Patient Diagnosed With Cancer - Essay Example

Patient Diagnosed With Cancer Abstract The essay aims to address a two-fold objective to wit: (1) to identify the principles of professional nursing practice; and (2) to outline the ethical and legal frameworks for professional practice and incorporate evidenced-base practice in relation to quality patient care. Case Study Introduction/ State the Problem This paper will study the case of Tabitha and determine the rights of the client based on Kerridge, Lowe and McPhee (2005) Model for Ethical Decision Making. In addition, this case study will discuss the ethics and legality of minor patients in terms of decision to receive or refuse treatment, as well as the capacity of the parents to give consent. Tabitha is 1-year-old patient who was diagnosed with cancer two years ago and has received two courses of chemotherapy. She understands and respects every decision with regards to treatment and is due to have another round of chemotherapy. The treatment can make a 30% chance of survival or approximately two years. Without this, Tabitha will die within three months. Tabitha has a good relationship with clinical team. She also has a supportive family and friends all throughout the treatment. She attends the local school when she is not sick and lives with her brothers and parents. The ethical dilemma started when Tabitha refused consent chemotherapy because of being fed up in the hospital to receive unpleasant treatments. According to the ANMC National Competency Standards for the Registered Nurse Section 2.3 (2008), a registered nurse practices in way that acknowledge the dignity, culture, values, beliefs and rights of individual groups, including the consideration of individual/group preferences when providing care (p. 3). Respecting Tabitha’s refusal to treatment is in line with the practice of professional and ethical nursing framework; however, doing so might sacrifice the safety of Tabitha and death within three months. The legal issue in this case study centered on Tabitha’s right to make decision. Although she is mature enough to understand the treatment and her parents are supportive of the decision to refuse chemotherapy, she is still a 16-year-old patient. According to New South Wales Department of Health (2005), children and young people under the age of 18 should not solely make treatment limitations decisions especially on end-of-life care, even if decision-making capacity is unquestionable (p. 12). State the Facts Cancer is a disease that affects all age groups and has caused high mortality rates not only among Australia but in U.S. population. Cancer refers to a group of diseases that has multisystem effects and there are many types of it. It was not stated in the case study what type of cancer Tabitha has but this paper will discuss cancer in general. Cancer involves altered cell differentiation and growth that results in a process called neoplasia or new growth (Porth, 2010, 131). Cell division in cancer is both abnormal and uncontrolled most especially if people are at risk for developing cancer. Heredity, environment, and lifestyle play a vital role in the development of cancer. The pathophysiology of cancer is integrated in the process called carcinogenesis or oncogenesis. Here, cellular transformation underwent four stages, namely: initiation, promotion, progression, and metastasis (Daniels & Nicoll, 2012, 317). In the initiation, a carcinogen invades, damages, and changes the DNA of the cell. Promotion immediately follows where the initiated cell is repeatedly exposed to a promoter that causes cellular proliferation and the carcinogen becomes a promoter and a malignant tumor. The malignant cell increases in size and malignancy, becomes more anaplastic, and less differentiated – signals of morphological change during the progression stage. It is also in this stage when the primary malignant tumor established its own blood supply and formed new blood vessels through the process known as angiogenesis (Daniels & Nicoll, 2012, 317). The fourth stage of cancer development is the metastasis – the spread of malignant tumor to other location through direct invasion to nearby tissues or spreading to distant sites by venous circulation. Clinical manifestations of cancer depend upon the primary site of tumor or involvement. However, most common clinical manifestations include: ulceration, necrosis and bleeding among compressed and eroded blood vessels, effusions in pleural, pericardial and peritoneal spaces, anemia, anorexia and cachexia, fatigue and sleep disorders, and paraneoplastic syndromes (Porth, 2010, 146). The triad treatment for cancer includes surgery, pharmacotherapy with chemotherapy, and radiation. Other complementary and alternative therapies are also used to ease the symptoms, pain, or due to cultural beliefs; among of which include acupuncture, chelation therapy, energy healing, guided imagery, natural products, yoga, and others (Daniels & Nicoll, 2012, 300). Cancer prognosis has been better since the last decades and treatments can now cause permanent destruction of cancer cells, remission of the disease, and improvement of the quality of life. Four Ethical Principles Autonomy refers to the ethical principle that focuses on the right of the patient to make decisions on any interventions that may affect the quality of life (Finkelman & Kenner, 2010, 197). As a patient, Tabitha has