Ethical Dimensions of Nursing, Essay Example

Abstract

In the nursing industry today, it has become more difficult for practicing nurses to make legal and ethical decisions. The professional nursing issue is legal and ethical issues concerning terminal ill patients’ rights and care. In the state of Nebraska, they are considering passing a legal mandate that no patient would be denied denial of food and water. The nurses are required by law to follow legal mandates to not deny a patient food and water regardless of the terminal disease of that patient. These two opposing moral decisions suggest that nurses are put in position to legally follow the Nebraska mandate, however, the nurse may be violating their oath to advocate and provide care for patients while striving to protect the rights and health of the patient. The ethical problems faced by nurses are the most difficult because there is fine line between the legal and ethical situations. The legal situations are in black and white however, the ethical situations require sound judgement from the nurse. The adherence to these legal and ethical rules are not always clear cut.

Key words: legal, moral, rights, ethical

Ethical Dimensions of Nursing

In the field of nursing, the nurse practitioner plays a critical part in the care of terminal patients while pledge their lives to take care of patients while maintaining moral and ethical compassion care. The transitional period to end of life is traditionally led by the physician on record. However, the nurse deals with all the moral, legal, ethical decisions along with the patient’s family. The primary problem is the legislation makes the laws, the physician provides the care and the social worker helps provide support, however, the nurse practitioner is left to make critical moral and ethical decisions. Nursing educators believed that the healthcare industry, does not truly understand the ethical and moral decisions that nurses have to make on a day to day bases(Davis,2015). The nurse practitioner is often faced with the making a decision based on what is best for the patient versus what the legal system or physician’s orders indicated what is best and ethical for the patient.  The nurse practitioner’s face ethical and moral dilemmas that are more challenging, complex and risky than ever before.  These dilemmas are complicated by advancements in medical technology that serve to prolong life as well as philosophical and legal debates over patients right to make decision about final days. The Nebraska for Humane Care Amendment will mandate that that terminal patients would not be denied water or food. This Nebraska mandate case shows the legal, ethical and moral decisions made by nurses.

Nebraska Mandate

The best example is the Nebraska legal mandate to not deny a patient food and water regardless of the terminal disease of that patient. There are number of complicated issues that the nurses face such as patient has verbally requested to no longer be given water and food intravenously or the patients “Durable Power of Attorney” has made a decision to no longer give the patient food or water because they are terminal. The primary goal of the nurse ethics is to protect the patient while administering ongoing care. The nurse has to make the ethical decisions concerning the care of a terminal patient along with facing legal ramifications from the Nebraska laws and the patients’ family. The practicing nurse encounters ethical and problematic decisions during the course of their day-to-day application of their care to patients that may conflict with the family’s values and the nurses moral conscious (Johnson,Megan-Jane & Hutchinson,2015). What happens when the nurse cease providing intravenous water and food at the patients verbal request? The nurse has broken the Nebraska law because the patients’ rights has to be respected when they are able to make their own medical decisions. The nurse is performing her duties that are morally right and ethical by following the patients’ rights. According to Furlong (2015), the passage of the Nebraska Amendment would create ethical dilemmas for the nurse, patient and family members because the best treatment plan for the patient may be to stop food and water.

The Nebraska legislation passed the law without considering the repercussions from making decision that may not be in the best interest of the patient’s quality of life. In addition, the precarious position the law puts on the nurse who have to care for the patient providing intravenous food and water. The legal ramification are the nurses were put on notice that all nurses had to abide by this new legislation or face criminal charges by the state(Furlong,2015).  Finally, the courts did not consider the decision impact on nurses’ ability to provide compassionate and proper care to the terminal ill patient.

Background

In 1990, the case of Cruzan v. Director, Missouri Department of Health concerning a patient that had right to die clause documents that during her illness any evidence she was in a vegetative state, the intravenous feeding must be stopped(Linder,2011). The Supreme courts accepted the additional documents and the living will confirmed the patient’s wishes for the feeding to stop. The decision was made that the patient was within their rights to die and the feeding was stopped. Consequently, the nurses are faced with ethical decisions and legal ramifications while the courts are trying to make a decision. The nurses spend more time with the patient and provide the compassion care while building a relationship with the patient. However, the physician decides that the patient should enter hospice without asking the nurse about the patients’ response to treatment or the patients personal wishes.

In the fight for patients to be able to make their own decisions concerning actions taken during terminal illness or when incapacitated is a long standing issue. The nurse practitioner is faces with legal ramification of not following the Supreme Courts law or legal ramification for continuing water and feeding when the family wants the feeding to stop but nurse continues based on the laws. In addition, the nurses’ moral judgement on the best action to take which is best for the patient. The morale issue must be addressed by the nurse cause the patient rights are to be considered during the Cruzan v. Director, Missouri Department of Health case. Once again, the nurse is left by the Supreme court to follow laws that may not be morally right for the patient. In addition, the nurse is left to deal with the families, legal issues, and moral issues all within the confines of the nursing oath and attempting to follows the laws of the land.

