Ethical Issues in Nursing Scenario the Scenario

Ethical Issues in Nursing

Scenario

The scenario in this study involves a nurse who has intentionally disregarded the elderly patient's expressed wishes to receive pressure area care. The patient finds the procedure uncomfortable, embarrassing, and painful. The nurse continues to turn the patient in spite of the patient's wishes. This study will answer if the nurse is justified in turning the patient and if so, on what ethical grounds and if not then why not. This case will be discussed in light of the principles of bioethics and at least one ethical issue.

The work of Lakeman (2000) entitled "Nurses as Tools: Instrumentality and Implications for Nursing Ethics" states "Nurses are left in a particularly compromised position when required to administer compulsory treatment. The task of administering the treatment is often left to nurses who are legally required to follow "doctor's orders." There is little room for conscientious objection by nurses, as a moral objection is perceived as a challenge to the clinical judgment of doctors and the ethos of psychiatry. That nurses must 'do as they're told' in relation to the compulsorily detained and treated person does not, however diminish their personal moral responsibility for their own actions." (p.4) Lakeman (2000) additionally states that medicine "…is often presumed to have greatest competence in moral decision making, followed by other groups such as nursing who have some, but a lesser understanding (partial insight) of medical knowledge, and lastly by the patient who is deemed to have the least competence." (p.4)

Consent for Treatment

Consent for treatment is particularly important in the ethical consideration of healthcare providers. Consent "is the cornerstone of patient's rights." (Lakeman, 2000) In the case where a patient is incompetent, only a legally appointed guardian may make decisions concerning treatment. (Lakeman, 2000) For consent to treatment to be meaningful, a person must be able to understand the information he/she is given, which must be sufficient for him/her to evaluate the available choices, and he/she must feel free to make that choice. Determining the appropriate amount of information or a person's ability to understand and evaluate it can be difficult in a health care context, and the very nature of the health care relationship and health care setting can lead to implicit if not explicit coercion.(Ethicsnetwork.org, nd)

Ethical Obligations of the Nurse

First, health professionals have an obligation to endeavor to enhance autonomy and facilitate the likelihood of a patient being able to make an autonomous decision. Second, where a patient is unable to make an autonomous decision, it is the duty of the health professional to act in the patient's best interests. However, even in these situations, an effort should be made to discover any previous preferences of the patient, or current wishes, in order to respect his/her autonomy as far as possible." (Ethicsnetwork.org, nd) Beneficence is usually considered to rely on an objective view of what would be best for the patient." (Ethicsnetwork.org, nd)

Analysis of an Ethical Problem

The work of Jonsen, Siegler and Winslade (1998) states the suggestion that each clinical case, when involving an ethical problem should undergo analysis through sue of four topics stated as follows:

1. Medical Indications;

2. Patient Preferences;

3. Quality of Life; and

4. Contextual Features. (Jonsen, Siegler, and Winslade, 1998)

Otherwise, stated analysis is conducted through the "social, economic, legal, and administrative context in which the case occurs." (Jonsen, Siegler, and Winslade, 1998)

Medication indications are related to the clinical discussion content including diagnosis and treatment of the patient's condition.

Patient preferences speak of the patient's values and "personal assessment of benefits and burdens" all of which are ethically relevant. (Jonsen, Siegler, and Winslade, 1998) Additionally stated is "If the patient is mentally incapacitated at the time a decision must be made, we must ask, "Who has the authority to decide on behalf of this patient? What are the ethical and legal limits of that authority? What is to be done if no one can be identified as surrogate?" (Jonsen, Siegler, and Winslade, 1998)

The third component of analysis is related to the consideration of the quality of life of the patient. Stated is that any injury or illness "…threatens persons with actual or potential reduced quality of life, manifested in the signs and symptoms of their disease. The object of all medical intervention is to restore, maintain or improve quality of life." (Jonsen, Siegler, and Winslade, 1998)

Finally the contextual features are such that patients

"Come to physicians because they have a problem that they hope the physician can help to correct. Physicians undertake the care of patients with the intent and the duty to make all reasonable efforts to help them. The topics of medical indications, patient preferences and quality of life bring out these essential features of the case. Yet every medical case is embedded in a larger context of persons, institutions, financial and social arrangements. Patient care is influenced, positively or negatively, by the possibilities and the constraints of that context. At the same time, the context itself is affected by the decisions made by or about the patient: these decisions have psychological, emotional, financial, legal, scientific, educational, religious impact on others. In every case, the relevance of the contextual features must be determined and assessed. These contextual features may be crucially important to the understanding and resolution of the case." (Jonsen, Siegler, and Winslade, 1998)