All papers examples
Get a Free E-Book!
Log in
HIRE A WRITER!
Paper Types
Disciplines
Get a Free E-Book! ($50 Value)

How Might the Conflict of Rights Occur When of HIV Infection? Essay Example

Pages: 14

Words: 3816

Essay

The importance of ethics in nursing is not only a theoretical imperative but an issue which has implications of life and death in the real world. As such, dilemmas in ethical decision-making that are faced by nurses during their practice are as profound in implication as they are common. A large part of what it means to be a nurse is to understand how to evaluate and weight complicated and emotionally-charged ethical decisions. The outcome of any decision that is made by a nurse involves potentially harmful consequences to both the patient or patients who are directly impacted by the decision but also the organizations to which the nurse or nurses belong including a specific office of hospital as well as to the medical profession as a whole. Nursing decisions a practical decisions and are often made under conditions of stress or even outright conflict.

In addition to be being indispensable health-care providers, nurse’s are also advocates. As such there ethical decision-making must be based on a rational assessment of any given situation. The following scenario will illustrate the kind of ethical decision that must be made by a nurse in the field. In the scenario, a pregnant woman who is known to be at risk for HIV infection refuses to be tested for the HIV virus and therefore is endangering her fetus. This particular scenario brings into conflict a nurse’s duty to protect patient rights, such as the right tor refuse treatment and patient confidentiality, with the duty to protect patients from harm.

To resolve the dilemma, it is necessary to utilize Cassell’s “Ethical Assessment Framework” (EAF) which consists of a series of steps which are meant to provide a strong guideline for nurse’s in regard to ethical decision-making. Some of the ideal behind the EAF model are also important to understand in relation to the scenario, particularly the ideas of Consequentialism and deontology. As the following examination of the HIV scenario will clearly show, a nurse who faces and ethical decision that is rooted in an emotional or personal sense of advocacy is, in fact, remaining faithful to the duties of a nurse. However, the ultimate medical decision must be determined rationally in order to facilitate the most effective form of advocacy. As Lachman points out in Applied Ethics in Nursing (2006), advocacy is the natural duty of nurses partly because nurses are in the best position of the health-care system to act as advocates. Lachman writes that “Advocacy is a traditional role for nurses; nurses are in the best position on the health-care team to advocate; nurses know how to advocate; and nurses and patients can be partners in advocacy.” (Lachman, 2006, p. 15). The key idea in this statement, in regard to the HIV scenario that is being examined is that nurses and patients can be partners in the processes of advocacy. The scenario which follows tests that idea in practice.

Before describing the actual scenario in detail, it is useful to review certain specifics about the disease of AIDS and the way that HIV infection is spread. These facts are highly relevant to the scenario in question because ethical issues associated with HIV infection and AIDS, and especially those that relate to the transmission of the disease have been exceedingly controversial over the past decades since the peak of infections in the 1980’s. The basic facts in regard to the transmission of the virus are relatively simple. As Powell indicates in AIDS and HIV-Related Diseases: An Educational Guide for Professionals and the Public (1996) there are three elements of a transmission of the HIV virus. Powell cites “ (1) a point of exit from the infected individual, (2) a mechanism to transport the virus to another person, and (3) a point of entry into a second body” (Powell, 1996, p. 33). obviously the aforementioned criteria are applicable to any case of transmission for the HIV virus, including that which could be associated with a breastfeeding child.

As Powell writes, there are several methods that are commonly thought of when assessing the ways in which the HIV virus can be spread from one person to another. Powell insists that the three aspects of his criteria for transmission “exist in the human dynamic every day. Sexual intercourse, injection drug use, and medicine each facilitate the virus’s ability to spread from one person to another. (Powell, 1996, p. 33). This places a special emphasis on testing potentially high-risk candidates for infection in order to minimize their engaging in risky behavior. This fact plays a large role in why the AIDS epidemic spread world-wide resulting in an estimated twenty-five million deaths. The rates of infection have slowed over the ensuing years mainly due to testing and treatment.