The moral issues that a nurse will encounter during terminal care are very complex because there is a fine line between what is legally right or morally and ethically wrong concerning the patients care.  It is the nurse practitioner’s oath and duty to protect the patient regardless of other legal or written testaments. The best example is the Cruzan case patient if the patient had made a dying declaration that she wanted to live under all circumstances.  However, while she has faded into a coma, the courts were basing their decision on her last will and testament to not revive her in a vegetative state. This is an example a complex situation that the nurse has to make the best decision for the patient. In the same Cruzan case, the children arrive to spend their last moments with the patient. However, the patents will and verbally that the husband be allowed only during her last moments. The nurses has to make the ethical and moral decision to allow the children in the room because the father has given permission or respect the patients’ decision. It is morally wrong for the nurse to let the children in the room before the mother passes because the father gave permission.  Yes, it would be legally and morally wrong to allow the children in the room contrary to the patient’s wishes. The nurse that understands the meaning of the nursing code of ethics must follow and accept the patient’s last request. The husband is arguing that he can override that decisions allowing the children in the room.

However, the nurses were all told by the mother on many occasions that her children do not deserve to be there in those last moments, she only wants her husband.  The husband argues his is the legal guardian as her spouse but does not have power of attorney. The moral issue is should the nurse let the children see the mother or should she follow the patients last dying declaration before going into a coma. The nurse has sworn to respect and honor the patient under the nurse’s code of ethics while honoring the wishes of the patient regardless of personal feelings, social states, nationality or religion.  In this situation, the nurse must follow the patients last written and signed declaration, however, she could soften the blow by allowing the children in to see the mother after she has passed. The declaration stated she wanted her husband at her bedside in her last moments, she did not say they could not visit her after her death. These are the type of ethical and morally situations in the real world nurses are faced with on a day-to-day basis.

Literature Professional Issue

The end of life environment for patients is a complex treatment that has nurses making ethical decisions. The terminal ill patient builds a relationship with the nurse and confides their last wishes verbally which the nurse honors. However, as the final days remain the family does not have a living will to make a determination of how the patient wants and does not want. The nurses’ perspective and the patients’ rights are often left out of the process until the patient is comatose. It is the nurse that makes the moral and ethical decisions based on the patients last wishes (Karlsson et al.,2013).  The author Karlsson (2013) found that the nurse practitioner is not always include in the decision treatment plan for the patient, however, the nurse is the one makes the moral and ethical decisions based on the patient rights. This article supports the theory that the healthcare industry needs to include the nurse practitioner in treatment plan decisions and issues concerning the patients well-being.  In summary, the Karlsson article believes that the healthcare industry needs to ensure more collaboration with the treating nurse concerning the best plan of care.

The article by Suzuki, Ota & Matsuda (2015) found that nurses make tough ethical decisions concerning patients and the physicians make life changing decisions without considering the nurses’ feedback. The relationship between the physician and nurse need to be more collaborative so the nurse can make sound ethical and moral decisions.  The summary of this article concluded that the nurses are often put in situations to make moral and ethical situations without the backing of the administration. The nurses make the wrong decision and they end up with problems with the hospital administration and possibly the family.  The Winland-Brown, Lachman, and Swanson (2015) found that nurses have difficult time providing compassionate care when they feel the pressure of their moral and ethical decisions. The Furlong (2015) study found that legislation concerning terminal ill patients did not consider the ethical and moral decisions the nurses are forced to make.

Conclusion

The healthcare industry needs to implement a more comprehensive treatment plan that includes the nurses’ feedback because they ultimately end up delivering the treatment plan. In addition, the Nebraska legislators need to solicit the feedback from nurses who spend every day treating the patients. In the situation of a patient with a terminal illness it should be the responsibility of the administration to ensure the living will or last medical request by patient are documented. The providers are more concern with getting the patients terminal visits paid instead of concentrating on moral and ethical decisions which the nurses constantly make on behalf of the patient.

References

Davis, Mary. 2015. “Teaching ethics and the Code: Nurse educators weigh in.” American Nurse 47, no. 2: 1-6 6p. Retrieved from EBSCOhost database

Furlong, B. (2015). Right or wrong: Policy, legal, and ethical issues and decision-making. In S. Lewenson & M. Truglio-Londrigan (Eds.). Decision-making in nursing: Thoughtful approaches for leadership. (2nd ed.) (pp. 33-50). Burlington, MA: Jones & Bartlett.

Linder, D. (2011). The right to die: The issue: Does the Constitution protect the decision to ends one own life, at least if one is terminally ill or in great pain. Retrieved from http://law2.umkc.edu/faculty/projects/ftrials/conlaw/righttodie.htm

Johnstone, Megan-Jane, and Alison Hutchinson. 2015. “‘Moral distress’ – time to abandon a flawed nursing construct?.” Nursing Ethics 22, no. 1: 5-14 10p. retrieved from EBSCOhost database

Karlsson, M., Karlsson, C., Barbosa da Silva, A., Berggren, I., & Soderlund, M. (2013).

Community nurses’ experiences of ethical problems in end-of-life care in the patient’s own home. Scandinavian Journal of Caring Sciences, 27(4), 831-838 8p. doi:10.1111/j.1471-6712.2012.01087.x

Winland-Brown, J., Lachman, V. D., & Swanson, E. O. (2015). The new ‘code of ethics for nurses with interpretive statements’ (2015): Practical Clinical Application, Part I. MEDSURG Nursing, 24(4), 268-271.