The Ethical Aspects of the Nurses - Case Study Example

The Ethical Aspects of the Nurses Abstract One of the best ways to learn about what takes place in a medical facility setting is to look at a real case study. In this project, a case study is analyzed involving nurses abusing their power and sending unqualified nursing assistants into a room to care for a patient with full-blown AIDS. Then, the ethical aspects of the nurses doing what they did are analyzed. Description of Case My first job in the medical field was at a rural hospital, which was actually quite large despite its location. It had all of the usual departments that are present in larger hospitals in big cities. Most of the time, I enjoyed my work as a nurse, loved my job, and did not encounter any difficulties. One day, I noticed an ethical dilemma brewing. A patient had been admitted on my floor that was dying of full-blown AIDS. He was housed in one of the two isolation rooms on the floor. I noticed that none of the nurses were going in the room on a regular basis to perform the normal nursing duties they should have been doing as they were doing with the other patients on the floor. That alone would have posed enough of an ethical dilemma, but what I noticed next placed the situation in a territory nowhere near where it should have been. The other nurses were sending Certified Nursing Aids and untrained student nurses into the room with the AIDS patient. This was clearly because they did not want to risk catching the disease themselves. I can say this with confidence because they were having these CNAs and student nurses do things to the patient that they simply were not qualified to do. Examples of what these workers were being sent into the room to do were to draw blood work, give shots, and work with other hazardous bodily fluids and materials. It was clear to me that not only was this ethical dilemma forming right in front of my eyes, but it was also very likely illegal. I was at a loss regarding what I should do at the time. It felt like I would be betraying my fellow nurses by turning them in. However, I knew it was wrong to send unqualified workers into the room with the patient to perform tasks that they were not trained to do. Ethical Reasoning Primarily Used The primary ethical reasoning used in this case was deontological ethics. According to the Stanford Encyclopedia of Philosophy (2009, pg. 1), “The word deontology derives from the Greek words for duty (deon) and science (or study) of (logos). In contemporary moral philosophy, deontology is one of those kinds of normative theories regarding which choices are morally required, forbidden, or permitted. In other words, deontology falls within the domain of moral theories that guide and assess our choices of what we ought to do (deontic theories), in contrast to (aretaic [virtue] theories) that — fundamentally, at least — guide and assess what kind of person (in terms of character traits) we are and should be. And within that domain, deontologists — those who subscribe to deontological theories of morality — stand in opposition to consequentialists.” In this case, the choices made by the other nurses were clearly wrong. In other words, they were not morally permitted or required and, in fact, were morally forbidden. It was a cut and dry case. The Four Topics Model The Four Topics approach to clinical ethics was presented by Jonsen, Siegler, and Winslade. The following diagram shows the Four Topics Model in the Interrogatory Format, which is stating that the four topics (medical indications, patient preferences, quality of life, and contextual features) are listed individually in the format of questions for the observer to answer. Figure 1: The Interrogatory Format of the Four Topics Approach to Clinical Ethics MEDICAL INDICATIONS 1. What is patient’s medical problem? history? diagnosis? prognosis Full-Blown AIDS 2. Is problem acute? chronic? critical? emergent? reversible? Chronic and Critical 3. What are goals of treatment? Make the patient as comfortable as possible 4. What are probabilities of success? Reasonable, considering 5. What are plans in case of therapeutic failure? Try again 6. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided? Ask his needs and try your best to accommodate PATIENT PREFERENCES 1. What has the patient expressed about preferences for treatment? He wants to be cared for by doctors and nurses only. 2. Has patient been informed of benefits and risks, understood, and given consent? Yes 3. Is patient mentally capable and legally competent? What is evidence of incapacity? Yes; N/A 4. Has patient expressed prior preferences, e.g., Advance Directives? Yes 5. If incapacitated, who is appropriate surrogate? Is surrogate using appropriate standards? N/A 6. Is patient unwilling or unable to cooperate with medical treatment? If so, why? He is willing to cooperate with treatment. 7. In sum, is patient’s right to choose being respected to extent possible in ethics and law? No QUALITY OF LIFE 1. What are the prospects, with or without treatment, for a return to patient’s normal life? Impossible 2. Are there biases that might prejudice provider’s quality of life? Yes 3. What physical, mental, and social deficits is patient likely to experience if treatment succeeds? Treatment will not succeed. 