How would one approach the following assignment?
Look at the case study from the perspective of the nurses:
- State the problem in ethical terms.
- Articulate the desired goals of the nurses. Describe how the goals are consistent with or in conflict with the patient, the family, and the attending physician, including conflicts with applicable laws and regulations.
- List as many options for the nurses as possible. Examine the underlying ethical principle and value of each.
- Propose a range of acceptable options that are consistent with your personal and professional values. For each option consider how the ANA Code of Ethics can provide guidance for decision making.
- Choose one option and evaluate its ethical outcome.
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Your assignment is definitely weighty, and as we are limited in space, below are some ideas to help get you started.
Many different ethical questions can arise when undertaking the practices of nursing. Such ethical questions concern whether or not a patient has the right to choose a course of action; how best to advocate for a patient to "take positive action; "how to avoid doing harm"; how to best be loyal, fair, truthful, and dedicated to a patient; how to distribute goods and resources among patients equally and fairly; how to decide what information to reveal and withhold from the patient based on the medical care providers' beliefs in what "diagnosis, therapy, and prognosis" is best for the patient; what moral decision is best for the patient based on "the norms of [the patient's] culture"; how to act to best affect the patient, his/her family, and other people who depend on the patient; how to make moral decisions with respect to a patient based on how well the decisions "adhere to rules"; and, finally, how to make a decision to act based on the value of the act's usefulness (American Nurses Association (ANA), "Short Definitions of Ethical Principles and Theories: Familiar words, what do they mean?"). All of these ethical questions can respectively be defined by the ethical principles labeled autonomy, beneficence, nonmaleficence, fidelity, justice, and paternalism; the ethical questions can further be addressed respectively by the ethical theories called ethical relativism, feminist theory, deontology, and utilitarianism ("Short Definitions of Ethical Principles"). To be able to complete your assignment, which is to analyze your assigned case study, what you will first need to do is be able to explain the problem using ethical terminology. So, you will first want to gain a thorough understanding of the ethical principles and theories listed above. There are definitely many ethical principles and theories that apply to your case study and will help you write about what actions as a nurse you would take in the given scenario; however, two of the most applicable are the principle of autonomy and the theory of ethical relativism, so, to help get you started, let's look more closely at those.
Your case study describes a man referred to as Mr. O in the final stages of AIDs who verbally agreed to a "Do Not Resuscitate Order." Regardless, he was recently been resuscitated after an emergency and put on dialysis. It's also important to note that, while he may not be a devout Catholic, his family members, like his mother and brother, are devout Catholics. Mr. O has expressed that he does not want to be put on "a lot of machinery." Also, after being resuscitated, he expressed the fear of having to suffer more pain and of prolonging his inevitable death. It's also important to note that he presently feels himself capable of making the decision to be removed from dialysis but is unsure of how much longer he will be competent. Finally, you want to make note of the fact that his family is unaware of his desires to be removed from dialysis and not be resuscitated, and Mr. O is fully aware that his decision will conflict with his family's spiritual beliefs, particularly his partner's faith that he can still get better and his mother and brother's religious conviction in the immorality of making a decision that would end one's own life. So, as you can see, Mr. O's desires, what treatments that have been rendered so far, and his family's religious and cultural beliefs all raise many ethical questions concerning what should be done for Mr. O.
The first ethical question Mr. O's situation raises concerns the principle of autonomy. Based on the ethical principle of autonomy, a person has the "right to self-determine a course of action"; in other words, based on the Patient Self-Determination Act of 1990, a patient who is still competent like Mr O has the absolute right to decide what treatments he does and does not want to undergo ("Short Definitions of Ethical Principles"). If he does not want to prolong his suffering, he has the right to request he not be resuscitated. However, the fact that his medical care providers have so far failed to adhere to his request not to be resuscitated certainly complicates his circumstances, and the question now remains, should he be allowed to make the decision to terminate dialysis? Regardless, under the the Dialysis Patients' Bill of Rights, a dialysis patient has the absolute right to suggest a change in dialysis treatment, including ceasing the treatment altogether, and the patient has the right to expect medical care providers to listen to his/her suggestions for change in dialysis treatment (National Kidney Foundation, "Dialysis Patients' Bill of Rights and Responsibilities"). Therefore, based on the ethical principle of autonomy and under the Dialysis Patients' Bill of Rights, Mr. O has the right to request being taken off of dialysis treatment and the right to expect his medical care providers to listen carefully to his request and to possibly comply.
However, based on the theory of ethical relativism, Mr. O's situation is further complicated by the fact that his family would disagree with his decision based on their Catholic beliefs and culture. The ethical theory of relativism asserts that the morality of a decision is "relative to the norms of one's culture" ("Short Definitions"). In other words, the theory states that ethical decisions must be made based upon the larger context of the patient's culture. What makes the medical care providers' decision with respect to Mr. O complicated is that Mr. O himself does not practice Catholicism, while his family does. What to do based on ethical relativism certainly is no easy answer, and perhaps your textbook and other course material can shed further light on the best decision. However, based on the ethical principle of autonomy, it seems it would be safe to conclude that the decision to discontinue Mr. O's dialysis treatment should be made based on the relativity of Mr. O's own religious and cultural beliefs, not his family's. However, in light of task 5 in your assignment, you should also bear in mind that such a decision may result in the ethical outcome of the family becoming angry at the healthcare providers, possibly even resulting in a law suit, regardless or whether or not the family's suit would be considered reasonable.
Hence, as you can see, in order to complete your tasks for this assignment, you need to understand and write about Mr. O's situation based on what you know of ethical principles, such as autonomy and the theory of ethical relativism. You would also use ethical theories and principles to discuss your goals as a nurse, such as benefiting Mr. O, doing no harm, and complying with his decisions based on autonomy. You will also list all of your options concerning what actions to take with respect to Mr. O's desires. You will also identify the most acceptable options and think about how the ethical principles and theories laid out in the ANA Code of Ethics supports these acceptable options. Finally, you'll select the best option, such as agreeing to take Mr. O off of dialysis treatment, and discuss its ethical outcome.
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