An 18 year old female arrives to the ER for the chief complaint of vaginal bleeding. The patient began her menstrual cycle 3 weeks prior and the bleeding has not stopped. Upon assessment her skin is pale, cap refill is greater than 3 seconds, mucous membranes are dry, and she is hypotensive, tachycardic, and tachypneic. An IV is placed; labs are obtained; and a 1 liter normal saline bonus is given. Labs return, and her hemoglobin is 4.8, with a hematocrit of 16. It is decided that a blood transfusion is needed, so the physician discusses the lab results, risks and benefits of receiving and not receiving a blood transfusion, in order to obtain an informed consent for blood. The patient is Jehovah witness and refuses the blood transfusion. In addition, she has an advanced directive prohibiting blood transfusions. The patient, whom is in hypovolemic shock, begins to seize and becomes unconscious.
1. Define 5 ethical concepts.
There are five ethical concepts that represent fairness, honesty, and respect for all human beings and these ethical concepts often arise in interactions between healthcare providers and their patients. These concepts are autonomy, beneficence, nonmaleficence, justice, and confidentiality. These concepts are great in theory, but applying some of them to practice can at times be difficult and lead to ethical dilemmas.
a. Autonomy means that an informed, competent person can refuse or accept treatment and invasive procedures according to their wishes.
Autonomy refers to an individual’s right to self- rule or governs one’s self (Beauchamp Childress, 2009). Autonomy is refer to the individual right to make his or her own decision regarding their health care needs. This is respected in the health care setting.
In health and social care sector, health care professionals take into account four key ethical principles when providing service to the service users. The key ethical principles are justice, autonomy, beneficence and non-maleficence. In health and social care settings people must be treated fairly without being judgemental regardless of who they are or where they come from. Health care professionals must allow their service users choose the type of services or treatment they want and the professional should support them in getting quality care that will benefit their service users. Also, health care professional must not
Cambridge (2016) defines autonomy as the ability to make a decision without any influence from any individual. Similarly, it is the freedom for someone to exercise their own will or action (Dictionary.com 2016).
Autonomy includes three primary conditions: (1) liberty (independence from controlling influences), (2) agency (capacity for intentional action), and (3) understanding (through informed consent) (Beauchamp & Childress, 2009, p. 100). According to Beauchamp & Childress (2009) to respect autonomous agents, one must acknowledge their right to hold views, to make choices, and to take actions based on their personal values and beliefs (p. 103). Respect for autonomy implies thaturges caregivers to respect theassist a patient in achieving? Heed? the autonomous choices of their patients. From there, patients can act intentionally and with full understanding when evaluating medical treatment modalities. Autonomy also includes a set of rules, one of which requires that providers honor patient decision-making rights by providing the truth, also known as veracity (Beauchamp & Childress, 2009, p. 103). In this case, several facets of the principle of respecting autonomy, specifically veracity, informed
These principles have become widely used frameworks for ethical both in healthcare practice and also in clinical research. A few brief definitions; beneficence refers to the balancing of benefits of a treatment against the risks and acting in the way that most benefits the patient. Nonmaleficence is the avoidance of excessive harm. All treatments will have some risks and harm however minimal, the principle of nonmaleficence requires that the harm should not be disproportionate to the benefits of the treatment. Respect for patient autonomy is just as it states, that the patient should be respected as someone who can make reasoned, informed decisions of their own free will. Lastly, the principle of justice simply requires that risks and benefits be distributed fairly and that patients in similar situations should get similar treatments from their healthcare professionals. In another article, Macklin criticizes the four principles for not providing a useful way of solving bioethical issues, rather she believes that they provide a “sound and useful way of analysing moral dilemmas” (Macklin, 2003). I am inclined to agree with Macklin here, because it appears that
An adult patient is a member of a religion that does not believe in receiving blood. The patient receives a colostomy and begins hemorrhaging. He is unable to voice his objections. You know of this patient’s strong beliefs and that he does not want to receive blood. On the admission sheet, the area for religion is blank. He has no family. The nurses and doctors want to give blood and you do not want him to die.
Autonomy is the right to make decisions for oneself and have those decisions be respected by others. This allows patients to have full knowledge and power of treatments and procedures being done to them. Along with having complete knowledge of what is going on medically with the patient, this principle enforces one to tell their patient any and all risks, benefits and alternatives to what is being suggested. This principle also allows patients to have the right to refuse treatment whenever they choose. Autonomy is one of the four main ethical principles that used when making decisions. The movie Miss Evers Boys shows numerous examples of how this very important principal was violated and swept under the
Since the patient was a Jehovah Witness she refused any treatments involving a blood transfusion because she felt that if she accepted the blood transfusion she would be going against her family and religious beliefs. Her husband who was also at her bedside agreed with his wife 's decision. Eventually her husband left to pick up their children from daycare. Her condition worsened and she decided to change her mind because she realized that she was really going to die if she did not have the transfusion and wanted to be around for her children. She then asked the nurse if she could still receive the blood without informing her husband of her decision. The nurse was so relieved with the patient’s decision and informed the healthcare provider. Because of this decision the patient and unborn child were able to make a full recovery.
