The Principle of Substituted Judgment Essay

Ethical dilemmas exist everywhere around us in everyday situations. Something as simple as picking up a piece of trash off the floor to whether you should use a previously written paper from a separate class for a current assignment in this class. It exists in reality and even on television shows. How, then, do people resolve these ethical dilemmas and how do they defend their decisions? Nurse Jackie is a television series impregnated with ethical dilemmas, especially in medical care. In this paper, I will discuss the ethical issues found in the “Tiny Bubbles” episode of Nurse Jackie. I will further discuss the ethical reasoning with support of ethical principles. In addition, I will discuss how patient’s autonomy and non-maleficence principle of bioethics plays a role in decision making. Overall, there was a difficult struggle on the ethical theory of and utilitarianism, with ethical relativism playing a huge factor.

In the essay Defending My Life, author Geov Parrish tells the narrative of his personal experience with the medical field and healthcare industry regarding life-saving organ transplants in which he underwent. Throughout his narrative he brings up many key issues present in current day medicine that relate well to our BEST medical curriculum. The first issue involves behaviorial aspects of medicine and the importance of the patient’s perspective in care. The next issue involves the social and ethical dilemmas relating to the cost of healthcare and adequate access to proper care.

With the statement, “warmth, sympathy, and understanding may outweigh the surgeon 's knife or the chemist 's drug” physicians are given the responsibility to step down from their systematic ways of scientific thinking and make decisions on the level of human kind. The modern oath also provides for the necessary address of issues in liability in relation with a physicians judgment. This is predominately done by promoting the uniting of colleagues and defending a physicians right to be unsure in a world of so many unknowns. This acceptance and appreciation is essential for fostering a comradely among physicians that challenges each to think independently, dispute their own peers and still be conducive of making advancements.

For as long as I could remember, I have seen my father rushing to the hospital in a white coat, answering pagers in the middle of important family conversations and attending night calls even in the most terrible weather. I had always wondered; what could be so important that it belittles every other responsibility in his life. It was only after many years of anguish and protests that it finally made sense to me. This defining moment of realization occurred when I first met a patient in his office. I saw how the gratitude in the patient’s eyes can provide a sense of fulfillment that triumphs all other feelings in the universe. It was human life that was most important. Being a doctor does not make you a mere healer but also gives you the responsibility of a caregiver. I had never felt more proud of my father and that was the day I felt the urge to relive this feeling many times over. It was there in that moment that I decided to pursue a career in medicine.

- When you think of a doctor, what comes to mind? Someone who does everything in their power to save lives might be one of the thoughts. But what if the patients’ of these doctors death is incurable, and no medical involvement can change that fact, than what becomes the role of a doctor?

There are unique ethical and legal obligations of the Emergency Room Physician. Commonly faced issues include patient “dumping”, organ donation, and Do-Not Resuscitate orders. These issues have ethical and legal considerations for the Emergency Room Physician in regards to their responsibilities and actions.

Autonomy Autonomy is defined as self-determination or self-governance. Autonomy is composed of four key features: (1) intentionality, (2) understanding, (3) sufficiently free of external constraints, and (4) sufficiently free of internal constraints. Intentionality is defined as performing an action deliberately. Understanding is described as the ability to comprehend a situation, concept, or idea to a matter of degree. Free of external constraints is the freedom from physical barriers that would prevent an individual from acting out a conscious decision.

Should medicine intervene in the delay of a person dying when they have a terminal disease, or have experience major traumatic injury to their body? How physicians participate at times in prolonging the natural course of dying while trying to fix what cannot be fixed. “The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy.”(Gawande, 2014) The truth is death is not the enemy, it is the fear of death that perpetuates the many of the treatments that done. The author did not ignore the fact that some physicians do not really engage with their patients. If a physician truly engaged with the patient, as Dr. Benzel did with the author’s father, they would recognize fear, in the patient and it may avert some treatments; and provide palliative care instead.

Another topic discussed between the articles involved, is the importance of surrogate decision makers and advocacy for the substituted judgement standard in situations where the patient does not have the capacity to make his or her own decisions. Both McGowan (2016) and Blacker (2016) agree that the proxy should confirm the incompetent patient’s actual interests and preferences when making a decision on their behalf. In these situations nurses should acknowledge the difficult nature of the situation and help the proxy analyze the patient’s interests from the interests of the proxy and/or

Whenever a situation poses the threat of a patient dying, there seems to be a sense of obligation at times that may drive physicians to do whatever it takes to try and save the patient. In some cases that could be the deciding factor in whether a person can get better or will die in the process. However, there are always situations that no one really wants to face that involve the terminally ill who have extremely low to no chance of recovery. Though a certain treatment will keep the patient alive, it can be seen as only prolonging the inevitable.

Person: Simple. Physicians have an obligation to relieve pain and suffering and to promote the dignity of dying patients in their care. They must also respect the patients’ decisions to forgo life-sustaining treatment.

There has been an increase in the number of organs donated for transplantation since the development and acceptance of brain death. (Guidelines for the determination of death, 1981) The strict rules surrounding the diagnosis and the ability to develop individualized Policy and Procedures in the determination of brain death has removed the fear of law suite surrounding this definition of death. (Guidelines for the determination of death, 1981)

Kant provides us with these ethical guidelines however there are cases in medicine which illustrate that a physician’s expertise allows him to see that following a patient’s autonomous decision may lead to further suffering causing the health professional to take a paternalistic course of action. This ethical problem has lead me to investigate whether medical practice should uphold Kant’s categorical imperative, and if not where should we search for a way forward? I intend to analyse Kant’s ethics to see where its strengths and weaknesses lie when applied to the medical field before exploring other ethical theories in an attempt to find the most suitable means of decision making in medicine. I will use case studies to illustrate the point that Kant’s ethics, although perfect for an ideal world, does not work in the medical field, nor does a utilitarian approach. This leads us toward an intuitionist stance in order to keep the benefits of the categorical imperative offers us while maintaining applicability to medicine.

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

As an observer from the east, Chen Cheng had many preconceived values granted by his biography. Inevitably, these values are recognizable in his portraits of the Timurid world. In five major aspects did Chen Cheng appear to be "judgmental." I define the nature of "judgmental" as shown by negative, or occasionally, positive, semantic fields characterized by the usages of adjectives and descriptive sentences. Every case of being judgmental hints at Chen Cheng 's unique background that tells the readers both about the Confucian tradition of China and about the daily scene of the Timurid society.