Nursing Ethics: Advance Directives and Medical Disclosure
This paper examines key ethical issues in nursing practice through utilitarian and Kantian philosophical frameworks. It addresses the justifications for advance directives such as the living will and healthcare proxy, the ethical and legal obligations surrounding full disclosure of medical errors, and the landmark Nancy Cruzan case. The paper analyzes why Missouri courts required "clear and convincing evidence" of a patient's wishes before terminating life-sustaining treatment, connecting these legal standards to broader principles of patient autonomy, informed consent, and the ethical responsibilities of clinicians toward patients and staff.
- Introduction to Nursing Ethics and Advance Directives: Utilitarian and Kantian justifications for advance directives
- Medical Error Disclosure: Ethical and Legal Obligations: Clinician duty to disclose medical errors fully
- The Nancy Cruzan Case: Court Decisions and Patient Autonomy: Missouri trial court ruling on terminating life support
- The Standard of Clear and Convincing Evidence: Supreme Court demand for evidence of patient's wishes
- Conclusion: Ethical frameworks applied across nursing scenarios
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What makes this paper effective
- Applies two distinct philosophical frameworks — utilitarianism and Kantian ethics — consistently across multiple nursing ethics scenarios, demonstrating comparative ethical reasoning.
- Connects abstract ethical theory to concrete legal and clinical outcomes, such as the real-world consequences of non-disclosure and the Cruzan court rulings.
- Uses case law (Cruzan) to ground ethical argument in historical precedent, adding credibility and specificity to claims about patient autonomy.
Key academic technique demonstrated
The paper demonstrates applied ethical analysis — taking established philosophical frameworks (Kantian deontology and utilitarian consequentialism) and systematically applying them to specific clinical and legal scenarios. Rather than merely defining the theories, the author uses them as analytical lenses to evaluate the justifications for advance directives, the ethics of disclosure, and judicial reasoning in end-of-life cases.
Structure breakdown
The paper is organized as a structured question-and-answer response covering four related topics: (1) philosophical justifications for advance directives, (2) the ethics of medical error disclosure, (3) the Missouri trial court's ruling in Cruzan, and (4) the Missouri Supreme Court's demand for clear and convincing evidence. Each section builds on the same ethical principles introduced at the outset, creating thematic coherence across the otherwise discrete responses.
Introduction to Nursing Ethics and Advance Directives
The healthcare proxy and the living will are two ways in which a patient can express advance directives relating to healthcare and/or end-of-life treatment should that person become incapacitated. The utilitarian justification for advance directives is that the end justifies the means — in other words, the greatest good for the greatest number of people. If an advance directive is given, it covers all the people involved and lets the patient's wishes be known ahead of time in case there comes a moment when the patient cannot speak for him or herself. The doctors and caregivers will be obliged to accept this as the greatest good, because it relieves them of any duty to provide care (if the directive specifies that it should be refused) and vice versa.
The Kantian justification for advance directives is that they respect the autonomous position — that is, the individual's right to refuse treatment, should that be the patient's choice. The individual makes this known ahead of time in the living will, for example, and this is respected because Kantian philosophy upholds autonomy as a basic right.
References
Edwin, A. K. (2010). Non-disclosure of medical errors an egregious violation of ethical principles. Ghana Medical Journal, 43(1): 34–39.
Gallagher, Thomas H. "A 62-year-old woman with skin cancer who experienced wrong-site surgery." (CIB, 65–71).
Philipsen, N. C., & Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practitioners, 7(9): 740–746.
Tabler, Norman G. (2006). Should physicians apologize for medical errors? The Health Lawyer, 19: 23–26.
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