Identifying Ethical Issues In Nursing Practice: A Case Study Analysis

The case study of Arthur

Ethics in the nursing profession have been defined as a set of standard moral principles that are pivotal in maintaining the sanctity of the profession. It can be said that moral ethics represent an underlying philosophy that helps in differentiating between a right or a wrong conduct. It should further be stated that ethical principles or moral philosophy comprises of a diverse range of pivotal elements that comprise of identification and systemization of a conduct, followed by analyzing it with defending strategies and finally recommending essential concepts to differentiate between what is right and what is wrong. This essay would focus on the reported case study of Arthur and proceed with the identification of critical ethical issues while dealing with the client and the associated implication. It would further recommend strategies that could be taken in order to render effective professional practice.

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The case study clearly reveals that Arthur had a long medical history of epilepsy. He had recently been admitted because of an event of tonic-clonic seizure. The medical history further reveals that the client had also experienced episodes of status-epilepticus. The medication therapy and the Deep Brain Stimulation therapy (DBS) have had no significant effect on the client. The primary care provider of the client, June who is the client’s daughter thus requests the registered nurse not to resuscitate Arthur in case of a cardio-pulmonary arrest. The scenario typically reveals the presence of three important ethical issues. The first being the lack of patient consent, the ethical issue related to patient advocacy, the ethical issue related to justice and the patient dignity (Oolins & Grainger, 2015). The appeal of non-resuscitation was made by the daughter of the client. On being asked if she had consulted the same with the client, the response was negative. This proves that the patient consent in performing the requested act had not been sought by the primary care provider. At the same time, the situation had only been portrayed in alignment to the client’s daughter’s perspective. Hence, it can be said that there is nil evidence of patient advocacy. Further, the conscience of the registered nurse should aim at delivering justice after analyzing the case scenario. It should also be noted that the case scenario presents an example of compromising the patient dignity. It has been reported in studies that the first step to provide an efficient patient-centered care is to reasonably identify the ethical issues and proceed with the analysis of the ethical issues in relation to the professional guidelines (Kerridge et al., 2013). Therefore, the ethical issues identified in the case scenario must be analyzed and evaluated with the professional ethics before undertaking a clinical decision.

The notions of human dignity and human rights

Human dignity and human rights advocate the choices that individuals can make for themselves. It should be noted here that individuals irrespective of their physical or mental health condition are entitled to live a life as per their expectation. Hence, the request made by June does not reflect the consent of the patient in undergoing the process. In addition to this, the case further reveals complete violation of the human rights law as guaranteed by the United Nations. According to the human rights law, each individual is subjected to a right to life, liberty and personal security which under no circumstance should be compromised with (Sanggaran et al., 2014). The case also violated the Australian health care rights that guarantee to the citizens of Australia the right to, health and healthcare, confidentiality, consent, cultural liberty and the right to be treated with dignity and respect (Foley & Christensen, 2016). Therefore, it can be stated that the spirit of the notion of human rights and laws must be complied with under any critical circumstance or it would lead to fatal legal consequences. 

The professional codes of ethics require the nursing professionals to strictly adhere to the NMBA guidelines while practicing within the clinical setting (Australian Nursing and Midwifery Board ,2017). It is expected that the nursing professionals would obey the guidelines at all times and comply with the code of conduct, code of ethics and standards for practice (Hudson et al., 2015). As a registered nurse, Declan is expected to practice in compliance with the legal standards (Australian Nursing and Midwifery Board ,2017). It is also expected that the care giver would practice safely, effectively and maintain a collaborative approach that would involve undertaking a patient centred approach and advocate cultural practice and maintain respectable relations with the client (De Lima et al., 2017). Further, it is also expected that the nurse would act with professional integrity and promote overall health and well being of the client (Australian Nursing and Midwifery Board ,2017). Thus, complying with the request of the client’s daughter would lead to violating the ethical considerations of the professional practice and hence the registered nurse should be alert and cautious while undertaking a decision.

The administration of the procedure of euthanasia or promoting voluntary suicide in a client has been a subject of debate for a long period of time in Australia. However, it should be noted that the law does not consider the procedure as legal (Emanuel et al., 2016). The first initiative to legalize the law for the terminally ill patients with their consent was attempted in the year 1995, under the law ‘Rights of the terminally ill person’ (Husted et al., 2014). However the law was rendered ineffective by the parliament in the year 1976 with the amendment of the Federal Parliament of the Northern Territory (Self-government) Act, 1978 (Emanuel et al., 2016). At the same time, it should also be mentioned that at present the Australian Human Rights commission does not have any legal projects on Euthanasia. Hence, the process is illegal and is strongly condemned by the government and might even lead to serious legal actions.

