Sociology Ethics in Nursing - Report Example

Applying Law and Ethics in Practice Introduction The principles of ethics and law are applicable in various fields including nursing and they are crucial especially when making medically related decisions concerning the life of a patient as presented in the case of James B. In that regard, the case presents a quadriplegic patient who is forced to be fed via a PEG catheter in his stomach, something most patients do not enjoy. The patient has a reached a point where he demands the discontinuation of nutrition from the PEG claiming that his life is intolerable and that he wants to be allowed to die. Additionally, the patient has the ability to communicate and is considered mentally competent and also has good psychological support from family members. Hence, this raises ethical issues on the part of nurses and the medical practitioners on whether or not he should be given access to the right to die. The code of ethics for nurses provides guidance for ethical responsibilities, decision-making, behaviors and relationships in cases such as these. The code is also a means for self-reflection and self-evaluation for ethical nursing. It is also an ethical basis whereby nurses are put in a position to advocate for good work environments that lead to the provision of safe, competent, compassionate and ethical care. Therefore, this essay will identify the key issues raised in this scenario using the ethical principles of autonomy, beneficence, non-maleficence and justice. The Principle of Autonomy Autonomy can be defined as self-determination and self-governance and when nurses seek to protect the dignity of the patients they care for, then they show respect for autonomy (Bird, 2009). This allows patients to make decisions concerning their choice of treatment. In addition to that, the practice of informed consent that needs to be respected by the nurse is grounded. A patient is allowed to write a directive in advance in the event of being incapacitated to make informed choices hence enabling the patient to maintain autonomy. According to the code of ethics for nurses, the principle of autonomy expects medical practitioners to respect the decision of a patient, having the capacity to make decisions to forgo treatment that is life-sustaining (Beauchamp, 2001). By definition, life-sustaining treatment is treatment that intends to prolong life without necessarily reversing the current medical condition (Burcher, 2004). In this case, James is undergoing life-sustaining treatment by artificial nutrition and hydration. He is also said to be mentally competent and thus has been able to make the informed decision about ending his life by withdrawal of food. In such a case, nurses know that food is essential for the life of James and as healthcare professionals; they may be reluctant to deny their patient food. In addition to that, the kind of feeding he receives intends to act as medical therapy. It is an invasive method of feeding that needs nutritional expertise and skilled nursing since it is associated with complications. Furthermore, the supportive family members of James would not want him to die of hunger. However, in spite of all these uncertainties, James has qualified by law to the principle of autonomy since he is of sound mind. The next step therefore lies with the doctors. Many of such cases are normally presented in the court of law especially when the doctor becomes unwilling to give the patient his or her right to autonomy. Included in the right to autonomy, is the right of every human being that is an adult and of sound mind to make a decision about his or her own body (Bernheim, 2003). This principle thus implies that a service provider or medical practitioner such as a nurse who provides treatment that goes against the wishes of a patient who is mentally competent breaks the law since he trespasses against the individual. Hence, according to the law, James has the right to decide whether or not he wants to continue to be treated. Nurses promote and respect the autonomy of persons and assist them to be in a position to express their health values and needs and to get the desired services and information so that they are able to make informed decisions (Bird, 2004). Principle of Beneficence Beneficence is acting in a way that will benefit others; it incorporates balancing of benefits over harm and also requires nurses to take action (Kass, 2001). This principle may result in ethical issues especially when there is some form of conflict concerning what is good between the organizations and patients, between the nurse and patient, between patients and between states. There is a general agreement that the good of the patient should come before the good of the organization or the good of the nurse but nurses confuse what the patient’s good is with what the nurse’s belief in what seems good for the patient is. Thus, there is an underlying debate concerning what should be good for a patient without necessarily violating the autonomy of the patient or letting the patient inflict or cause harm to him or herself. Hence, the question is whether or not it is right for nurses to overrule the preferences of their patients. In the case of James, the nurses may see that it is not right to end his life through the method of withdrawing food since it will result in starvation and eventually undesirable death. In that connection, they may prefer an alternative method that seems good to the patient thereby foregoing his decision to withdraw food. In this case, this is beneficence since the nurse feels that it is for the good of the patient if he does not die by starvation but