Ethical Issues in Patient Care



Ethical Issues in Patient Care



Chapter Objectives



1. Differentiate between ethics and bioethics.


2. Identify ethical dilemmas in nursing.


3. Discuss the role of the nurse in advance directives.


4. Review the principles of ethical decision making.


5. Identify interventions designed to protect patients’ rights.


6. Discuss the responsibility of the ethics committee.



Definitions











ETHICAL DECISION MAKING


Today’s nurses are in the public eye in the discussion of many different ethical issues and dilemmas, such as technology that maintains life for severely premature infants, technology that advances the life of severely brain-damaged patients, stem cell research, the issues of what constitutes brain death, transplant and donor programs, and end-of-life decisions. Concern for ethics has also moved beyond the clinical arenas to the business of health care, with the potential for Medicare fraud, suspect business decision making, and the protection of patient information. Ethical decision making will have an impact on your clinical professional role, your leadership role, and your research role.


Ethical decision making is required when there is an ethical dilemma. Ethical dilemmas occur when there is a conflict between two or more ethical principles.




Common Ethical Principles and Their Rules




1. Beneficence—Duty to do good and to protect the patient’s welfare. An example is carefully adhering to infection control principles for all patients.


2. Nonmaleficence—Principle of doing no harm. Nurses who maintain their skills are practicing the principle of “doing no harm.”


3. Justice—Principle of fairness in which an individual receives what is owed. All patients receiving the same level of culturally competent care is an example.


4. Autonomy—Respect for individual liberty and the person’s right to self-determination. Informed consent is an example of adherence to the principle of autonomy.


5. Fidelity—Duty to keep one’s word. Senior leaders adhering to all contracts is an example of leadership fidelity.


6. Respect for others—Right of people to make their own decisions, such as not telling a patient what he “should do” but allowing him to make his own decision.


7. Veracity—Obligation to tell the truth. As a professional, this would be a requirement to admit mistakes promptly or to not lie to a patient about bad news (list adapted from Little, 2003, p. 469).


Such a conflict comes into place with the conflict between (a) the principle of autonomy (the duty to respect the patient’s choice) and the duty to do only what the patient wants and (b) the principle of beneficence (the duty to protect the patient’s welfare) and the duty to do only what the patient needs. An example would be the conflict that arises when a patient refuses dialysis that will prolong her life. Another example would be the situation where the family does not want their frail elderly mother given the news that her grandson has been hospitalized with a life-threatening injury. The conflict here is between veracity and self-respect. The decision of what to do is guided by beneficence. Often, there is no correct decision. There are many questions that arise in clinical care, such as the following (Schroeder, 1995):



In addition to the clinical situations that cause ethical conflicts, nurses and health care personnel bring their own values and beliefs into the dilemma. There are times where the beliefs of the health care personnel are the dilemma. An individual with a strong religious belief in the sanctity of life may have ethical conflicts about DNR (do-not-resuscitate) orders or abortions. It is important be aware of your beliefs and to not let them interfere with the legal and professional requirements of your position. If you have beliefs that will prevent you from performing some of the requirements of your position, it is necessary to inform your supervisor, so that the patient needs can always be met.



TRADITIONAL ETHICAL THEORIES


The study of ethics has resulted in different theories that are used to guide decision making. Box 8-1 provides traditional ethical theories.



Box 8-1   TRADITIONAL ETHICAL THEORIES


Utilitarianism






Kelly-Heidenthal, P. (2004). Essentials of nursing leadership and management. Clifton Park, NY: Thomson Delmar Learning.


As a nurse, you will be guided by ethical theories and your own personal values and beliefs and professional expectations (ANA, 2001; ICN, 2009). The fundamental values of nursing are expressed in the Code of Ethics for Nurses. They are the values, such as respect for patient autonomy, acting in the patient’s best interest, and maintaining professional competence, that all nurses commit to uphold when they enter the profession.



AMERICAN NURSES ASSOCIATION’S CODE OF ETHICS FOR NURSES


Nurses must always act as patient advocates on a daily basis. The American Nurses Association (ANA) House of Delegates approved the most recent Code of Ethics for Nurses at its June 30, 2001, meeting in Washington, DC. In July 2001, the Congress of Nursing Practice and Economics voted to accept the new language of the interpretive statements (Tomey, 2004).




Revised Code of Ethics for Nurses with Interpretive Statements




1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.


2. The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.


3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.


4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.


5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.


6. The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.


7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.


8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.


9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy (ANA, 2001).



