This paper examines a nursing ethics scenario in which a nurse continues to administer pressure area care to an elderly patient despite the patient's explicit objections. Using the principles of bioethics — including autonomy, beneficence, and consent — the paper evaluates whether the nurse's actions are ethically justified. Drawing on the analytical framework proposed by Jonsen, Siegler, and Winslade (1998), the discussion addresses medical indications, patient preferences, quality of life, and contextual features. The paper also considers the tension between paternalistic nursing practice and the ethical obligation to respect patient autonomy, particularly when a patient's competence may be in question.
The scenario in this study involves a nurse who has intentionally disregarded an elderly patient's expressed wishes regarding pressure area care. The patient finds the procedure uncomfortable, embarrassing, and painful, yet the nurse continues to turn the patient despite those wishes. This paper examines whether the nurse is justified in doing so — and if so, on what ethical grounds — or, if not, why not. The case is discussed in light of the principles of bioethics and at least one central ethical issue.
Lakeman (2000) notes that "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) further observes 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 is particularly important in the ethical consideration of healthcare providers. Consent "is the cornerstone of patient's rights" (Lakeman, 2000). In cases 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 given, which must be sufficient to allow evaluation of the available choices, and the person must feel free to make that choice without coercion.
Determining the appropriate amount of information, or assessing a person's ability to understand and evaluate it, can be difficult in a healthcare context. The very nature of the healthcare relationship and its setting can lead to implicit — if not explicit — coercion in medical ethics.
Health professionals have an obligation to endeavor to enhance autonomy and to facilitate the likelihood of a patient being able to make an autonomous decision. 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. 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 or her autonomy as far as possible.
Beneficence is usually considered to rely on an objective view of what would be best for the patient. However, this objective standard must be weighed carefully against the patient's subjective experience and expressed preferences, particularly when the patient is conscious and communicating their wishes.
Jonsen, Siegler, and Winslade (1998) suggest that each clinical case involving an ethical problem should be analyzed through four topics:
"Four-topic framework applied to the case"
"Competence assessment as the nurse's first step"
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