Treatment for the disease is complex and difficult. Part of the challenge is due to the fact that since the HIV virus attacks the patient’s immune system, patients experience a wide-variety of associated health problems. Powell indicates that the treatment of the disease therefore requires specialists. He remarks that “those who have AIDS face one medical crisis after another.By virtue of the many diseases that may attack the body, the person with AIDS often has to go to specialists in order to take care of the many possible infections.” (Powell, 1996, p. 107). This means that nurses who advocate on behalf of patients must be aware of the reality of how challenging treatment for the disease is and how vital detection and testing are in preventing teh spread of the virus.

Finally, in regard to treatment for the disease, there are basically two primary medical treatments. They are immune-boosting drug-therapies and anti-viral drug therapies. Powell points out that “Antiviral drugs focus on inactivating or holding back the AIDS virus itself” (Powell, 1996, p. 118) while immune boosters, obviously increase the patient’s ability to resist associated infections and other complications of the disease. So, basically, the background of the AIDS virus is that it is difficult to treat, but relatively easy to spread. therefore what it logically indicated is that methods be used for detecting as many infected people as possible to prevent the further spread of the virus. Keeping all of these factors in mind, we can now move to the specifics of the previously mentioned scenario where a pregnant woman who is suspected of being at high risk for carrying the HIV virus refuses to let herself be tested for the disease. The basic dilemma faced by the nurse in this scenario, of course, relates to the conflict between her advocacy of the pregnant woman as a patient to whom she owes certain rights and the unborn baby to whom as a patient the nurse has a duty to protect from harm.

The conflict between these two aspects of advocacy is the main basis of the following scenario. Here are the facts. The basic rules about HIV testing of patients is that patients must give their consent to be tested. Similarly, mothers must give consent for their babies to be tested for HIV. Jane Doe, a patient with a history of IV drug-abuse has given birth to a baby girl in the emergency room. she is unmarried and received no kind of prenatal treatment or care. The emergency room physician recommended that she be tested for HIV. Jane Doe refused on the grounds that she claimed to not have used drugs during the pregnancy and claimed also that the baby’s father had not used IV drugs. She admitted however that she had past sexual partners who were IV drug users. The nurse in the scenario understands two important things about HIV transmission and the situation with Jane Doe and her baby. The first is that there is a possibility that Jane Doe is infected with the HIV virus and that, because she wants to breast feed her child, the baby will be exposed to the virus. Secondly, that because Jane Doe refuses to allow her self or the baby to be tested, the baby could contract a fatal infection and die before any kind of treatment could be administered.

The nurse decides to ask the patient, again, for her permission to be tested and for permission to test the baby. Jane Doe again refuses. The nurse then suggests that Jane Doe bottle-feed her baby in order to reduce the chances of exposing the baby to HIV infected breast-milk. Jane Doe reacts angrily and refuses to listen to any advice from the nurse. The nurse debates whether or not to have the HIV tests done without Jane Doe’s permission. Emotionally, the nurse feels she should at least test the child in order to potentially save its life. Jane Doe and the baby will be discharged from the hospital in twenty-four hours and afterward will untraceable. What is the ethical solution to the nurse’s dilemma in this scenario, and why?

The answer to that question is readily determined, as previously mentioned, by referencing Cassell’s “Ethical Assessment Framework” (EAF). The point by point framework of the EAF will allow the nurse to make an ethically informed decision given the facts as described in the scenario above. Lachman points out that the ethical decisions that are made by nurses are not optional and they are anything but theoretical. For this reason “To have an ethical responsibility means to have an obligation to act as an advocate. It is not optional.” (Lachman, 2006, p. 15). The EAF guides advocacy and ensures that precepts are met under a wide range of responsibilities. The emotional intensity of the ethical dilemma faced by the nurse is reflected both by the nurse and patience response to the issues at hand. By relying on the EAF guidelines, the nurse will be able to work beyond a simply emotional response to the situation.