INTERNATIONAL COUNCIL OF NURSES’ INTERNATIONAL CODE OF ETHICS FOR NURSES


The International Council of Nurses’ (ICN) International Code of Ethics for Nurses, most recently revised in 2006, is a guide for action based on social values and needs. The code has served as the standard for nurses worldwide since it was first adopted in 1953. The code is regularly reviewed and revised in response to the realities of nursing and health care in a changing society. The code makes it clear that inherent in nursing is respect for human rights, including the right to life, to dignity, and to be treated with respect. The ICN International Code of Ethics for Nurses guides nurses in everyday choices and supports their refusal to participate in activities that conflict with caring and healing.




International Council of Nurses’ International Code of Ethics for Nurses




1. Nurses and people


    The nurse’s primary professional responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment. The nurse holds in confidence personal information and uses judgment in sharing this information.


    The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction.


2. Nurses and practice


    The nurse carries personal responsibility and accountability for nursing, practice, and for maintaining competence by continual learning. The nurse maintains a standard of personal health such that the ability to provide care is not compromised. The nurse uses judgment regarding individual competence when accepting and delegating responsibility.


    The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence. The nurse in providing care, ensures that uses of technology and scientific advances are compatible with the safety, dignity and rights of people.


3. Nurses and the profession


    The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. The nurse is active in developing a core of research-based professional knowledge.


    The nurse, acting through the professional organization, participates in creating and maintaining equitable social and economic working conditions in nursing.


4. Nurses and coworkers


    The nurse sustains a cooperative relationship with coworkers in nursing and other fields. The nurse takes appropriate action to safeguard individuals when their care is endangered by a coworker or any other person (ICN, 2006; copyright © 2006).


One mark of a profession is the establishment of determination of ethical behavior for its members. In addition to the ANA and ICN codes, specialty nursing organizations and hospitals have developed codes of ethical behavior.


To assist you in dealing with the complex ethical issues that exist, hospitals have formed ethics committees. These committees are interdisciplinary and include representatives from clinical nursing, administration, medicine, social work, pharmacy, legal, and clergy. The work of ethics committees lies in three areas (Agich and Younger, 1991; Dalgo and Anderson, 1995):



As a nurse, you have the right to call on the ethics committee for a referral. Cases are often referred to the ethics committee for discussion. Issues commonly addressed by ethics committees are end-of-life issues, organ donation, and futility-of-care issues.



END-OF-LIFE ISSUES


End-of-life issues frequently revolve around the issue of advance directives. An advance directive is an end-of-life decision made by a patient in advance of the actual need. Many individuals confuse an advance directive with a DNR order, but they are not the same.


An advance directive instructs health care personnel on the patient’s desires for care in certain circumstances. An advance directive, sometimes called a “living will,” is a set of instructions documenting a person’s wishes about medical care intended to sustain life. It is used if a patient becomes terminally ill, incapacitated, or unable to communicate or make decisions. Everyone has the right to accept or refuse medical care. A living will protects the patient’s rights and removes the burden for making decisions from family, friends, and physicians. The ethical dilemma exists if the patient’s family refuses to allow the advance directive to be used or if a health care professional refuses the directives. The legal issues regarding advance directives are presented in Chapter 18.



ORGAN DONATION


Although organ donation is a personal choice, there may be times when an ethical dilemma may ensue with carrying out this wish. For example, if a person has decided to be an organ donor and has made this clear on his or her driver’s license, at the time of death, the family may strongly disagree with this decision.


Some states have mandated that a request be made for organ or tissue donation at the time of a patient’s death. Some families may feel this is a way for their loved one to remain alive in some way; other family members feel just the opposite and are opposed to the idea. Organ donation cards can be completed and placed in your wallet with your driver’s license. Mine, for example, stipulates that certain organs can be used for organ donation, excluding my skin. I have made my wishes known to my husband that, in the event of an accident, I wish to have my organs donated.


In hospitals where organ transplantations are done, there usually is a full-time organ donation coordinator. Nurses may be called on to request organ donations if the facility where you are employed charges nurses with this responsibility. Again, the nurse should be very direct in making these requests so there are no miscommunications, saying, for example, “Have you considered organ donation for your loved one?”


Written consent and hospital policies and procedures must be strictly followed. There is no cost to the donor family. The usual funeral expenses still apply.


Organ donation list:


Related posts:

  1. Organizational Planning
  2. Evidence-Based Practice
  3. Hospital Information Systems
  4. Strategic Management and Planning

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Dec 3, 2016 | Posted by in NURSING | Comments Off on Ethical Issues in Patient Care

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