Ethical Decision Making Process in Nursing - Essay Example

Ethical Decision Making Ethical Dilemma is a situation in the critical care unit which has disagreement as to the correct of action. Thevalues and beliefs of the nurse may at times be in conflict with those of the patient. The nurse may find it difficult to select between the choices, since both beliefs appear to be correct. Medical Philosophy and Nursing Religion play a significant role in such situations. Often the problem may not be solvable. Nurses are required to maintain Beneficence, justice, autonomy, veracity and respect for persons while keeping the needs and safety of the patient as priority. Patients have autonomy to decide about the type of treatment and nurses must respect their decision. But conflict occurs when patient's beliefs are different from nursing practice. A planned approach, applying appropriate knowledge, should be used in coming to a decision. Erickson (1989)2 identified areas of knowledge that are needed to resolve ethical dilemmas successfully. These include knowledge of oneself, the situation, the profession and the law. To these should be added knowledge of the patient's values. Collaborative decision-making involving the patient/client, family and members of the health care team is the optimal approach with the patient's/client's wishes always taking Precedence. When an ethical situation does occur within the health environment, it usually involves all members of a health team. The ethical issues involved in a particular patient/client care situation should be discussed openly in an attempt to resolve any difficulties that may be experienced by individual members of the team. Knowledge of patient/client values: The spiritual and cultural values of the patient , and his family should be taken into consideration while making a medical decision . Knowledge of own Values : Nurse's own moral values will affect decision making. Knowledge of the Situation : A comprehensive understanding of the situation and associated conditions that may impinge upon the situation. Knowledge of the Profession's Values and Standards : Medical profession codes of ethics and Professional conduct provides substantial guidance in such critical conditions . Knowledge Of The Law Commonwealth and State laws that are relevant to the decision. Medical Professionals can't break the law. There may be significant differences in applicable law in different jurisdictions. For instance, Euthanasia (mercy killing ) is legalized in Netherlands but not in many parts of the world. In Scotland it is possible for a person to appoint a welfare attorney to make decisions about medical treatment for that person in the event that he / she becomes incompetent (Adults with incapacity (Scotland Act 2000) . But this is not possible in England . The current development of a Mental Capacity Bill in the UK highlights the need to enable patients to make treatment decisions for themselves. In India, Medial Profession falls under Consumer Protection Act . The Act states that the doctor is liable to patients and his family for negligence and emphasizes the need to exercise utmost care and diligence by health care professionals. " It would not be correct to say that every moral obligation involves a legal duty , But every legal duty is founded on a moral obligation " . Precedents: Department of Geriatric Medicine, St George's Hospital Medical School, London SW17 0RE Whether drugging the patient without his / her knowledge as a last resort amounts to Professional Misconduct A day hospital sister was suspended and given a final formal warning for obeying the request of her consultant to give a patient tranquillizing medication in disguise. Though a disciplinary inquiry exonerated the consultant, the action on the nurse has not been rescinded. AmeriCare Health Services 1132 E Second Street, Defiance, OH 43512 USA - Joseph K Wells The case is a classic example of a seemingly simple yet frequent dilemma encountered by occupational and physical therapists in the United States serving clients who are covered by Medicare (the government's health insurance) for home health. The ethical dilemma in the case involved whether or not to continue treating a client who clearly needed occupational therapy services based on medical necessity, yet the payer-source (Medicare) coverage criteria for services to be delivered at home was questionable. That is, should one continue to treat the client and uphold the principle of beneficence yet run afoul of the law, or should one discontinue treating the client to uphold the law but possibly cause harm to the client However, considering ethical principals like autonomy . veracity , fidelity , beneficence , non - malfeasance , justice and avoidance of killing , the nurse , after detailed discussions with the client and her family, discontinues home-based occupational therapy services and referred the client for outpatient rehabilitation. Case Study : Mr. Joseph Carter , a 79 year old patient , who is diagnosed for prostate cancer wants to try dietary treatment , instead of the radiation treatment prescribed by his doctor. This case presents an ethical conflict frequently faced by health care professionals in discharging their duties. The nurse is under a dilemma as to whether he /she should accede to patient's request or strictly follow doctor's advice ignoring patient's desire . The patient's wish to try dietary treatment in lieu of Radiation treatment (prescribed by doctor) is in conflict with Medical beliefs. The above situation can be viewed from various ethical principles. Autonomy: The client's right based upon his self-determination to receive dietary treatment and nurse's professional autonomy to decide which treatment the client should receive is under question. Exceptions to autonomy : Prevention of suicide , protection of third parties, maintain integrity of the health care profession and the maintenance of institutional order are exception to autonomy. Veracity: Professional obligation to give radiation treatment to the patient interfered with client's autonomy. Reality bites. If the nurse gives dietary treatment and the situation of the patient worsens, the act will be questionable. On the other hand, if she/he gives radiation to the patient much against his wishes, she / he will be deceiving her / his conscience. Justice: Justice to the profession and to the client. Whether the dietary treatment is good for the health of the patient or radiation Whether the nurse is justified in giving dietary treatment Whether by giving dietary treatment, the nurse is upholding the professional principles Whether justice is done if radiation is given to the patient against his wishes. Fidelity: Nurse's ability to uphold his / her commitments to the client and organization, versus nurse as a moral agent. This depends upon the level of emotional bond between the patient and nurse . Beneficence: Obligation to maximize possible benefits and minimize possible harms to the patient/client and their significant others. Whether dietary treatment is beneficial for the client as against radiation Whether it is good or valuable to the client Whether radiation can be ignored and dietary treatment can be provided in the best interest of the patient Whether that would result in maximum benefit to him Non malfeasance: whether the act of giving dietary treatment (as against the radiation therapy prescribed by the doctor) to the patient would amount to malfeasance Legal aspects : Statute and case laws , State Acts governing the Profession are to be considered while making a decision . Whether giving dietary treatment would result in the violation of law Further , the nurse may consider different ethical theories as well for decision making : Teleology : Whether the decision would make the client happy . What would be the end result Deontology : The action and its process, and the moral rules and principles involved with the act versus the consequences of the action itself. Resolution of Ethical conflicts One to one meeting and discussion with the patient, patient's family, doctor, Organization and regulatory authority (if any) in the interest of patient's health and well being may resolve the ethical conflict. Ethical Decision Making: Ultimately, the nurse is under the burden of making life or death decision. After observing above ethical principles and consultation with doctor, family members, and Organization she / he can take a decision that is based on justice and equity . By doing so, the nurse not only respect patient's wish but also upholds the dignity of Medical Profession . The nurse may reflect on the decision once it is implemented. The nurse may try dietary treatment for the patient as per his wish after taking written consent from him and his wife .If the situation improves (sometimes the patient responds positively since the treatment is given as per his wish )the nurse may continue it . If the situation worsens, the nurse can discontinue the same and try radiation. In any case, the patient and his family should be fully aware of the nature of treatment. As Abraham Lincoln once stated, "Let us have faith that right makes might, and in that faith, let us, to the end, dare to do our duty as we understand it." Bottom of Form References : rnbob.tripod.com/ethical.htm www.bmj.com www.issuesinmedicalethics.org/ www.nursing-standard.co.uk findarticles.com/p/articles www.nmbwa.org.au www.ncbi.nlm.nih.gov/sites www.issuesinmedicalethics.org www.blackwell-synergy.com Read More