Importance of Ethics in Nursing

Write an essay discussing the professional , legal and ethical responsibilities of the nurse under current legislation presented in the case scenario.

Nursing professionals are seen to work in a fast paced as well as a technical environment in the healthcare organizations. They have to make effective but quick decisions about the acre of the patients and at the same time communicate effectively with patients, family members and the other healthcare professionals. The service users need to depend on the honesty of the nurses and the adherence of the nurses to different ethical standards (Cherry & Jacob, 2016). Therefore, every nursing professional have to be very careful that the care they provide align with all the aspects of human dignity, ensure patient satisfaction, and meet the human rights. Therefore, ethics have become an important part in nursing. Researchers are of the opinion that all the nursing professionals need to respect their patients and thereby maintain the autonomy and dignity of the patient so that the rights of the patients can be respected (Urden, Stacey & lough, 2017). All the nurses need to make sure that they are creating an environment of mutual trust and respect between those professionals and the patients and family members. The service users are seen to entrust their dignity of the nurses and therefore nurses should also guard their privacy, listen to their concerns. They should also consider the wishes of the person regarding their care that they want to receive. In this assignment, a case study is provided and accordingly the ethical, legal as well as professional principles that the nurses need to follow would be discussed.

One of the barriers that every nursing professional has to face in life is ethical dilemma. Healthcare professionals define ethical dilemma as an issue that involves the need for choosing from among two or more morally acceptable options or between equally unacceptable courses of action when one choice prevents the selection of the other. In different aspects of practices, professionals often have to face many complex situations that can result in different types of mental conflicts mainly between the moral imperatives where in order to obey one; it would result in transgressing the others (Jesus et al., 2014). In order to help nurses in providing guidelines, bioethical principles have been introduced of which two of the most important are the beneficence and the other is the non-maleficence. Nurses are seen to demonstrate beneficence by helping the patients in reaching their highest levels of wellbeing and this may be achieved by providing care directly to an individual patients or developing healthcare policies that affect the larger population. The care should be such that it is the most evidence based and is the safest and best options available for the development of health of the individuals. If such aspect is taken in consideration, then the nursing professionals who are treating the patient in the case study should try their best to help the patient come back into normal life irrespective of the response of the patient to the treatment (vanHoof et al., 2018). Following such bioethical principle, it becomes excessively important for the nursing professional treating the patient dawn to provide the best evidence based treatment that would help the patient to live and gradually come back to normal lives. Healthcare professionals should never leave the hope on patient, as they are believed to be the human beings who have the capability to save lives. Recent day researchers have a huge amount of trust on the rehabilitation departments where experts work in association with the family members and the patient so that the patients can come back into daily course of life. Therefore, the nursing professionals should never become negative about the fact of the person and try their best to provide care that helps the patients to recover (Bollig et al. 2016). 

The Principles of Beneficence and Non-Maleficence

However, on the other hand, this bio-ethical principle completely counteracts with another principle called the non-maleficence. The principle is mainly seen to state that nursing professionals should not inflict any harm to the patient intentionally. This is seen to be useful in dealing with the difficult issues that surround the terminally as well as seriously ill patients or those who are injured (Park et al., 2014). Harm and its effects are to be considered by this principle while making decisions and the intervention that should be applied should cause no suffering to the patient or reduce the suffering of the patient. Therefore, by following this principle, a nursing professional may come to a conclusion in this case study that the patient is unconscious and even when she come back to conscious state it would be very difficult for her to maintain dependent life. She might remain paralyzed throughout the rest of the life and might have to suffer mentally and emotionally not only due to loss of freedom and dependency but also mainly due to her poor quality of life (Botkin et al., 2015). Therefore, in a way it also becomes important for the professionals to consider those options that would reduce her sufferings. Therefore, if the nursing professionals need to follow the principle, then they can consider the “do not resuscitate” option where they would withdraw support in a way that would not enable her to recover from her consciousness at all. This would reduce the chances of her suffering even if she comes to a conscious state and would prevent her from living a frustrated life from being in a vegetative state.

Laws belong to four important sources out of which are the constitution, legislation, administrative as well as common law. Nursing profession are mainly directed to follow the legislations that are developed in order to ensure best care to the patients which are not only safe but also need to be of higher quality. There legal issues that nursing professionals might face. This is the criminal as well as civil laws and this mainly includes any conducts of the nursing professionals that are harmful for the society of the individual (Flo et al., 2016). It is mainly punishable by fines or imprisonment. In the case of the patient, there are a number of dilemmas that can be faced by the nursing professionals that make this a complicated case. Here, the main patient is unconscious and therefore she is not being able to communicate or participate in any form of decision making. This becomes one of the most important concerns for the professionals as any intervention taken on her part by the professionals may involve the later in any form of legal obligations. In such a scenario, to prevent any form of issues, the nursing professionals need to consult with the power attorneys of the patient who has the right to make decisions on the behalf of the patient. Power of attorney mainly directs individuals whom a person trusts to act as his agent if that person is unable to advocate on her own behalf, is unable to speak or is sin no situation to take decisions on her health. It then becomes the duty of the professionals to first confirm and then consult with the power of attorneys in order to take their suggestions about what interventions they need to take (Steinberg et al., 2018). In this case study and even the video that depicts the discussion, the confusion that rose about the decisions that needs to be taken shows that none of the family members were made the power of attorneys and therefore no one was eligible enough to take the decisions on behalf of the patient. It clearly becomes a legal concern as the professionals would not be able to decide on whose decision they should act on. The husband of the patient was seen to be highly emotional. He stated that the professionals should try their best to develop the best care plan for the patient. He was not ready to accept the withdrawal of resuscitation of his wife. On the other hand, the daughter of the patient was seen to be much practical and stated that the professional should withdraw resuscitation as it would help her mother to get relived from future days of suffering. Since both the family members were not coming to one particular decision, it become problematic for the healthcare professional to reach to an objective and plan accordingly. Such a situation is highly vulnerable to legal obligation due to a number of reasons (Ecarnot et al., 2018). 