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Professional codes of ethics/conduct

The principles of health care ethics suggest the respect for patient autonomy, the principle of maleficence and the principle of beneficence (Beauchamp & Childress, 2013). The principle of maleficence focuses on the aspect of causing no harm to the patient and promoting recovery (AustralianHealth Practitioner Regulation Authority, 2017). The principle of beneficence refers to the moral obligations and the duty to do the best for the patient. Also, the principle of patient autonomy deals with respecting the individual concern and the choice of the patient (Australian Health Practitioner Regulation Authority, 2017). Hence, the registered nurse must strictly adhere to the three important principles before engaging in the decision making process.

The recommendations that can be proposed in order to effectively strengthen the professional practice would include the following:

  • It should also be noted that while dealing with cases that involve ethical issues, the first and foremost procedure that should be undertaken is to educate the client about his medical condition and ‘tell him the truth’. ‘Telling the truth’ is a phrase most commonly used in the nursing profession in association to cases that display issues related to patient dignity and uninformed consent (Berglund, 2012). The registered nurse must effective educate the patient about his condition and enlighten him about ‘euthanasia’ After the process the nurse can proceed with seeking a consent of the patient in being subjected to the process.
  • The registered nurse must proceed with an effective decision making process. It can be suggested that a formal discussion with the supervisors and other health care professionals in charge of taking of Arthur must discuss the scenario and develop a decision in collaboration
  • A thorough analysis of the existing laws and health care policies in relation to euthanasia and obtaining a legal permission from the court of law is extremely important. Further, a legal permission must be sought of the ministry of health, NSW. A thorough review and analysis of the previous cases can help in effectively strengthening the level of professional practice.

Hence, it can be expected that on complying with the proposed recommendation strategies, the decision making ability of the registered nurse would be enhanced. Further, it would also help in developing a clear in-sight into the process in which critical cases involving ethical complexities are managed with convenience.

Conclusion:

Therefore to conclude, it should be stated that critical cases involving ethical complexities are common in the nursing professional. These circumstances have often been reported to elicit a professional dilemma in the nursing professionals entitled to take care of the patients. A number of ethical models in nursing have tried to identify the different ethical issues encountered while dealing with patients and their family members. It is important to note here that as a registered nurse the primary goal is to provide a holistic care to the patient and advocate patient rights. Hence, it is suggested that educating the patient about the existing medical condition and obtaining an informed consent are areas of high priority. After obtaining a consent, the nursing professional should engage in a collaborative decision making process that would involve the experienced supervisors, physician and other health care professionals in charge of taking care of the client. Finally, only after obtaining a legal permit from the court of human rights and the ministry of health an effective decision should be undertaken that involves serious ethical consideration issues such as administering euthanasia.

References:

Australian Institute of Family Studies(2016). Mandatory Reporting of Child Abuse and Neglect. Retrieved from: https://aifs.gov.au/cfca/publications/mandatory-reporting-childabuse-and-neglect

Australian Nursing and Midwifery Board (2017). Position statement on nurses, midwives and vaccination. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-GuidelinesStatements/Position- Statements/vaccination.aspx

AustralianHealth Practitioner Regulation Authority (2017). Court and Tribunal Decisions. Retrieved from: https://www.ahpra.gov.au/publications/tribunal-decisions.aspx

Beauchamp, T. & Childress, J. (2013). Principles of Biomedical Ethics (7th ed). New York: Oxford.pp.60

Berglund, C. (2012). Ethics for Health Care (4th ed). South Melbourne: Oxford.pp.127

De Lima, L., Woodruff, R., Pettus, K., Downing, J., Buitrago, R., Munyoro, E., … & Radbruch, L. (2017). International Association for Hospice and Palliative Care position statement: euthanasia and physician-assisted suicide. Journal of palliative medicine, 20(1), 8-14.

Freegard, H. & Isted, L. (2012). Ethical Practice for Health Professionals. South Melbourne: Cengage.pp.87

Foley, M. & Christensen, M. (2016). Negligence and the Duty of Care: a case study discussion. Singapore Nursing Journal, 43 (1): 7-11

Hudson, P., Hudson, R., Philip, J., Boughey, M., Kelly, B., & Hertogh, C. (2015). Legalizing physician-assisted suicide and/or euthanasia: Pragmatic implications. Palliative & supportive care, 13(5), 1399-1409.

Husted, G., Husted, J., Scotto, C., & Wolf, K. (2014). Bioethical Decision-Making in Nursing (5th edn). New York: Springer Publishing Co.pp.111-123

Kerridge, I., Lowe, M. & Stewart, C. (2013). Ethics and Law for the health professions. Annandale NSW: the Federation Press. pp 127

Ozolins, J. & Grainger, J. (2015). Foundations of Healthcare Ethics: Theory to Practice. South Melbourne: CUP.pp.45

Sanggaran, J.P., Ferguson, G., & Haire, G. (2014) Ethical Challenges for doctors working in immigration detention. Medical Journal of Australia, 201 (7): 377-378. doi: 10.5694/mja14.01014