Ethical Dilemmas
As population ages, clinicians will care for an increasing number of elderly patients. Just as these patients may present unique and challenging medical dilemmas, so may they also present ethical ones. Ethical dilemmas are present in everyday practice. It provides a brief overview of the situations that may raise ethical concerns. Although, these are not the only ethical concerns that may arise during care of the elderly and are not unique to the population, they represent the most common scenarios that clinicians may encounter in their everyday course of practice. Ethics, according to (Mueller, Hook & Fleming, 2004), is the analysis and identification of the moral problems that arise in the care of patients. Ethical issues on geriatrics: a guide to clinicians (2004) reports that clinicians will care for an increasing number of elderly patients with challenging medical problems.
Ethical principles are judgments that serve as a basic justification for the ethical evaluation of one’s action. They are the viewpoints from which guidance can be obtained along the pathway to a decision. According to the Journal of the American Nurse Association, ethical principles are the general goals that each theory tries to achieve in order to be successful. The widely accepted prima facie ethical principles are; Autonomy, duty to respect one’s right. Beneficence, the desire to do good. Non-maleficence refers to avoidance of harm or hurt. Justice, duty to treat one fairly. (Beauchamp, 2004). While some of the ethical dilemmas includes: ensuring informed consent, determining decision-making capacity, promoting advance care planning, surrogate decision-making, withdrawing and withholdi...
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... clinical trial comparing two treatments is in progress, and a physician has an opinion about which treatment is better. This duty creates a barrier to the enrollment of patients in randomized clinical trials.
Advance Care Planning
Advance care planning allows a patient to identify health care preferences and surrogate decision making in the event the patient cannot make competent health decision. It promotes autonomy of patients who lack, but once possessed, the decision-making capacity. In general, there are two forms of Ads; the living will and the durable power of attorney. Nevertheless, most people, including elderly persons do not have Ads. One study of a random sample of all US deaths (N=13,883) found that only 9.8% of decedents had an AD. Patients with AD, however, were less likely to undergo cardiopulmonary resuscitation and more likely to use hospice care.
Nurses everywhere face problems and challenges in practice. Most of the challenges occur due to a struggle with the use of ethical principles in patient care. Ethical principles are “basic and obvious moral truths that guide deliberation and action,” (Burkhardt, Nathaniel, 2014). Ethical principles that are used in nursing practice include autonomy, beneficence, non-maleficence, veracity, confidentiality, justice, and fidelity. These challenges not only affect them, but the quality of care they provide as well. According to the article, some of the most frequently occurring and most stressful ethical issues were protecting patient rights, autonomy and informed consent to treatment, staffing problems, advanced care planning, and surrogate decision making (Ulrich et. al, 2013). The ethical issue of inadequate staffing conflicts with the principle of non-maleficence.
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 non-maleficence 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 first provision of the American Nurses Association’s (ANA) “Code of Ethics” states, “ The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” The second provision states, “The nurse’s primary commitment is the patient, whether the patient is an individual, family, group, or community” (Fowler, 2010). As nurses we need to respect the autonomy and allow for the patient to express their choices and concerns. We also need to provide them with support by giving them knowledge and understanding so they
In the code of ethics, the very first ethical principles that nurses are expected to uphold in order to exemplify that they are competent professionals are autonomy, beneficence, and nonmaleficence. That is, nurses as professionals are expected to advocate for their patients while preserving their respect and dignity and
In the medical profession, doctors and nurses run into ethical dilemmas every day whether it be a mother who wants to abort her baby or a patient who has decided they want to stop cancer treatment. It is important for the nurse to know where they stand with their own moral code, but to make sure they are not being biased when educating the patient. Nurses are patient advocates, it is in the job description, so although the nurse may not agree with the patient on their decisions, the nurse to needs to advocate for the patient regardless.
The four major ethical principles in health care are: Autonomy – to honor the patient’s right to make their own decision (the opposite is paternalism - the health care provider knows best for the patient), Beneficence – to help the patient advance his/her own good, Nonmaleficence – to do no harm (many bioethical controversies involves this principle), and Justice – to be fair and treat like cases alike. All 4 principles are considered to be in effect at all times. In theory, each is of equal weight or importance. Ethical responsibilities in a given situation depend in part on the nature of the decision and in part on the roles everyone involved play.
