This ethical scenario presents an 86 year old female with numerous health issues and chronic illnesses. Mrs. Boswell’s advancing Alzheimer’s disease makes it extremely difficult to initiate dialysis, leading her physician to conclude a poor quality of life. The ethical dilemma portrayed in this case is between nonmaleficence and autonomy. Health care workers should focus on promoting the patient’s overall wellbeing and weigh the benefits and risks of the course of action, while also considering what the family declares they want done. Since the patient is deemed unable to make decisions, the goal is to collaborate with family, assess patient quality of life, address prognosis, and establish realistic care goals. The ethical principle of …show more content…
Although autonomy is very important, it is significant that the family fully understand all BOOK> To avoid violating autonomy, health care workers must fully understand the involved disease processes, the options available for treatment, and possible outcomes. Strategies There are two different options evident concerning Mrs. Boswell’s treatment options. While considering both options, it is important to teach the family in depth the effects of the dialysis treatments along with her other chronic illnesses. The first option is to discontinue dialysis treatments and place her in a hospice facility. In hospice care, the goal is of focusing on minimizing pain and suffering, rather than to cure. Going to hospice care would allow Mrs. Boswell to forgo her stringent dialysis treatment and provide her comfort measures allowing her to endure her illnesses with optimal pain reduction. Along with treating the sole patient, hospice care allows for family to be there throughout the whole process while being provided bereavement support. The book p. 234 says that nurses play a pivotal role when tending to patients with notable poor outcomes, bringing attention to caring and not curing. The second option to explore would be continuing the dialysis treatments. While considering this option with the family it is very important to stress the hardships that go along with the aggressive treatment. Making the family fully aware of the
Studies have shown that many factors have been contributing to influence patient’s care in an ethical manner. What factors could affects one decision for their medical care? Does it also included the nurse’s individual views or should consider their moral obligations? But what is ethics really is? Based on the book Nursing Ethics by Butts & Rich, “Ethics is a systematic approach to understand, analyze, and distinguish matters of right and wrong, good and bad, and admirable and deplorable as they relate to the well-being”. Ethics should follow the current AMA guidelines.
Moreover, an emphasis is imposed on the rights of a single patient to commit an act or decision even though it is in contrast with the views of the others. In regards to the ethical dilemma, a nurse could not justify the morality of the two possible choices based on their results and consequences. The Deontological approach would encourage the health care staff as well as the patient to ask themselves the most righteous choice for their situation. With this in mind, a combination of ethical theories can also be employed to give light to the dilemma. In view of this, another ethical approach could be applied to solve the issue, and this is the Right-based approach. This theory also aim to promote the rights of every person, and that, they are indispensable just to make ends meet. However, not all ethical theories can be incorporated in every dilemma in a health care setting because their foundations would contradict one another. In order to provide an effective and efficient solution, nurses should be knowledgeable of the principles enveloping each of the ethical theories and should be wise to apply them in appropriate issues and
There are four principles of ethics: Respect for autonomy, Beneficence, Non maleficence and Justice. This four principles offers comprehensive thought of the ethical issues in clinical settings (Beauchamp and Childress 2001 cited in UK Clinical ethics Network 2011).
Sule stated that, “The Patient Bill of Right adopted by American Hospitals Association states that ‘a patient possesses the right to be informed of the medical consequences of his or her actions and decisions and refuse treatment to the extent permitted by the law’. However, this is true only if the patient is in position to understand the consequences of his treatment. Incompetent, senile patients neither have the correct judgment regarding which treatment is appropriate for them, nor are they in a state of understanding the implications of their treatment. In such case, their willingness to grant or deny consent cannot dictate the course of treatment.” Problem with the Act is being able to find that the patient component enough to make such a call. Another issue that Sule stated was on confidentiality and autonomy. According to Sule, “This is another ethical issue erupting from the conflict of patient's rights and professional ethics in nursing job and profession. The Patient Bill of Right makes it mandatory for the medical practitioners to reveal the form and extent of the ailment along with the course of treatment to be undertaken by the practitioners. However, this law of autonomy clashes with the nursing ethic that the professional should maintain high degree of confidentiality regarding the patient's health and treatment.” This can cause conflicting issues in the NP’s
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
To begin with the person is the centre of the plan, to be consulted with and their views must always come first: It should include all aspects of their care, and every professional should work together to provide it. (Leathard 2000) Autonomy refers to an individuals’ ability to come to his or her own decisions and requires nurses to respect the choices patients make concerning their own lives (Hendrick 2000).However Gillon Argues that the principle respect for autonomy may need some restriction, otherwise we may be morally obliged to respect an autonomous course of action with unthinkable consequences.( Gillon 1986) Every human being has an intrinsic value, they all have a right to well being, to self-fulfilment and to as much control over their own lives as is consistent with others (British Association of Social Workers 2002).Professional Judgement and patient preference cannot be suspended if practice is to be safe and effective rather than routine(DOH 2005) Alex had to attend this session as it was within his Timetable, how could it have been effective?, he was unhappy and
The ethical issues that we have had a hard time fulfilling are central to autonomy, beneficence and truth telling. The ANA recognizes autonomy as an agreement to respect another’s right to self-determine a course of action, support of independent decision making. In 1990 the Patient Self Determination Act was passed by the United States Congress this act stated that competent people could make their wishes known regarding what they wanted in their end of life experience when they were possibly not competent. Also included in this Act is the durable power of attorney, which designates a competent person to assist in making end of life decisions when the induvial was no longer competent. (Beauchamp, 2009) Beneficence: compassion, taking positive action to help others, desire to do good; core principle of patient advocacy. (Beauchamp, 2009)
In the hospice rotation of my clinical experience, I had the opportunity to observe the care for a ninety-seven year old female patient whose intitials were BA. BA has many medical diagnoses, but the most visible ones during my time there were: systolic and diastolic heart failure, stage four chronic kidney disease, primary osteoarthritis, and malignant neoplasm of skin. At the time of the visit, there were no family present however, I did notice many pictures of family members in her room.
