Nurses and their leaders are a pivotal group of healthcare professionals that contribute to the overall quality provision of appropriate care directed towards promoting positive patient care outcomes. Their successes however are achieved amidst various challenges inherent in the healthcare environment including ethical ones that must be appropriately resolved. Relatedly, Marquis & Huston (2014) acknowledge that nurses especially face greater difficulties as patients, physicians and the organization expect them to act as their simultaneously, while considering that each has different goals, needs and wants. This paper discuses application of ethics in healthcare, in reference to an ethical case study involving an assisted suicide scenario involving a patient, her family and a nurse.
Prevalent Ethical Issues
Firstly, the decision whether to assent to participate in, or enable the death of the patient, whether directly or indirectly, represents one of the ethical issues involved in the case study. This is because the terminally-ill patient affirms that she has no quality of life left, is at peace and ready to die. From an ethical point of view, the patient has a right to decide whether to die on the basis of the ethical principle of respect for personal autonomy which promotes self-determination and freedom of choice (Marquis & Huston, 2014). However, nurses are prohibited (in many states) in engaging in assisted suicide while others may also be opposed to the idea of assisted suicide. Additionally, Marquis & Huston (2014) affirms that the patient’s rights include provision of information on care management as well as provision of considerate and respectful care.
Use your promo and get a custom paper on
"Nursing and Ethics".
Another is that the patient has the right to actively participate in medical care decisions but restricted to provisions by law which, for this case and in states where assisted suicide is prohibited, the patient should not be granted her request. Secondly, the decision whether to inform the family (who had previously urged the patient to hold on) of the wishes of the patient in her choice for assisted suicide also highlights another ethical issue. This is especially since the family is shown as resisting acceptance of a recommendation by the doctor that the patient, after going into a coma, be provide hospice care. The nurse’s inclination to tell the truth of the patient’s wishes to the family may be a good idea but without understanding the family’s hesitation to provide the patient with hospice care, the information may be taken negatively.
Nurse Duties and Roles
With regards to assisted suicide, the American Nurses Association (ANA) (2013)
‘prohibits nurses’ participation in assisted suicide and euthanasia because these acts are in direct violation of Code of Ethics for Nurses…the ethical traditions and goals of the profession, and its covenant with society’.
Further they should not ‘act with the sole intent of ending a patient’s life, even though such action may be motivated by compassion, respect for patient autonomy and quality of life considerations’. This implies that legally, in states where assisted suicide is prohibited, the nurses duty in this case cannot entail participation in the assisted suicide that the patient requests but should relay the information to the attending doctor. This latter aspect is supported by the integration of patient advocacy roles of nurses in the code of ethics where nurses can promote, advocate for, and strive to protect the health, safety, and rights of the patient (Hanks, 2012). The author also indicates that the patient advocacy role entails provision of support for decisions made by the patient acting ‘as an informer to the patient’s decision-making, stand by your patient, and enable your patient to make his or her own decisions’. This includes speaking on behalf of the patient or even fighting for and standing up for him/her as well as acting as a liaison between the patient and other stakeholders. Aside from the aforementioned application of the ethical principle of respect for personal autonomy of the patient, the principle of beneficence, in this case, can also be applied in relation to promoting good for the patient. However, applying the aspect of paternalism should be checked so as to avoid abuses by the healthcare professionals involve, while strengthening aspects like tenacity in seeking justice for the patient.
Solutions
Participation in enabling the patient to end her life without telling the family represents one of the options available to the nurse in this situation. Another option is to tell the family about the patient’s wishes; leaving the decision to go ahead with the assisted suicide to the family. The second alternative provides the best alternative as it respects many rights of the various stakeholders involved including the patient’s family as well as the organization, in relation to adherence to set rules. The aspect of respect for the patient’s autonomy is contradicted by legal provisions on the issue where, presupposing that abiding by law is moral, balances ethical duty to the patient in comparison to other stakeholders (mostly family). This is also indicated by Marquis & Huston (2014) whose measurement criteria of nurse decisions and actions on the basis of ethical principles includes advocacy on behalf of patients as well as adherence to code of ethics for nurses. Using Wueste’s ethical decision-making framework, the second alternative remains the best option as the first step of identification/recognition reveals that the decision should incorporate all relevant stakeholders, including the family (Marquis & Huston, 2014). Further the second step involving analysis allows a clearer picture of dilemma where, taking the first option, would be met with hostility by the family, expose the nurse and the organization to litigation while violating professional rules. Application of the three theories to the dilemma indicates partial support by two (deontological and consequentialist) which provides better justification for the alternative which should inspire action as the last step.
- Hanks, R. (2012). From our readers…Practical approaches to patient advocacy barriers.
American Nurse Today, 7(2), Retrieved from http://www.americannursetoday.com/from-our-readerspractical-approaches-to-patient-advocacy-barriers/ - Marquis B. L. & Huston, C. J. (2014). Leadership roles and management functions in nursing:
Theory and application: 8th Edition. Philadelphia, PA: Lippincott Williams &Wilkins. - The American Nurses Association (ANA) (2013). Position statements: Euthanasia, Assisted
Suicide, and Aid in Dying. Silver Spring, MA: American Nurses Association.