4. Is patient’s present or future condition such that continued life might be judged undesirable by them? Yes 5. Any plan and rationale to forgo treatment? No 6. What plans for comfort and palliative care? Medication and therapy CONTEXTUAL FEATURES 1. Are there family issues that might influence treatment decisions? Yes 2. Are there provider (physicians and nurses) issues that might influence treatment decisions? Yes 3. Are there financial and economic factors? Yes 4. Are there religious, cultural factors? Yes 5. Is there any justification to breach confidentiality? No 6. Are there problems of allocation of resources? No 7. What are legal implications of treatment decisions? Unqualified personnel treating patient 8. Is clinical research or teaching involved? No 9. Any provider or institutional conflict of interest? Yes Source: Lakehead University (2009, pg. 1) Ethical and Legal/Regulatory Issues The aforementioned situation was clearly not ethical. According to WordNet (2009, pg. 1), ethics can be defined as, “of or relating to the philosophical study of ethics, conforming to accepted standards of social or professional behavior, or adhering to ethical and moral principles.” There are a number of governing bodies and agencies that control legal and regulatory issues in the medical field. These include the Agency for Health Care Policy and Research, the American Civil Liberties Union, the American Health Lawyers Association, the Center for Studying Health System Change, the Centers for Disease Control, the Centers for Medicare and Medicaid Services, the Code of Federal Regulations, the Department of Health and Human Services, the Department of Justice, EMTALA, the Food and Drug Administration, the Forum on Privacy and Security in Healthcare, the Health Administration Responsibility Project, the Health Care Compliance Association, the Health Coalition on Liability and Access, Health Hippo, the House of Representatives, the Internal Revenue Service, the Internet Law Library, the Joint Commission of the Accreditation of Healthcare Organizations, the Last Acts Campaign, the Medical Law Review, the National Committee for Quality Assurance, the National Conference of State Legislatures, the National Health Law Program, the National Health Policy Forum, the Occupational Safety and Health Administration, the Office of the Inspector General, the Supreme Court, Trial Lawyers for Public Justice, United States Code, and the United States Senate. It is safe to say that the case scenario presented above violated the laws and regulations of a great deal of these agencies (Pohly, 2009). Impact of Outcome on Nursing Systems, Professional Standards, and Relevant Research and Professional Literature The American Medical Association lists nine ethical standards that the medical community should adhere to at all times. Although the standards listed below specifically address physicians, the standards apply to nurses and other medical staff as well. They are: A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. A physician shall, while caring for a patient, regard responsibility to the patient as paramount. A physician shall support access to medical care for all people. (American Medical Association, 2009, pg. 1) The concept of medical ethics standards is meant to benefit the patient. Under no circumstance should a member of a facility’s medical staff put him- or herself before the patient. This is especially true when doing so not only puts the patient in harm’s way, but also puts other members of the medical staff who are not properly trained to deal with a certain situation in harm’s way. That makes it twice as unethical, which is certainly frowned upon by virtually everybody in existence. While it is important for everyone to practice good ethical behavior, it is especially important for medical professionals to practice good ethical behavior. This is mostly because they care for the sick and dying—those in the communities they work in who are most vulnerable. In certain cases, such as the case study reviewed herein, the nurses also played on the vulnerability of medical staff that was underneath them on the professional ladder. This behavior is absolutely intolerable, especially in the medical community. References Deontological ethics. (2009). Stanford. Retrieved April 18, 2009, from http://plato.stanford.edu/entries/ethics-deontological/ Ethical. (2009). Princeton. Retrieved April 18, 2009, from http://wordnetweb.princeton.edu/perl/webwn?s=ethical Interrogatory format of the “Four Topics” approach to clinical ethics. (2009). Lakehead University. Retrieved April 18, 2009, from http://bioethics.lakeheadu.ca/uploads/3._Four_Topics_Approach_to_Clinical_Ethics.pdf Medical law, ethics, accreditation, and compliance. (2009). Pohly. Retrieved April 18, 2009, from http://www.pohly.com/admin3.html Principles of medical ethics. (2009). AMA. Retrieved April 18, 2009, from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/ama-code-medical-ethics/principles-medical-ethics.shtml Read More