the right to have autonomy towards her treatment; however, being a 16-year-old patient complicates the situation whether Tabitha’s decision to refuse chemotherapy would be upheld in respect of patient’s autonomy or may be violated in favor of long term survival. In addition, it was stated in the case study that Tabitha refused treatment because of being fed up in the hospital and due to the unpleasant effects of treatment. According to the ANMC National Competency Standards for the Registered Nurse Section 2.4 (2008), nurses advocate for the rights of the individuals/groups within health care institution and management through identification of resources to meet insufficient care, communication to meet care needs, and facilitating informed decisions (p. 3). Thus, if the nurse can communicate effectively with Tabitha and can identify resources to address feeling of being fed up in the hospital and the unpleasant effects of treatment, Tabitha can be allowed to make some decisions in terms of her health to facilitate autonomous decision. Finkelman & Kenner (2010) define beneficence as the act of doing something good and caring for the patient (p. 197). The next round of chemotherapy that Tabitha will undergo will lengthen her chance of survival from three months to two years. ANMC (2008) stated that it is the nurses’ responsibility to provide comprehensive, safe, and effective evidence-based nursing care based on predetermined plan of care and achievement of short and long term goals (p. 5-6). Following Tabitha’s refusal to chemotherapy will not be inclined to nurses’ provision of safe care as evidence suggested that refusal of the treatment leads to shortening of survival rate. The nurse and other members of the health care team should provide comprehensive care by offering Tabitha other treatment modalities aside from chemotherapy in order to promote the common good of Tabitha. Non-maleficence means doing no harm and safeguarding the patient (Finkelman & Kenner, 2010, 197). In Tabitha’s case study, the decision to uphold or withhold chemotherapy has a two-fold effect. Upholding chemotherapy will not cause harm to Tabitha and will lengthen her chance of survival but chemotherapy has unpleasant effects and initiating without patient’s permission does not reflect safeguarding of patient’s right. On the other hand, withholding treatment in respect of Tabitha’s autonomy safeguards the patient’s right but may cause harm such as shortening of survival rate. The nurse should communicate to minor patients and their families the benefits and risks of every nursing intervention and must clarify individual/group refusal to care or treatment with other members of the health care team (ANMC, 2008, 3). Justice is the ethical principle that relates to treating people fairly (Finkelman & Kenner, 2010, 197). In healthcare, justice is often applied to situations where a few healthcare resources are to be allocated fairly to a number of people needing care. In this case study, Tabitha has no problems in terms of healthcare resources. In fact, Tabitha was scheduled for chemotherapy but refused to receive the treatment. According to the ANMC National Competency Standards for the Registered Nurse Section 6.1 (2008), a nurse determines priority health needs based on assessment of individual/group needs, preferences, and intervention (p. 5). Therefore, justice on allocation of health needs is served if needs, preferences, and interventions are agreed by both parties. Ethical Conflicts Autonomy vs. Beneficence. As a patient, Tabitha may have the right to an autonomous decision in matters related to her welfare and care treatment. She has the right to refuse treatment and suffer the consequences, provided that an informed decision has been made. However, conflict of autonomy arises because Tabitha’s decision to refuse chemotherapy may compromise her safety and the good outcome of prolonging survival to approximately two years. According to Hanson et al. (2005), children, minors, and young adults have the right to participate in their own care; however, parents or guardians have also the right to be involved in different aspects of patient care due to legal and moral responsibility (p. 14). Tabitha’s families were very supportive of her decision to withdraw treatment; therefore, beneficence is not being applied. Autonomy vs. Non-maleficence. In an intent to do no harm, members of the healthcare team told Tabitha and her parents that the next round of chemotherapy is needed for a 30% chance of survival for possibly 2 years. As she may have the right to refuse certain interventions or treatment, the nurse following the consent and order may find it in contrary to the principle of non-maleficence or doing no harm. Aside from patients’ rights, nurses promote the health of the patients and protect their safety. With knowledge that treatment refusal will shorten Tabitha’s survival to three months, the nurse is fully aware that the intent to do no harm was not followed; instead, the autonomy of the patient is upheld in the case study. Consider the Law Consent is an aspect of the law that defends healthcare professionals from acts related to assault, battery, or false imprisonment (Staunton & Chiarella, 2008, 112). The ANMC (2008) Competency Standards for the RN states that nurses “practice in accordance with legislation by complying with relevant legislation and common law, fulfilling