An ethical issue I’m currently dealing with at work is a female resident who is currently receiving dialysis due to being non-compliant with their diabetes condition, this individual had developed this condition since she was in her late teens but never really complied or took her condition serious. With years of abuse and miss management of the condition, she has been told that she is now in renal failure and requires dialysis. Before the dialysis commence there was several discussions of what would be required and what she would expect from this, also very clear guidelines where given to her that she must do to make the procedure more comfortable for her and hopefully receive the benefits. This resident has no guardianship in place as
Nursing is an all encompassing profession in which practitioners are not only proficient in technical medical functionality, they also have the obligation to remain compassionate and respectful of patients and as such are expected to adhere to pre established codes of ethics. Of these ethics, autonomy is of extreme importance as it offers patients a sense of personal authority during a time where they may feel as if their lives, or at the very least their health, is no longer under their control. Autonomy in the context of nursing allocates the patient and often their family with the final word on the course of treatment. The concept of patient autonomy is a highly variable subject in all fields of health care. It is a universal concept that varies widely in its meaning and interpretation. Autonomy in its simplest form can be defined as a state of independence or self governing (Atkins, 2006). Patient autonomy can also be defined as the ability to make once own decisions, based on one’s sound judgment. It is defined by the American Nurses Association (ANA, 2011) as the "agreement to respect another 's right to self determine a course of action; support of independent decision making." This seemingly straight forward ethical concept is rife with difficulties when one considers potential disagreements that may arise even when informed consent is provided, particularly among children or vulnerable people. Relevant research and
The third principle is autonomy; it deals with the ability to practice as a nurse and also it refers to the patient being able to make the decisions they want on their own. The issue is what constitutes good for a patient without infringing on the patient's autonomy or letting the patient come to serious harm.
In end-of-life scenarios, where the patient may not be able to communicate their wishes, decisions must be made either by the healthcare professional(s) or family member(s). However, who gets to decide or where the line should be drawn are not always clear. Consequently, not all decisions may be ethically permissible. To illustrate, I will discuss a scenario in which physicians and family are not in agreement. Upon proving a brief summary and explaining the ethical dilemma, I will provide moral reasons for two ethically permissible choices from which, by referencing the principle of autonomy and Utilitarianism, will determine which course of action ought to be carried out.
Moreover, the family understands the specifics about the individual's condition and their daily routines. This can help health care professionals to decide if the person is following the proper steps in their therapy. Once this takes place, is the point that health care professionals can make adjustments to reflect changing realities. Those patients, who have their families involved, will be able to receive better care by ensuring that nothing is overlooked. This is the point that physicians will have a more complete picture surrounding their underlying levels of health. (Saleeba, 2009)
Everyday, healthcare professionals are faced with ethical dilemmas in their workplace. These ethical dilemmas need to be addressed in order to provide the best care for the patient. Healthcare professionals have to weigh their own personal beliefs, professional beliefs, ethical understandings, and several other factors to decide what the best care for their patient might be. This is illustrated in Mrs. Smith’s case. Mrs. Smith is an 85 year old who has suffered from a large stroke that extends to both of her brains hemispheres which has left her unconscious. She only has some brain stem reflexes and requires a ventilator for support. She is unable to communicate how she wishes to proceed with her healthcare. Mrs. Smith’s children, Sara and Frank have different views regarding their mother’s plan of care. The decision that needs to be made is whether to prolong Mrs. Smith’s life, as Sara would like to do, or stop all treatments and care, as Frank feels his mother would want. In the healthcare field, there are situations similar to this case that happen daily where moral and ethical judgment is necessary to guide the decision that would be best for the patient. The purpose of this paper is to explore and discuss, compare and contrast the personal and professional values, ethical principles, and legal issues regarding Mrs. Smith’s quality of life and further plan of care.
Autonomy applies to the profession of nursing because the patient should always be allowed to make decisions regarding their care while being treated with respect and dignity; however, autonomy can serve as a limiting agent when the patient decides to refuse care that would be of benefit to them. Autonomy is a sensitive issue because it allows the patient to choose to die and all health care can do from that point is allow the patient to do so comfortably. With healthcare always being one step ahead, it allows a surrogate to serve as a voice piece for that patient when they are unable to make decisions. However, that surrogate can end up making decisions they think is best for the patient ignoring the patients’ will. The responsibility of the nurse and interdisciplinary team is to inform and educate the patient and patient’s surrogate on all aspects of care to include medical diagnosis, treatment, and care plan so that the patient and