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Autonomy in patient's rights
7 Ethical Principles in Nursing
7 Ethical Principles in Nursing
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Ethical Issues Ethical issues are “moral challenges” facing the health care profession (Stanhope & Lancaster, 2012, p. 127). Ethical issues is a major concern in the healthcare field because healthcare providers observe ethical issues every day and have to make ethical decisions. Advance directives are written documents that addressed an individual’s medical care preferences. These documents usually take effect when patients no longer can make informed health care decisions for themselves. While these documents are helpful to loved ones and health care providers, there are a number of ethical considerations that can make the development and execution of advance directives difficult (Llama, 2014). This author is a geriatric nurse that recently observed an advance directive ethical issue in the clinical setting. The purpose of this paper is to outline the steps of ethical decision-making within the seven steps for the framework. This paper will also identify the facts of the case from the perspective of each person impacted by the situation and identify which ethical principles were involved in the situation. Ethical Issues and People impacted Advance directives can become ethical issues especially when a family attempts to enforce their opinions on healthcare instead of what a patient had requested in a living will. Advance directives, sometimes called a living will, are legal documents that allow an individual to spell out your decisions about end-of-life care ahead of time (MedlinePlus, 2014). A living will address which treatments an individual wants if he or she is dying or permanently unconscious (MedlinePlus, 2014). People impacted by this situations was the patient, the patient’s daughter, and all the patient... ... middle of paper ... ... own life when the need arises (Llama, 2014). If the patients’ living will is clear, family member and health care providers should respected the patient’s autonomy. DPOA is a person appointed by the patient to make medical decisions on the patient’s behalf if the patient become incapable to do so (Llama, 2014). In all health care settings, nurses should apply the four primary ethical principles. Works Cited Llama, H. (2014). What Is A Living Will and Ethical Implications? Retrieved from http://hubllama.hubpages.com/hub/What-Is-A-Living-Will-and-Ethical-Implications MedlinePlus. (2014, March). Advance Directives. Retrieved from http://www.nlm.nih.gov/medlineplus/advancedirectives.htm Stanhope, M., & Lancaster, J. (2012). Public health nursing: population-centered health care in the community (8th ed.). Maryland Heights, Mo.: Elsevier Mosby.
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.
As we get older and delve into the real world, it is important to start thinking about end-of-life care and advance directives. Although it is something no one wants to imagine, there is an absolute necessity for living wills and a power of attorney. Learning about the Patient Self-Determination Act and the different legal basis in where you live is important because it will help people understand why advance care directives are so important. Although there are several barriers in implementing advance care directives, there are also several actions that healthcare professionals can take to overcome these obstacles. These are also important to know about, especially for someone going into the medical field.
Consequently, she was left in what most assumed to be a vegetative state for years eventually because her husband continued to advocate for her right to die she was unplugged and died soon after. This case served as a warning for most people who didn’t really consider Advanced Directives before. Are family members sure of what lengths should or shouldn’t be taken worst case scenario. Repeatedly this has proven not to be the case. Death or dying is always a taboo subject however, when high profile cases like this arise people are forced to evaluate their own lives? A study regarding knowledge about advance directives conducted in 2004 suggested that there was a direct correlation between attitudes, financial stability and the number of people who had advanced directives. Surprisingly this same study discovered that doctors or healthcare professions assumed it was the patient’s duty to seek out
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.
Patients are encouraged to attend this workshop with friends and family to start the discussion about Advance Directives. So far, there has been high patient satisfaction and high rates of patients who state they will complete an Advance Directive within the next month. We understand that Advance Directive need time and further discussions to complete, therefore we do not pressure patients to fill it out on the spot. We have also received feedback from my patients that doctors and nurses do not educate or, at the very least, mention Advance Directives to patients unless they are scheduled to undergo some type of invasive procedure. Patients are very appreciative of the Life Care Planning Class. I would like to further our efforts in bringing awareness to Advance Directives by developing a training to help the health care team promote Advance Directives in a similar way we do in our class, but also focus on reminding and emphasizing the patients’ rights and autonomy through their Advance Directives. Even though patients are vulnerable when they are seeking our care in the hospital, we need to respect their rights and health care choices. With these efforts, we are assuring
A patient’s spouse or other family members have no right to override the patient’s decisions or their doctor’s understanding of them. Though, the patient’s doctor does have the right to overrule their living will. For example, if a patient’s doctor believes that going along with their wishes in spite of their living will, will harm someone else like an unborn child in a mother’s womb, he can overrule it. Circumstances defined in a person’s living will may not always concur some situations. When this happens, the patient’s medical care team will make a decision based on the “spirit” of the living will to be careful, and will contact anyone named in the patient’s living will along with their primary care doctor or clergy in attempt to spell out the patient’s desires since they are not able to overrule the living will. Clearly, when everyone involved are in agreement with the patient’s requests, the situation is made much easier. Legal and ethical dilemmas are possibly created if everyone involved is not supportive. A patient should review his or her living will every year due to advancements in science and medical treatments that may affect them in the future along with the possibility of their feelings changing, based on many factors and laws that may change over the years. There are three different types of living wills a person can make. One is a statement made by a person diagnosed with a terminal condition before any deterioration and after all medical measures have been exhausted. Another is a statement made by a person of good health and quality of life that is written prior to becoming ill. The third is a statement of issues surrounding a patient’s religious convictions which could include their spouse, stepchildren, adopted...
