Introduction to Nursing Arts & Sciences
Introduction
In the daily operation, nurses face different ethical decisions situations that range from routine vaccination to issues relating to dying and death. It is essential that these nurses have knowledge on how to analyze these bioethical issues based on nursing ethical values, facts, principles to be able to make ethical decisions about their duties and responsibilities. This will also help support their patients and families as they struggle with understanding application of ethical decisions.
PART A
Moral aspects/issues in the scenario
The scenario has various moral issues that require to be addressed. One of the moral issue concerns the decision whether to save the life of Matt or not. The family members are of the view that, their son can be saved from death while the physician has given up on the same. Matt is in a very critical state, as his brain has stopped working, his dark blood is visible in the suctioning canister. This indicates that indeed he is at risk of dying. However, amidst all these, he is unable to express his will. Despite this, family members are optimistic that he can survive and therefore there is no need for the physicians to end his life and therefore have refused to assign him a “do not resuscitate’. Furthermore, the physician refusal to abide by the directive of the family members to ensure that the patient life is not terminated is a moral issue, as the physician does not want the patient to have any further resuscitation. It is also a moral question for the nurse to state that she dislikes taking care for drug abuse patients and yet that is her duty to enhance the health of patients.
In this case, the ownership of the situation was the family members. This is captured in the case, “the family told the healthcare team that they wanted to do everything possible to save their son’s life”. This indicates that the family had the last decision of the end of life decision. Even though Matt was in a critical condition, they were the only people to give directive on the next decision to be taken and there decision was to ensure that all assistance was provided to ensure that their son was saved. Furthermore, the family members refused to assign “Do not resuscitate” status after being approached. Therefore, this is a clear indication that the family members owned the situation and was supposed to make the last decision.
The five essential nursing values that suit this scenario include; altruism, autonomy, human dignity, integrity and social justice. Altruism means that the nurses should aspire to do well and be concerned with other people issues (Andre, 2002). Therefore, the nurses should put in their best in restoring Matt life. They should also have autonomy in the sense that they should put on a spirited heart to save the life of Matt. They should also has human dignity by respecting the uniqueness of the patient, should have integrity by being honest and acting in accordance to the code of ethics and standards and practice. Lastly, the nurses should have a sense of social justice by working to ensure that there is equal treatment and equal accessibility to quality healthcare. The scenario in which the nurse expression her dislike to attend to drug patients should not have arisen. The nurse has the moral duty to use her professional qualifications to serve all patients without discrimination. Therefore, these five values are of importance in ensuring that appropriate services are provided that adheres to ethical standards.
PART B
Analysis of two bio-ethical issues in the scenario in relation to ethical theory
One of the ethical issues in the scenario is the wish of the family members and that of the physician. The family refused to assign DNR despite the physician’s advice and the physician’s decision to make Matt a DNR over the objections of the family. The second bio-ethical issue concerns the nurse. The nurse is torn apart whether to support the family on DNR or the physician who has contrary thought otherwise. To address these issues in depth the theory of Deontology by Kantianism will act as guidance. The theory provides direction on determining what is rational and what is not. The will and reason should also come into play in making decisions. An individual is also required to do that which is required by being consistent and avoiding self-contradictory policies since people are evaluated on what they do. This theory also seeks to differentiate between what is good and bad. Doing good is brought by doing the right action. Therefore, right is a basic notion and people need to have a positive attitude towards doing or acting according to ones moral duty (Curtis, 2011). Therefore, this theory relates to this situation especially when it comes to making the right decision of end of life care. Physicians in the case had an obligation to choose from what was good and right from what was not right. The physician had the duty and moral obligation to act in ethical manner by coming up with the right decision that would be in tandem with the wish of the patient. He therefore, chose to stop to give further resuscitation after learning that their family members had failed to assign DNR. The physician therefore failed to adhere to ethics by refusing to abide by the wishes of the family members. Refusing to provide resuscitation was against the law. In the second case of the nurse, there was also lapse in adherence to ethics. It is the moral duty of the nurse to make appropriate decisions concerning end of life decisions. Therefore, the nurse would have supported the family members, as this was the right way to go because she could have acted in moral way. Abiding by the directive of the manager and physicians indicates that she failed to act in a moral way. The physicians also breached ethical standards by failing to adhere to the wishes of the family who were the owners of the situation.