duty of care, and recognizing and responding appropriately to unsafe or unprofessional nursing practice (p. 2). As consent is an essential medical care, healthcare professionals must be knowledgeable of the Department’s policy on consent. Staunton and Chiarella (2008) define consent as the agreement between two parties that requires a level of common understanding (p. 116). Consent can be given on an implied, verbal, or written basis and must be considered as valid. Tabitha is under the legal age requirement that is necessary to legally acknowledge her decision to refuse treatment but there are also other issues that need to be considered such as her right as a patient, mental capacity, health status, and parental involvement in decision-making. According to the Age of Majority Act 1972 (WA) a person has to be 18 years old and above to assume full legal capacity; however, the Consent to Treatment policy for WA outlined that a patient is capable of giving informed consent when she has full understanding of the things required by the Division, matters involved in the decision, and the effect of giving consent (Department of Health, 2009, 52). In addition, consent is also highly regarded in oncology treatments and procedures. Accountability in nursing practice is a must, especially when it comes to consent. The Council of Australian Governments signed an Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions that requires all registered health practitioners to report other registered health practitioner who has a notifiable conduct or behavioral conduct that may cause public harm (Bird, 2010, 593). Therefore, under the Australian law, it is not only the doer of the action who is accountable if mistakes are made in obtaining in obtaining consent but the other registered health practitioner who is aware of the faults and failed to report the incidence. Ethical Decision Tabitha’s condition would deteriorate if chemotherapy will not be performed. On the contrary, insisting her to go onto treatment would violate her right to autonomy and eventually might create distress with the patients as Tabitha wishes to have a peaceful and dignified end to her life. According to ANMC (2008) National Competency Standards for the Registered Nurse, a nurse who practiced within the professional and ethical nursing framework acknowledges the dignity, culture, values, beliefs and rights of individuals/groups, including the refusal to care and treatment (p. 3). Allowing Tabitha not to receive chemotherapy does not violate the competency standards of a registered nurse to provide a quality and safe care because upholding the patient’s consent in relation to care, comfort, dignity, and alleviation of pain and suffering is the highest quality nursing care a nurse could offer to the patients (ANMC, 2008, 1). Therefore, it is ethically acceptable to uphold Tabitha’s right to refuse to treatment. Legally, Tabitha is also entitled to decide on her own care. It was stated earlier that under the Consent to Treatment policy for WA, young adult like Tabitha can decide to accept or refuse treatment when she demonstrates competence and understanding of medical condition and consequence of treatments. In the case study, Tabitha has shown maturity and understanding with respect to treatment decisions and has been informed of the consequences of refusing the chemotherapy. Added to these, families expressed their support towards Tabitha’s decision which is also essential in making decision related to care. Therefore, Tabitha’s decision to refuse chemotherapy is considered legal under the Australian law. References ANMC. (2005). National competency standards for the registered nurse. Retrieved on May 18, 2012 from http://www.anmc.org.au/userfiles/file/competency_standards/Competency_standards_RN.pdf Bird, S. (2010). Mandatory reporting of health practitioners: notifiable conduct. Australian Family Physician, 39(8): pp. 593-594. Retrieved on May 18, 2012 from http://www.racgp.org.au/afp/201008/201008bird.pdf Daniels, R. & Nicoll, L. (2012). Cancer Management. Contemporary Medical-Surgical Nursing (2nd ed.) (p. 313-351). Melbourne: Cengage Learning Australia. Daniels, R. & Nicoll, L. (2012). Complementary and Alternative Therapies. Contemporary Medical-Surgical Nursing (2nd ed.) (p. 299-313). Melbourne: Cengage Learning Australia. Department of Health. (2009). Policy for the Western Australian Health System. Retrieved on May 18, 2012 from http://www.health.wa.gov.au/circularsnew/attachments/404.pdf Finkelman, A. & Kenner, C. (2010). Ethics and Legal Issues. Professional Nursing Concepts: Competencies for Quality Leadership (p. 195-216). Massachusetts: Jones and Bartlett Learning LLC. Hanson, S. et al. (2005). Applying the Standards to special needs populations. Standards for Providing Quality Palliative Care for all Australians (p. 14-17). Australian Capital Territory: Palliative Care Australia. New South Wales Department of Health. (2005). Specific Issues. Guidelines for end-of-life care and decision-making (p. 12-14). New South Wales: Better Health Centre – Publications Warehouse. Porth, C.M. (2010). Neoplasia. Essentials of Pathophysiology: Concepts of Altered Health States (3rd ed.) (p. 131-158). New South Wales: Lippincott Williams & Wilkins. Staunton, P. & Chiarella, M. (2008). Consent to Treatment. Nursing and the Law (6th ed.) (p. 112-135). New South Wales: Elsevier Australia. Read More