rather another method that seems effective and tolerable to James. In addition to that, the nurses may find that James is making the decision under the influence of stressful circumstances such as the desire to end an intolerable life. Weak paternalism involves the protection of the patient by the nurse in the case where the patient is not in a position to make informed decisions due to challenges of depression or medical influence. On the contrary, strong paternalism intends to benefit a patient even though the risky actions and choices of the patient are voluntary, informed and autonomous. Thus, the nurses may decide to practice strong paternalism it benefits to James. Principle of non-maleficence This principle gives nurses the duty of ensuring that they refrain from causing harm on the patient. In the case of James, non-maleficence may be as a result of complications caused by the mode of feeding, in this case the PEG catheter in his stomach. This makes him not to enjoy his food and thus may result in prolonged suffering. The nurses may thus have the need to restrain the patient from the experience that seems to cause harm by withdrawing the PEG catheter thus complying to his wish to die. In addition to that, non-maleficence can be caused by communication failure between the nurse and the patient where the nurse decides to overlook the needs of the patient with the belief that the patient is not in a bad state. Moreover, the withdrawal of the PEG may also result in harm on the body of the patient. In addition, it is stated that James communicates via a tracheotomy and by the movement of his two fingers. This form of communication may be interpreted in different ways by different nurses thus resulting in a failure to give accurate information about the patient. Moreover, the breaking down of the equipment that is used to feed him may also result in the cause of harm to the patient. The harm that is caused may be life-threatening and result in heart attacks or strokes. Principle of Justice Justice is aligned with what a patient deserves. It can be determined in terms of equality, fairness, need or other justice decisions. In the field of nursing, justice refers to equitable access to care where resources are scarcely allocated. In that regard, elderly patients also have the right to access treatment regardless of their age. Percutaneous gastronomy (PEG) catheter has been inserted in the stomach of James so that the burden of nursing is reduced even though it was not the interest of the patient. The use of this mode of feeding should be considered in terms of cost effectiveness or whether there are other options for James. In addition to that, the decision of James to stop the feeding by the PEG catheter and the kind of treatment he receives in the nursing home needs to be determined by finding out how it affects the availability of treatment on others. Nurses also have the obligation to provide competent, ethical and safe care to all their patients. The denial of these will be denying justice to the patient. Nurses also have the obligation to preserve the sanctity of life. An exception to preserving the sanctity of the patient is when he or she is suffering from terminal illness and untreatable conditions that make the patient go through immense suffering (Mann, 1999). In the event of preserving the sanctity of the life of James, the nurses and medical practitioners provided him with nutrition and hydration until it reached a point whereby he turned the treatment down. The provision of food to James before he refused the feeding meant to give him quality life even as he was in hospital. The law forbids nurses and physicians to give treatment to against a patient’s will and if the nurses do so without considering the decisions by the patient, they may face ethical, professional and legal censure. Conclusion The decision of whether or not the life of a terminally ill patient should be preserved is debatable in the field of nursing. Medical practitioners may not be willing to end the life of a patient who seems to show the potential to heal while the patient may want to die due to the intolerable prevailing circumstances. It even becomes difficult when the decision is to die is made by a patient who is fully aware of the present situation. It has been shown that nurses have an obligation to practice the principles of ethics during the practice of their profession. The principle of autonomy is exclusive to the patient as long as he or she is of sound mind and is thus capable of making informed decisions. The principle of beneficence involves doing what is good to the patient and it is this principle that has caused debate in the field of nursing. The principle of justice states that all patients should receive the limited resources of health care while the principle of non-maleficence gives nurses the duty not to cause harm on their patients. Thus, these principles were clearly demonstrated in the case of James and it shows how important the ethical principles for nursing are in aiding patients to make informed decisions. List of References Beauchamp, T. 2001. Principles of Biomedical Ethics. Oxford: Oxford University Press Bernheim, R. 2003. Public Health Ethics: The Voices of Practitioners. The Journal of Law, Medicine and Ethics, 31 (4), 104-109. Bird, S. 2009. To Treat or Not to Treat. Australian Family Physician, 38 (11), pp. 23-40. Burcher, B. 2004. Ethics and Community Health Nursing in Canada. St. Louis, MO: Mosby Kass, N. 2001. An Ethics Framework for Public Health. American Journal of Public Health, 91 (11), 1776-1782. Mann, T. 1999. Health and Human Rights: A Reader. New York: Routledge. Read More