Discussions on Identified Ethical Principles, Essay Example

When is it acceptable to refuse an assignment?

That nurses reserve a right to refuse an assignment is a well-known fact, but to make such refusal legal or ethically justified, nurses should meet several essential criteria. Nurses can and are even obliged to refuse an assignment if they do not possess training, which is needed to perform such assignment in accordance with established professional standards (Lippincott Williams & Wilkins, 2002). Nurses must not perform assignments unless they are adequately trained or are accompanied by a nurse who possesses skills, knowledge, and training needed to perform this assignment (Lippincott Williams & Wilkins, 2002). Other reasons for which professional nurses may refuse an assignment include (a) inadequate staff and excessive workloads; (b) inappropriate skills when floated to a unit; (c) inadequate non-clinical support staff; (d) personal beliefs – moral, ethical, religious, etc.; and (e) potential threat to nurses’ safety (Powers, 1993). Under most circumstances, nurses are not allowed to refuse their assignments, and even if they present their reasons in a written form, they may still carry a legal responsibility to provide care (Lippincott Williams & Wilkins, 2002).

What is the nurse’s duty when a patient confides that he wants to harm himself?

Cases when a patient confides that he wants to harm himself pose a dilemma: a nurse must balance patient’s confidentiality with the duty to protect the patient. The nurse’s duty is to establish “the imminence” of the threat (psychological and related tests may apply) and to report the threat to the supervisor and/ or responsible authorities. In such cases, HIPAA justifies the breach of privacy by the nurse and permits nurses to disclose protected information to the extent, which will allow to protect the patient from harm (Medscape, 2009). If a patient confides that he will harm himself, nurses will not require his written authorization to disclose information about his health, and it is within the scope of the nurse’s duty to avert the serious and imminent threat to the patient’s health.

Is health care a right?

According to the Universal Declaration of Human Rights, “every human being has the right to health, including health care” (Amnesty International, 2010), but professionals in nursing ethics express their concerns as for whether health care can be considered a human right. Barlow (1999) lists several reasons of why health care can hardly be a right: first, health care is difficult to define, and thus it is difficult to define whether individuals have the right for the basic preventive care or whether they also have the right for more expensive medical services. Second, if health care is a universal human right, who carries the burden of responsibility for providing health care to everyone? (Barlow, 1999). This question is yet to be answered. Third, health care as a right lacks any philosophical basis and rational justification (Barlow, 1999). Even if health care is the basic human right, this knowledge will hardly replenish the lack of resources that are needed to provide every single citizen with at least the basic access to health care.

What should the nurse do when her personal values are in conflict with those of the patient?

Value conflicts in nursing environments are not uncommon. In case of a value conflict, the nurse must identify values involved, their strength and relevance, and the rights and duties that follow (Fry & Johnstone, 2002). The nurse must then take a decision as for what values are the most important and what claims deserve respect (Fry & Johnstone, 2002). Yet, regardless of the result, the nurse must provide care to patients, and those in need for medical care have the right to receive this care regardless of their values and beliefs (Fry & Johnstone, 2002). In no way should value conflicts interfere with the care provision in nursing settings, and if such value conflicts persist, a nurse should consider changing the field of practice.

References

Amnesty International. (2010). Health care is a human right. Amnesty International.

Retrieved March 23, 2010 from http://www.amnestyusa.org/demand-dignity/health-care-is-a-human-right/page.do?id=1021216

Barlow, P. (1999). Health care is not a human right. BMJ, 319(7205), 321.

Fry, S.T. & Johnstone, M.J. (2002). Ethics in nursing practice: A guide to ethical decision making. Wiley-Blackwell.

Lippincott Williams & Wilkins. (2002). Illustrated manual of nursing practice. Lippincott Williams & Wilkins.

Medscape. (2009). Legal obligations to the dangerous patient: Legal considerations for a decision-making framework. Topics in Advanced Practice Nursing, 9(3). Retrieved from http://www.medscape.com/viewarticle/707580_2

Powers, J. (1993). Accepting and refusing assignments. Nursing Management, 24(9), 64-67.