Legal Concerns in Healthcare

Withdrawal of resuscitation is associated with cases of euthanasia. Till data euthanasia is illegal in the nation and any professionals who are engaged in any such act or provoke other people to undertake euthanasia are subjected to criminal offence and will get involved in legal obligation. This might result in cancellation, termination or suspension of the nursing license and may subject the nurses to various types of fines and punishments. Among the four different types of euthanasia, the main type of euthanasia that needs to be described in this case is the passive involuntary euthanasia. Such type of euthanasia is seen to occur when the medical treatment is withdrawn or withheld from patient not at the request of the patient but in order to end the life of the patient. Here the nursing professional if conducts passive involuntary euthanasia, she might be subjected to two types of legal obligation (Cohen et al., 2017). One of them is that she might be fined or her licenses may be cancelled as euthanasia is illegal and she would have conducted an illegal practice. Another would be that the patient had no prior advanced directives and only her daughter had stated that her mother had uttered about her wishes on a Christmas in certain year. Therefore, this might also lead to issues when she would be conducting the euthanasia without any documentation to support her actions. 

The professional responsibilities of nursing advises the nurse to be accountable and thereby take responsibility got the own nursing actions as well as for the professional conducts. The professionals should make sure that they are able to function within own level of competence and this should be also within the legally recognized scope of practice and within the relevant legislation (Heinderer, Friedman & Fins, 2015). The researchers in the healthcare fields also advised the nursing professionals to take proper initiatives and action for promoting the provision of safe, appropriate as well as ethical care to the clients. The nursing professionals who would be assisting the patient of the case study should make sure that she should be applying interventions about which she should be fully accountable. Her responsibility should be to take effective action that would ensure welfare of the patient helping her to provide all the chances that she deserves to live a quality life. The nursing professionals should also maintain their own physical, physiological and emotional fitness for practicing. The professionals who would be treating the patient should not be blown away or handle the situation emotionally and should apply her critical thinking skills to judge the situation. She should abide by all the ethical, legal as well as professional frameworks so that the interventions she takes would not involve her in any legal or ethical obligations. The Australian law states that the purpose of the establishing liability for any crimes under the Australian law can never be based on motivation of the professional by compassion for the patients, when the patient is terminally ill, or when the doctor’s action hastens the death that is inevitable or imminent (Mockford et al., 2015). The professional in the case was seen to be emotional about the patient and seemed to be supportive of withdrawal of resuscitation when although she did not accept it entirely. She was seen to be motivated by the suffering and compassion of the patient. Such should not be the scenario. The nursing professionals had to conduct critical reasoning skills, analyzing skills, proper reasoning skills, decision-making skill and other in such arena to come out with a suggestion (Tseng et al., 2017). 

The Role of Power Attorneys in Making Treatment Decisions

From the above discussion, it becomes clear that the argument among the family members was about whether to conduct withdrawal of resuscitation interventions or not. While handling the case, the nursing professionals may suffer from ethical dilemma as she may suffer from conflicts between the beneficence and non-maleficence. Moreover there are also chances of legal obligation as the patient had neither power attorneys nor advanced directives. In such a situation, she might get engaged in legal obligations in whichever step she takes. Moreover, euthanasia is illegal and that will take her into legal issues. The profession of the nurses asks them to be accountable for their actions and therefore nursing professionals need to critically analyses the situations and decide intervention that will help to provide effective care to not only patients and help families to come out from stressful situations. 

References:

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Botkin, J. R., Belmont, J. W., Berg, J. S., Berkman, B. E., Bombard, Y., Holm, I. A., … & Wilfond, B. S. (2015). Points to consider: ethical, legal, and psychosocial implications of genetic testing in children and adolescents. The American Journal of Human Genetics, 97(1), 6-21.

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Cohen, A. B., Knobf, M. T., & Fried, T. R. (2017). Do?Not?Hospitalize Orders in Nursing Homes:“Call the Family Instead of Calling the Ambulance”. Journal of the American Geriatrics Society, 65(7), 1573-1577.

Ecarnot, F., Chopard, R., Seronde, M. F., Schiele, F., & Meneveau, N. (2018). End-of-Life Situations in Cardiology: A Qualitative Study of Physicians and Nurses’ Experience in a Large University Hospital in France.

Flo, E., Husebo, B. S., Bruusgaard, P., Gjerberg, E., Thoresen, L., Lillemoen, L., & Pedersen, R. (2016). A review of the implementation and research strategies of advance care planning in nursing homes. BMC geriatrics, 16(1), 24.

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Hinderer, K. A., Friedmann, E., & Fins, J. J. (2015). Withdrawal of Life-Sustaining Treatment: Patient and Proxy AgreementA Secondary Analysis of “Contracts, Covenants, and Advance Care Planning”. Dimensions of critical care nursing, 34(2), 91-99.

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Tseng, Y. P., Huang, L. H., Huang, T. H., Hsu, L. L., & Hsieh, S. I. (2017). Factors associated with the do-not-resuscitate decision among surrogates of elderly residents at a nursing home in Taiwan. International Journal of Gerontology, 11(2), 95-99.

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