During week 4, we became familiar with the application of ethics in the nursing practice settings. We learned about ethical theories and principles, which are crucial when practicing in any clinical settings during ethical decision-making and while facing one or multiple ethical dilemmas. Also, we were introduced to the MORAL model used in ethical decision – making progress. The MORAL model is the easiest model to use in the everyday clinical practice, for instance at bedside nursing. This model can be applyed in any clinical settings and its acronyms assist
Providing the steps to ethically sound excellent care, healthcare providers must acknowledge first the legal and ethical matters involved with proper investigation and then devise a plan for best possible action recognizing the rights of the patient and its benefits followed by the application of the chosen intervention with positive outcome in mind (Wells, 2007). Delivery of excellent and quality of care at a constant level (NMC, 2008) must be marked in any responsibilities and duties of the care provider to promote exceptional nursing practice. Codes of nursing ethics and legal legislation have addressed almost all the necessary actions in making decisions in consideration to the best interest of the patient. Nurses must make sure that they are all guided by the set standard to lead their action and produce desirable and ethically sound outcomes.
The classical term for the word ethics is, moral philosophies that rule an individual’s or group behavior or action. The American Nurses Association used ethics to write the Code of Ethics for Nurses with these values and visions in mind: “(1) As a statement of the ethical obligations and duties of every person who chooses to enter the profession of nursing. (2) To act as the nonnegotiable standard of ethics. (3) To serve as an expression of the understanding on nursing’s commitment to society.” (Nurses Code of Ethics, 2015). With our ever-changing society and healthcare, also comes changes to the American Nurses Association’s
1020). According to his mother we were not allowed to tell him, and he can feel it in our face. In this case, the nurse autonomy was affected because we should tell the patient about his condition. Then we had a barrier not only supported by the charge nurse and even the patient’s primary care was supported that decision. “Understanding nurses in the process of exercising their autonomy in EOL situations means generating knowledge about a new phase of activity for ICU nurses relating to evidence that can clarify and strengthen the decision process” (Paganini, & Bousso, 2015, P. 22). From the unit 1, we have learned the five ethical principles that can be applied to ethical decision-making which are autonomy, nonmaleficence, beneficence, justice, and fidelity. Although these ethical principles decision-making are established, but sometimes it can be very challenged. “The principle of autonomy, supported by the other ethical principles, is a predominant focus in Western healthcare with a key role of healthcare understood as supporting patient autonomy, hence the centrality of patient
Physicians as healers; Many physicians regard PAS as violating a fundamental tenet of medicine: to heal and not to harm. Dr Kenneth Stevens, chairman of the department of radiation oncology at the Oregon Health and Science University in Portland, and an opponent of the Oregon law, says, “I went into medicine to help people. I didn’t go into medicine to give people a prescription for them to die.” (Steinbock, 2005)
The American Nurses Association Code of Ethics for Nurses has five elements that pertain to the Principle of Autonomy. Each individual element applies to “respect individual persons” (Baillie, McGeehan, Garrett T, M., Garrett R. M., 2013, p.33). In Chapter 2 of the Health Care ethics: Principles and problems text, it discusses thouroghly the consent of an individual to make their own decisions regarding their health and future requests of care. As a nurse or within all heath care professions, we must treat each individual patient with care, respect, and to remain mindful to the patient regarding any aspect of their lives. In the ANA Code of Ethics for Nurses, it explains ways of maintaining the empathy required in the health field. It further discusses that the respect for human dignity must be a priority, relationships to patients must remain neutral, the severity of the situation, the right to self-rule, and the professionalism that must be upheld by the nurse and their associates.
Ethics is defined as moral principles that govern a persons or a group’s behavior, ethical principles apply to both personal and professional relationships (Webster, 2015). The field of nursing is a profession that has been highly regarded and respected in society. Most nurses enter the profession in order to utilize their clinical skills to help others in their time of need. Those in failing health rely on nurses to care for them in their most vulnerable states, and expect a level of compassion and humanity while receiving care. Nurses have an ethical responsibility to their patients, clients, and their community. Compassion, empathy, and integrity are staple characteristics that nurses possess that allow them to successfully perform their
The four fundamental nursing responsibilities of promoting health, preventing illness, optimizing health and alleviating the ill are represented in the code of ethics. (Arnold & Boggs, 2016) One can say that the code of ethics are rules that a nurse needs to follow in order to effectively communicate and protect the patients. The American Nurse Association provided the code of ethics to guide nurses to ensure that patient’s care, safety, rights and health are well cared for and well managed. Models like Utilitarian, deontological, and the human rights-based all contribute in answering dilemmas that can arise with a patient. Thus, explaining what some of the code of ethics are, and how the code of ethics influence our responsibilities as a nurse will impact the overall care of the
Ethics asses the values, morals, and principles of nurses. Legal codes or laws are rules established by our government. It’s important that nurses have a clear and comprehensive understanding of ethical and legal codes within their career. The understanding of these codes is essential for nurses to safely practice and to protect their patients. Nurses must abide by these principles or face the consequences of legal action. These principles include autonomy, utilitarianism, confidentiality, and many others. Autonomy is the agreement to respect ones right to determine a course of action, while utilitarianism is what is best for most people as defined in American Nurses Association. In order to give you a