One of the applicable law that would have enabled this case to be handled well is if uniform rights of the terminally II Act law was adhered to (Saunders 2010). This law was formulated in 1985 and revised in 1989. United States of America recommends it as a Uniform Act. The law gives authority to an individual to declare a living will, which clearly states that in circumstance that he or she does not wish to remain alive in case of a coma, terminal ill or through support life, and then the physicians can take away the patient’s life. Therefore, had Matt declared this living will then the end of life decision would have gone on smoothly. Furthermore, the law allows a patient to obtain a health care known as power of attorney, which allows appointment of an agent that is required to make medical decisions for the patient incase the patient becomes incompetent. Hence, if Matt had obtained the power of attorney then this problems of end of life decisions would not have surfaced as the uniform rights of the terminally II Act law could have been used.
PART C
Discussion of how alternative actions might have affected the patient outcome
The patient outcome could have been affected through Cardiopulmonary resuscitation (CPR) interventions. This is because there were no written physician orders that deterred performance of CPR (Bishop, Brothers, Perry & Ahmad, 2010). CPR interventions could have helped to extend the life of the patient. Further alternative action in this scenario would be to use the agency laws and policies. For instance, the agencies policies that concerns mechanisms for safer transfer of care by agency or providers should have been adopted. In such a case DNR decisions has ethical conflicts and the best way is to transfer the patient (Matt) to another nurse or physician that is competent to take care of the patient (Matt). This alternative action could have provided hope of recovery as another physician could have used his skills and experience to safe his life as the level of skills and knowledge among physicians varies. An ethics committee is yet another appropriate alternative action that suits this case. The committee will come up with deliberations after investigating on the breaches of adherence to ethical standards by physicians and nurses in their conduct and therefore they will have to come up with alternative solutions such as looking for another physician to provide treatment to the patient. Such alternative course of actions would have provided hope for resuscitation because of the different levels of skills of physicians. The family members would also been in peace and in harmony with the decision hence disputes between them and the physicians would not have ensued anymore.
American Nurses Association codes of ethics (ANA) are helpful in understanding how these alternatives could have impacted on the patient’s outcomes. American Nurses Association code of ethics is composed of provisions that guide the behavior and the way nurses need to behave during their service delivery. The nurses at all the time are required to appear professional in their service delivery and relationships with patients. Therefore, they have a duty to always save the lives of their patients; they are also required to be always committed to their patient’s, community and groups to ensure that they improve their health status (Michael, 2010). They also need to have integrity when carrying out their roles. Furthermore, they need to collaborate with other nurses and patients to ensure that they provide the best services. Therefore, in case of a situation that requires an appropriate decision they need to help physicians with ideas on the ways of solving problems (American Nurses Association 2011). Hence, as stipulated in the American Nurses Association, nurses have the responsibility of impacting positively on the end of life care by being professional and upholding to high level of integrity among other important values.
References
Andre, J. (2002), Bioethics as Practice, Chapel Hill and London: University of North Carolina Press,
American Nurses Association (ANA). (2011). Codes of ethics. Retrieved from: http://www.nursingworld.org/Mobile/Code-of-Ethics
Bishop, J., Brothers, K., Perry, J., & Ahmad, A. (2010). Reviving the conversation around CPR/DNR. American Journal of Bioethics, 10(1), 61–67.
Curtis, B. (2011). Ethical Theories Compared. Retrievd form: Ethical Theories Compared
Hayry, M. et al (Eds.) (2010). Arguments and Analysis in Bioethics. Amsterdam/New York: Rodopi
Michael, D. (2010). The role of the American nurses association code of ethical decision making. Retrieved from: http://www.nursingcenter.com/lnc/static?pageid=864590
Saunders, L. (2010). Legal and ethical issues in health care Occupations (Aiken) Pg 6
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