Advance directives might have many guidelines for patient’s preferences with regard to any number of life-affecting, or end of life situations, such as chronic disease or accident resulting in traumatic injury. It can include directions for other health situations, such as short-term unconsciousness, impairment by Alzheimer disease or dementia. These guidelines may consider do-not- resuscitate (DNR) orders if the heart or breathing stops, tube-feeding, or organ and tissue donation. The directive might name a specific person, or proxy, to direct care or may be very general with only basic instructions given for treatment in time of the incapacitation of a patient. Some states say that if you do not have a written directive, a spoken directive is acceptable.
Within palliative care, caregivers and patients take on roles that should balance each other out. The patient should be comfortable with trusting the caregiver to keep the patients promises while receiving treatment, being unconscious, or awaiting death. As a caregiver, they are to respect their patients wishes even if there is an ethical battle within the caregiver. This battle can cause the relationship between the patient and caregiver to become disrupted. The disruption within their relationship can cause strain which will put added pressure on both parties. Whenever a patient relies on the caregiver to work out their wishes, the care giver should always support the patient’s rights, no matter how big an ethical dilemma there might be.
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.
The advanced nurse practice role of a family nurse practitioner in the primary care setting has many ethical dilemmas. “Ethical principles include beneficence, nonmaleficence, respect for autonomy, fairness, truthfulness” and justice (Advanced Nursing Practice Toolkit, 2012, para. 1). One ethical issue that I was faced with in the clinical setting was that of a ninety-two year old man whom in my opinion, clearly needed palliative care due to his chronic congestive heart failure and the fact that his lungs were consistently filling up with fluid which inevitably always needed a thoracentesis and hospitalization. He had a poor quality of life and had been placed into a nursing home some time ago. Within the past two to three weeks he had needed
Several ethical principles that are incorporated in the nursing care of patients on a daily basis are nonmalificence, autonomy, beneficence, justice, fidelity and paternalism. Nurses should strive to comply to as many of the principles as possible. In this case there are principles which support and conflict with the wishes of the patient. The first principle that supports the wish of the patient is autonomy. Autonomy means that competent patients have the right to make decisions for themselves and the delivery of the healthcare that they receive. Another factor that would support the patient’s wish to not be resuscitated is nonmalificence. Non maleficence means that nurses should not cause harm or injury to their patients. In this case the likelihood of injury after resuscitation was greater than if the patient were allowed to expire. A principle that could have negatively affected the outcome of the provision of ethical care was paternalism. Paternalism is when a healthcare provider feels that they know what is best for a patient, regardless of the patient’s desire for their own care. I demonstrated the principle of paternalism because I thought that I knew what was best for the patient without first consulting with the patient or family. This situation might have had some very negative consequences had the patient not have been competent. Practicing a paternalistic mindset might have caused a practitioner in the same instance to force their ideas about not resuscitating the loved one onto the family. This could have caused a sense of remorse and loss of control of care amongst the
While conducting research studies, the American Psychological Association Ethical principles must be taken into account. This study has a few ethical issues that must be discussed including the use of children; especially children with developmental delays, privacy concerns, and other debriefing concerns for ABA therapies.
One ethical dilemma that comes up is how notes are taken for all students in the Glendale Union High School District, including Orlando. Typically, notes are entered onto Ms. Karter’s computer after a student is seen, and they are put into a system that every teacher and social worker in the district uses. Not enough information has been reported at this time about how, but it has been discussed with Ms. Karter that other individuals that utilize this software could theoretically read her notes on the students she sees. Because of this, she tries to keep her notes as vague as possible, in order to maintain student confidentiality. This ethical issue has been addressed by how notes have been entered into the system,
A = Affirm the decision. Considering that according to ANA position statement and that it is illegal in the state where I practice, physicians and the nurses should not participate in the patient assistant suicide.
The focus of this paper will discuss ethical issues faced when professionally counseling the (Developmental Disability) population ages 18 and older. It will touch basis on informed consent with the knowledge that these individuals understand the care being provided. Also I will provide examples of court cases and legal aspects of the practice when dealing with such population, as well as recommendations on particular treatment. Challenges of working with this population from an ethical standpoint respecting their rights within state guidelines will be discussed as well.