In order to ascertain the merit of managed health care, ethical presuppositions guiding our health care system require consideration. In the United States, four main principles undergird the way health care is practiced. These principles are: beneficence, nommaleficence, autonomy and justice. Beneficence is the obligation of health care providers to render help to people in need. Just as health care workers are called to provide care, they also have a duty to do no harm. This principle is commonly called nonmaleficence. At times, the possibility of doing good may result in injury. Therefore, the principle of beneficence and nonmaleficence do not always concur. Thirdly, the principle of autonomy allows patients to make choices regarding their health care. In other words, health care providers should allow patients to make the final decision regarding their treatment plan. Finally, justice refers to the ethical concept of treating everyone in a
During emergency moments, patients vary in their choice to receive blood transfusions. Fundamentalist Jehovah's Witnesses are not willing to receive blood products under any circumstances, even when it means losing their lives. Their position is so extreme that they are also not willing to receive a transfusion for their underage children, even those not born yet. However, Ecumenist suggests that secondary components of the blood, such as albumin, coagulation factors and immunoglobulins, should be accepted because they naturally cross the placental barrier during pregnancy, so they do not have the same connotation of the primary components and are no longer considered “blood”. Also, Ecumenist are flexible to those members who receive a transfusion against their will or those who have accepted the transfusion and regret of their actions (Besio). Because of ecumenist’s efforts, Jehovah’s Witnesses are allowed to carry a signed and witnessed “Advance Decision Document” listing the blood products and autologous procedures that are, or are not, acceptable to them. Usually, a copy of that document is placed in the patient records (JPAC). Moreover, ecumenist movements have made it possible for Jehovah’s Witness patients to undergo otherwise religiously questionable procedures such as apheresis, hemodialysis, cardiac bypass with non-blood fluids, as well as the use of recombinant products, like erythropoiesis stimulating agents and granulocyte colony stimulating
Respect for autonomy-one must live accountable to God and dependent on God, our Creator (Shelly, 2006, p. 158). “Patients and care-givers wanting total control over the beginning and end of life are grasping for an autonomy that God did not give to us” (Shelly, 2006, p. 163). Using autonomy is when the nurse respects the capacity of the patient to make his/her health care decision.
What should the pediatrician do? The pediatrician should override the patient’s decision, the pediatrician should allow the teenager to refrain from treatment or the pediatrician should refer this case to the ethics committee in the hospital. However, the goal is to pick the best option but the criteria for the best is different for different persons even met in conflict. Also, the judgment that is based on the point of view of those who make the decision, who require a decision, or who do not participate in decision-making (Figar & Đorđević, 2016). In this case, the dilemma arises from religious belief. We are faced with the religious beliefs of the patient who has strong criteria for choosing and decision making and this is the beginning for an ethical dilemma. As we know religious beliefs make decisions challenging, and in the medical community, Jehovah’s Witnesses are known for their faith believe. In their view, blood is a gift from God, a representative of life, and holy. Jehovah’s Witnesses beliefs with respect to God for giver life and obey him; they should not accept blood even in life-threatening situations. In their belief blood will be considered just for the atonement of sins. Therefore, all members of Jehovah's Witnesses abstain from the blood and refusal of blood transfusion not as a medical issue but as a religious issue. To dissolve
Respecting the patients free will was the cornerstone for a lot of medical bioethics , in the same time it was the source for many dilemmas cases . Autonomy is the capacity for all competent individuals to control what happen to their body even if what they want is not in their best interest.
There are five core ethical principles. The first one is beneficence, it is the action that is done for the benefit of others, which should be taken to help prevent or remove harms or to simply improve the situation of others (Pantilat, 2008)). In United Airline’s case, specifically for the case happened on April 9 2017, in order to accommodate crew members, the flight needed to select four customers and asked them to take the next flight. Dr. David Dao was randomly picked and been violently dragged out by security officers. The security officers dragged Dr. David Dao by his arms and legs down the aisle and off the Louisville, Kentucky- bound flight before it took off at Chicago O’ Hare International Airport. Dao was left bloodied and bruised
There are four basic ethical and bioethical principles that have a strong influence in the practice of medicine, predominantly medicine that deals with those who are dying. The first is beneficence, which directs the physician and health care worker to take positive actions, specifically by restoring health and relieving suffering (Bongard et al., 2008). Then there is nonmaleficence. Goldman and Schafer (2012) add that nonmaleficence is the idea that people should not be harmed or injured knowingly. The third ethical principle is autonomy,