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This paper evaluates the depths of patient autonomy as an ethical dilemma impacting the nursing profession. Patient Autonomy as an Ethical Dilemma in Nursing According to Tauber (2005), patient autonomy refers to the exclusive legal right of a patient to have his wishes accomplished by the medical personnel while in their custody. …
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Brief discussion of an ethical issue impacting the nursing profession
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Brief discussion of an ethical issue impacting the nursing profession College Lecturer Introduction Choosing to save life by applying the best perceived action might contradict the prevailing code of practice or legal rights of the patient. Either way, a number of nurses have found themselves along the corridors of justice for professional misconduct, negligence or malpractice (Gutierrez, 2005). But what would a nurse do at a time when one decision would jeopardize her profession or compromise the life of the patient? This paper evaluates the depths of patient autonomy as an ethical dilemma impacting the nursing profession. Patient Autonomy as an Ethical Dilemma in Nursing According to Tauber (2005), patient autonomy refers to the exclusive legal right of a patient to have his wishes accomplished by the medical personnel while in their custody. By this clause, every patient has a right to seek truthful details of their state of health. Besides, the patient reserves the right to choose not to take a particular course of treatment even if the practitioner deems it necessary. By that understanding, the right of autonomy already presents a potential conflict of interest between the patient and the practitioner (Cowen & Moorhead, 2011). For instance, patient got pregnant out of a rape ordeal that has since left her traumatized, demeaned and psychologically broken. Through family support and encouragement, this patient has carried the pregnancy for more than eight months but each passing day her emotional and psychological health status continue to deteriorate. She has become depressed, weak and torn to a point that she cannot take the pain anymore. The patient wishes to abort the baby by all means even if it means taking the crude options. How would a nurse deal with such cases especially when the law prohibits abortion? Encouraging her to abort against the law would amount to professional misconduct as argued by Botes (2000). Turning her away is no better than negligence in case she ends up executing her plans in the backstreet. Disregarding patient’s autonomy on the other hand is tantamount to malpractice as stipulated in the nursing code of practice (Casterle et al, 2008) Impact on the nursing profession Such hypothetical scenarios are common occurrences especially among the youthful population who might have got pregnant against their wishes and would therefore opt to abort, contrary to the law. Like many other clinical dilemmas, the issue of client autonomy often leave the nurse on the hot spot as to what would be best for their patients’ life and their nursing profession. Similar cases of autonomy and conflict of interest are also common among the terminally ill patients who may not wish to continue with their medication after years of deteriorating health as observed by Yamamoto and Aso (2009). The conflict that arises over patient autonomy in a clinical situation often touches on ethics, code of practice and the law. The available exceptions only allow a medical doctor or a physician to make a compromising decision, and only if the patient is not in her right state of mind to make a sound decision. Such critical decisions must be well-consulted and duly approved by relevant authorities in the medical hierarchy. Unfortunately, nurses do not have such provisions especially those below the managerial level who also forms the bulk of practicing nurses. They must always depend on the doctor’s directives or second opinion (Schermer, 2002; Hamilton, 2012). In reality, the balance between patient autonomy and professional opinion of nursing practitioners is a major issue in healthcare facilities below level 3 including community hospitals and village dispensaries. Not withstanding the number of nurses who have lost their jobs as a result of perceived malpractice, the law always favour the weaker party who happens to be the patient (Kulkarni, 2010). In the event that a doctor is not readily accessible, such cases that appear simple from the face value pose a major risk to the professional career of nurses. In addition to the conflict of interest associated with patient autonomy, a number of nurse have fallen victims of malpractice by making honest decisions that turned unsuccessful in saving the life of critical patients in the absence of a medical doctor(Guido, 2006; Boivin, 2009). On the contrary, the risk involved in nursing practice and the fear of malpractice cases have continued to discourage thousands of young professionals who would have wished to purse nursing. Veatch (2009) also argued that the complexities of handling patient autonomy have partially contributed to the increased shortage of nurses and precautionary approach to clinical medicine. Many patients have also suffered more harm than good when nurses finds their professional career at stake with respect to dealing with prescribed code of practice pertaining to patient autonomy. Conclusion While the integrity of healthcare service provision is entrusted in the hands of medical practitioners including nurses, it is high time that the law recognized the role of nursing in patient care. For that reason, the medical fraternity should draft an inclusive code of practice that takes into account the special conditions that might jeopardize the career of nurses. The law should articulate the grounds on which nurses can apply critical decisions to save life without undue fear as reiterated by Bandman and Bandman (2002). Such provisions should promote good practice, embrace ethics and empower nursing practitioners. References Bandman, E. & Bandman, B. (2002). Nursing Ethics across the Life Span. (4th Ed.). Upper Saddle River, NJ: Prentice Hall. Boivin, J. (2009). Nurses Struggle with Ethical Dilemmas. Retrieved February 11, 2013 from: Botes, A. (2000). Critical thinking by nursing practitioners on ethical issues such as termination of pregnancies. Curationis Review, 23(1), pp.26-33. Casterle, B., Izumi, S., Godfrey, N. & Denhaerynck, K. (2008). Nurses’ response to ethical dilemmas in nursing practice. Journal of Advanced Nursing, 63(6), pp.540–549 Cowen, S. & Moorhead, S. (2011). Current Issues in Nursing Practice. St. Louis, MO: Mosby Elsevier Publishing Group. Guido, W. (2006). Legal and Ethical Issues in Nursing. Upper Saddle River, NJ: Pearson/Prentice Hall. Gutierrez, M. (2005). Critical care nurses’ perceptions of and responses to moral distress. Dimensions of Critical Care Nursing, 24(1), pp.229-241. Hamilton, R. (2012). Ethical and Moral Dilemmas Faced by Nurses. Retrieved February 11, 2013 from: Kulkarni, S. (2010). Ethical Issues affecting the nursing profession. Retrieved February 11, 2013 from: Schermer, M. (2002). The different faces of patient autonomy: Patient autonomy in ethical theory and hospital practice. Dordrecht: Kluwer Academic Publishers. Tauber, I. (2005). Patient Autonomy and the Ethics of Responsibility. Cambridge: MIT Press. Veatch, R. (2009). Patient, Heal Thyself: How the new medicine puts the patient in charge. Oxford: Oxford University Press. Yamamoto, M. & Aso, Y. (2009). Placing physical restraints on older people with dementia. Journal of Nursing Ethics, 16(2), pp.192-202. Read More
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