Case Scenario Ethics

Ethics State Regulations and Nursing Standards There's a clear nursing standard of practice that needs to be upheld in this case which is the act of following federal laws, largely the Patient Self-Determination Act (PSDA).

Passed by Congress in 1990, "the law mandates that in healthcare institutions that receive Medicare or Medicaid funding, patients must be informed in writing upon the admission of 1) their right to accept or refuse treatment, (2) their rights under existing state laws regarding advance directives, and (3) any policies the institution has regarding the with-holding or withdrawing of life sustaining treatments (Ulrich, 1999, p.9). Thus, the implications as a result of the Patient Self-Determination Act are clear: Patients have the autonomy and independence to steer the direction their care takes if any at all.

Medical professionals have an ethical, though more importantly a legal responsibility and requirement to obey the wishes of the patient. Mr. E's advanced directive should have been addressed immediately and been honored from the start. Much of the drama and unnecessary speculation of the subject could have been rightfully addressed from the start. 3. Code of Ethics Self-determination and autonomy apply directly to this case, as elements of the code of ethics that directly connect to this case.

Self-determination and autonomy refer to the right of the patient to decide precisely how his map and protocol of care will unfold. An advanced directive authorizes people to state precisely the directions and exactions of the type of medical care they want if their mental and physical health reaches a state where they can't make decisions or communicate clearly and effectively with other people anymore.

Advanced directives also act as a form of direction for family members and doctors so that they can thus make decisions about the patient's care with a clear conscience (Mitty & Ramsey, 2008). From a legal standpoint this is essential as well, as it prevents decision-makers from becoming criminally liable when they were actually just following the terms of an advanced directive (Mitty & Ramsey, 2008). 4).

Impact of the Code Thus given the importance of honoring the ethical elements of autonomy and self-determination should not be underestimated; they're absolutely fundamental elements of decent care. Thus, in this decision, honoring the advanced directive that the patient made ahead of time is of the utmost importance. It doesn't matter if the health care professionals disagree with it or find it objectionable; not every course of treatment for a patient has to be found agreeable to medical professionals.

The issue of the most fundamental and absolute performance is that the legal plans that the patient created to guide the trajectory of his treatment be honored. 5. The ethical implications of putting the patient on the ventilator are staggering. While clinicians likely believe their upholding the ethical code of beneficence, this is just illusory. The reality is that they're violating the patient's autonomy and self-determination. Ultimately, the health care professionals are developing a state of malficence, something that should be avoided at all costs.

The patient had an advanced directive: Classic examples of advanced directives are power of attorney and living wills. Thus, autonomy and self-determination were the violated ethical codes in this example manifesting in subsequent legal violations. 6. Ethics of Authorizing the Ventilator There are numerous complex and inter-related factors that should be considered by Mr. Y. Mr. Y should have had a heightened awareness that the majority of the clinicians were trying to coax him to get his relative on the ventilator, at the suspension of Mr. E's patient rights.

"Respect for human dignity requires the recognition of certain patient rights, particularly, the right of self-determination… the philosophical basis for informed consent in health care" (ANA, 2001). Mr. Y should have made a strong inquiry to uncover why his brother wanted no part of the ventilator exactly. Mr. Y should not have allowed them to proceed with the intubation as there were clear ethical violations of his brother's sense of autonomy and right to self-determination, and a subsequent violation of human dignity. 7.

A variety of factors could be argued to have impacted Mr. E's advance directive. For example, his developmental delays, poor vision and bad hearing are all clear elements which make communication a challenge. This leaves far too many question marks over the entire situation. 8. The HIPAA violations are extensive: "Dr. K begins to explain Mr. E's condition. The boyfriend is standing next to Ms. H and there are several other people sitting in the waiting room." This is a breach of patient privacy. Another infringement occurred when Mr.

E's advanced directive is not mentioned at all. It was wrong of Dr. K to have moved forward with the intubation simply based on the verbal consent of Ms. H. 9. The professional conduct of the nurses in the scenario were also problematic. The nurses failed to inform Mr. Y of the full complexities of the situation. When the.