L.W. is a 72-year-old male who was admitted to the hospital 8 days ago with a COVID-19 infection. L. W. has a medical history of COPD and chronic heart failure

L.W. is a 72-year-old male who was admitted to the hospital 8 days ago with a COVID-19 infection. L. W. has a medical history of COPD and chronic heart failure. Social history is a 56-year history of smoking (1.5 ppd), social drinker of 7 beers per week. He is married, with three adult children.

The hospital is at 120% capacity with COVID-19 cases, influenza, and several adults have been admitted to the ICU with RSV. All elective surgeries have been postponed as the beds are needed for the numerous respiratory clients arriving daily in the emergency room. There are currently 15 clients in the emergency room waiting for admission to a unit and four clients currently admitted who are continuing to have decreasing oxygen saturation with a potential need for ICU admission. There are only two ICU beds remaining and one ventilator.

L.W. has not responded to treatment for his COVID-19, and his oxygen saturation continues to decrease. His providers are now considering the need to move him to the ICU and possible mechanical ventilation if his oxygenation does not improve. There are several challenges facing the providers and nurses who are caregivers to L. W.

• There are only two ICU bed available at this hospital. The nearest ICU bed available for a client is in the next state – a 14-hour drive from the location of this hospital
• The other clients who will most likely require intensive care support in the next 12 hours includes a 31-year-old mother of two who is pregnant with her third child, an 18-year-old male who is the high school quarterback, a 55-year-old with no chronic diseases, but is starting to show signs of acute kidney injury, and a 60-year-old woman with ulcerative colitis who is showing signs of necrotic bowel.
• L.W.’s wife is pleading with the doctors and nurses to “Do whatever is necessary to save my husband’s life.”
• One of L. W.’s adult children has medical-power-of attorney (POW) and has provided the hospital with L. W.’s advance directives. The advance directives indicate that L. W. does not want “heroic measures” to sustain life and the child with POW is adamant that providers follow L. W.’s wishes.

What role should justice considerations play in dictating who should get access to the scarce ICU bed and ventilator therapy? What are the legal and ethical responsibilities of the nurse for L. W.? What ethical principles does the nurse use to provide care to L. W. and his family? What mechanisms should the nurse use to address the ethical concerns?