refuse to accept brain death diagnoses will be out of compliance with the accreditation standards, which may lead to legal implications and loss of credibility. The decision to withdraw Tonya’s life support is supported by The Joint Commission.
The Joint Commission, as one of the accrediting bodies, sets ethical and medical standards that a hospital is supposed to follow, including adherence to legally recognized definitions of death. Since brain death is medically and legally defined as death in most jurisdictions, continuing life support for a brain-dead patient is inconsistent with evidence-based medical practice and ethical healthcare standards.
By following these, the hospital will be within the standards for accreditation, be bound within the legal liability, and uphold the integrity of medical decisions. Besides, The Joint Commission “encourages hospital ethics committees to address such situations in order to provide the family with sensitive communication and support in a decision that is appropriate from an ethical and legal standpoint.
Conclusion
The case of Tonya Archer highlights a deep ethical dilemma. The parents’ feelings and requests are comprehensible; however, the discontinuation of life support is supported by medical ethics, professional codes, hospital policies, and accrediting standards. The hospital should move in harmony with ethical principles and established medical guidelines, ensuring compassionate communication with the family while upholding ethical and legal obligations.
References
Allina Health. (2025). Allina Health Champlin Clinic. https://account.allinahealth.org/locations/52?utm_source=gmb&utm_medium=organic&utm_content=web-url&utm_campaign=gmb_website&utm_term=Allina-Health-Champlin-Clinic
American Medical Association. (2016). Physician-assisted suicide. AMA Code of Medical Ethics; American Medical Association. https://code-medical-ethics.ama-assn.org/ethics-opinions/physician-assisted-suicide
American Nurses Association. (2020). American Nurses Association code of ethics for nurses. https://nursing.rutgers.edu/wp-content/uploads/2019/06/ANA-Code-of-Ethics-for-Nurses.pdf
Driver, J. (2022, June 27). Moral theory (E. N. Zalta & U. Nodelman, Eds.). The Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/moral-theory/
Haddad, L. M., & Geiger, R. A. (2023, August 14). Nursing ethical considerations. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/
Omelianchuk, A., Bernat, J., Caplan, A., Greer, D., Lazaridis, C., Lewis, A., Pope, T., Ross, L. F., & Magnus, D. (2022). Revise the Uniform Determination of Death Act to align the law with practice through neurorespiratory criteria. Neurology, 98(13), 532–536. https://doi.org/10.1212/wnl.0000000000200024
Young, M., & Smith, M. A. (2022, December 13). Standards and evaluation of healthcare quality, safety, and person centered care. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK576432/
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Question 
Assessment 5 Tonya’s Case
Write a 2–3 page paper that examines end-of-life issues in relationship to hospitals, professional ethics, and accrediting bodies.
How Institutional Conceptual Frameworks Influence Ethical Decision Making
We wrap things up by exploring institutions and groups designed to help ensure that hospital staff at all levels think and act ethically in caring for patients. Accrediting bodies are oversight agencies charged with performing accreditation of hospitals and helping to establish standards for health care delivery. Their aim is to keep the quality of care as high as possible and to make sure the care is delivered ethically. Ethics committees are groups of individuals within hospitals that meet regularly to advise staff on ethically difficult cases and to promote an ethical institutional culture.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
- Competency 2: Apply sound ethical thinking related to a health care issue.
- Demonstrate sound ethical thinking in applying ethical principles and moral theories to a specific case.
- Competency 3: Analyze ethical issues associated with patient care from the perspectives of various health care professionals.
- Explain professional codes of ethics and apply them in to a specific case.
- Competency 4: Explain the conceptual framework that health care leaders use to make ethical decisions.
- Explain organizational documents like mission and value statements and use them to analyze a case study.
- Explain the role of accrediting bodies and applies this understanding in analyzing a case study.
- Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
- Provides validation and support within written communications by including relevant examples and supporting evidence using APA citations.
- Produce writing with minimal errors in grammar, usage, spelling, and mechanics.
Preparation
Complete the Case Study: Tonya Archer media activity, which is linked later in this assessment.
Before you begin creating your submission for this assessment, make sure you have worked through the Tonya Archer case study. This will provide the foundational context for the assessment, for which you will be carrying out independent research by using the Internet to complete the following:
- Identify the professional code of ethics for your professional specialty or a specialty that you are interested in.
- With a local hospital in mind (perhaps one you work for), locate the mission, vision, and values statement of that hospital.
After you identify the professional ethics code and the hospital mission, vision, and values statements relevant to your work and interests, it may be useful to complete the following:
- Identify which item in the ethical code you believe is the most important and explain why.
- Name something in the code you would like to see addressed in more depth. Why?
- Which item in the code do you think would be the most challenging to follow and why?
- Does your code make an explicit distinction between what is legal and what is ethical? That is, is the code clear that, while an action may be legal, it may not be ethical?
- Finally, how well does your professional code of ethics align with the mission and values statement of your hospital? Can you imagine a situation in which following one would make it challenging to follow the other?
The Influence of Institutional Conceptual Frameworks on Ethical Decision-Making
Instructions
For this assessment you will apply some concepts we have learned in the course, particularly those relating to the basic principles of health care ethics, professional codes of ethics, and values of health care institutions.
Write a paper that answers the following questions as it relates to the Tonya Archer Case Study:
- What are the most relevant end-of-life issues in health care ethics as they relate to this case?
- What should the hospital do? Should doctors simply keep Tonya on life support, as the parents want? Or, since all medical evidence indicates that Tonya’s brain damage is permanent, should life support be removed?
Support your answer with the following considerations in mind:
- Explain which principles of health care ethics and which moral theory are the best philosophical foundations for your view.
- Is your view supported by your professional code of ethics? If so, explain how. If not, explain what your code gets wrong about a case like this.
- Is your view consistent with the mission statement and values of the hospital you identified in your independent research you conducted to prepare to complete this assessment?
- Would an accrediting body, like The Joint Commission, support your choice? Why or why not?
Submission Requirements
Your paper should meet the following requirements:
- Written communication: Written communication is free of errors that detract from the overall message.
- APA formatting: Resources and citations are formatted according to current APA style and formatting guidelines. Refer to Evidence and APA for guidance.
- Length: 2–3 typed, double-spaced pages.
- Font and font size: Times New Roman, 12 point.