Ethical and legal dilemmas in nursing practice: the Lee case

Ethical Perspectives

Ethical decision making is a method that is utilized by most of the health care professionals all over the world. The principles of beneficence and autonomy are very crucial when it comes to carefully guiding the decision making process. A nurse needs to understand that the importance of these principles and thus use these principles for the patient's benefit. Chally and Loriz (1998) and Kolouroutis and Thorstenson (1999) have stressed on the relevance of nurses using this model to guide their practice and thus make decisions accordingly.

Being careful of a patient's autonomy means that the nurse is able to respect and understand that the patient has all the rights to make a decision about the care and treatment that the patient receives. (Mappes & DeGrazia, 2006) It is true that the patient may not have enough medical insight as the nurse and he may even make the wrong decision. Regardless, patient's decision has more weightage than the nurse's opinion and the nurse needs to respect that. If the patient is competent medically and is sane, then he can make personal decisions even if the decision is to refuse the treatment that he is getting. (Parker, 2007)

Beneficence means that the health care provider should work to do good for the patient in all the situations possible (Beauchamp & Childress, 2009) In other words; their main goal should be to improve the patient's health. Every situation that the nurse gets should be dealt with differently. This is crucial because what is good for one patient is not always good for a different patient. Along with doing well for the patient, the nurse also should keep their personal wishes and their values in mind.

Topic 2

Nurses all over the world are confronted with ethical and legal dilemmas during their practice. A dilemma is a situation in which the practicing nurse is not sure whether or not the decision that he or she is taking is the right decision or not (Dunn, 2013). ). The purpose of critically analyzing the cases and the ethical legal dilemma that the practicing nurses are faced with every now and then is to ensure the benefit of the patients and the nurses (Fant, 2013; Ward, 2012)

Mr. Lee was an 82-year-old male who had been admitted to the hospital after he suffered from stroke. He was brought to the hospital by his son and only legal heir and guardian. Since Mr. Lee was not in his usual state of health and was in a comatose state, the doctors and nurses reckoned that to fulfill his nutritional requirements, he needs a gastro-tubing for feeding. Every now and then Mr. Lee was seen in discomfort because of the tubing; however this was totally normal since most patients do feel uncomfortable with the tubing.

When Mr. Lee's son came to visit his father at the hospital, he did not approve of the tubing that was inserted through Mr. Lee's mouth to feed him so that his nutritional requirements could be met. He asked the nursing staff to remove the tubing. The head nurse, Mrs. Annie tried to convince his son that his father might day of lack of nutrition since he cannot take any food by mouth. Mr. Lee's son insisted that wants to the tubing out of his father because if he was conscious he would never agree to it. Mrs. Annie had no other choice but to remove the tubing. However, since she believed that it was not morally right to remove the tubing she did not take part in the procedure herself. While her co-workers were removing the tubing, an unfortunate incident took place. Despite taking all the important precautions, Mr. Lee's esophagus started bleeding and developed hypotension. Soon after, his blood pressure dropped to the point where his brain developed ischemia. Now the nurse was faced with a legal ethical dilemma. The dilemma was that it she did not feel morally right to remove the tubing since she believed that the patient could die of the nutritional deficit because he was taking anything by mouth. Moreover, since the patient developed brain damage while removing the tubing, this even could have legal implications.

Ethical Violation

She did not conform to the decision of the patient. In medical practice, the autonomy of the patient and guardians needs to be respected no matter what the consequences may be (Allen and Friedman, 2010). Therefore, it was her ethical duty to have been a part of the procedure (Ministry of Health, 2011).

Legal Violation

The procedure led to brain ischemia. This implies that the brain of Mr. Lee, or a part of it, was damaged. Since Mrs. Annie was an expert and a senior nurse, she could be held responsible for charges of refusing to treat the patient and letting the junior nurses perform the procedure that led to the damage (Royal College of Nursing, 2013).

Appropriate Decision

In her defense, Mrs. Annie could take up the plea that the guardian or the patient did not specify that they wanted her to remove the tubing. Since she believed that this was not the right thing to do, in good interest and spirit, because removing the tubing could mean the death of the patient, she decided not to take part in the procedure (Dolgoff et. al,