The first step on the EAF checklist is to “gather relevant facts.” The facts in this particular case are those which were described in the outlined scenario. Assuming that the nurse in the scenario has recourse to all of the previously stated facts, her next step according to the EAF is to “identify methods of ethical justification” For this step it is now necessary to consider the previously mentioned division between Consequentialism and the deontological approach toward ethical decision-making. On the one hand, there is Consequentialism which can be considered as a form of Utilitarianism which endorses the idea that an action is moral if it brings about the greatest amount of good or happiness of the greatest amount of people. On the other hand, there is the deontological approach which endorses the adherence to rules which have been previously constructed to promote ethical behaviors and justice. In regard to the HIV scenario, the nurse’s dilemma is framed in a very specific way. If there is any ethical justification for her desire to test the mother and baby for HIV without Jane doe’s permission, then this ethical justification falls under the theory of Consequentialism. (Cassells, 1989, p.463-473).

The moral justification for not testing Jane doe or her baby for the HIV virus falls under the deontological approach to decision-making. This theory holds that every action “has an inherent moral value in and of itself independent of its consequences” (Cassells, 1989, p.463-473) and is therefore generally viewed as the opposite of Consequentialism. In terms of the HIV scenario, the particular emphasis on the deontological approach is show by the EAH checklist itself which stresses adherence to any and all duties and professional codes. The pragmatic application of the deontological approach is that rules are established and followed. Steps 4-7 in the EAH code involve examine the duties and professional codes. These steps must be viewed as being an expression of the rule-based deontological approach of ethical decision-making.

Which brings us to point number 8 on the EAH list. This point is “identify and use relevant interdisciplinary resources” which is followed by 9 “identify and prioritize actions/options” and then “Select a morally justifiable action/option” (Cassells, 1989, p.463-473). Obviously as has been indicated throughout the foregoing discussion, the ethical decision-making process that is demanded by nursing is based in practical application. this means that the nurse in the HIV scenario must not only evaluate the facts of the situation, but she must also incorporate all known rules and regulations into her decision-making process. While it is perfectly true that the nurse must take into account the consequences of her actions, she must be very careful not to let her subjective interpretation of Utilitarianism cause her to ignore rules or protocols that are already established to guide her through her decision-making process.

This fact means that the nurse’s decision in the HIV scenario will not actually be based only in Consequentialism or the deontological approach, but on a combination of the two. The approach that must b e taken by the nurse in the scenario might best be described by what Cummiskey identifies as “Kantian Consequentialism.” According to Cummiskey. there is a way of adopting Utilitarianism to the rational application of rules. In his book Kantian

Consequentialism (1996), he writes that this for of ethical philosophy “insists that respect for persons is more important than maximizing happiness” (Cummiskey, 1996, p. 4). This kind of understanding of ethical responsibility also brings about an structure of rules and duty that would seem to eliminate the idea of testing Jane Doe or her baby without permission.

Also important to note is that rules themselves must be understood in light of their actual consequences. By respecting the rule of patient consent, the nurse in the scenario is allowing Jane Doe to virtually disappear back into society as a potential HIV risk to her baby and to anyone who falls into a transmittable relationship with her. As Narita indicates in the essay “Paradoxes of Consequentialism (2009), the use of rules must be always viewed in connection to the results that are achieved and not merely to an abstract principle. According to Narita “the purpose cannot be judged by itself in an absolute way but, in order to endow it with an ethical value, one must take into consideration its consequences. (Narita, 2009). Seen in this light, it is necessary not only for the nurse in the scenario to respect Jane Doe’s right to consent but to understand why doing so is the greater pragmatic application of ethics.

 

As Lachman points out, the Patient’s Bill of Rights is a cornerstone of the basis of modern medicine in the United States. In spite of any other considerations, patients in the United States are entitled by law to a specific set of rights that surround the treatment, testing, and flow of information in the health-care industry. According to Lachman, the bill of rights in America that patients may claim includes: “respectful care; current information about diagnosis, treatment and prognosis; informed consent; refusal of treatment; privacy and confidential communication” (Lachman, 2006, p. 39) along with several other important provisions. The aspects cited from the patient’s bill of rights show clearly that Jane Doe has a right to refuse to be tested for HIV and that the nurse must have her consent to perform the test on herself or on the baby.

Lachman goes on to explore the nature of the ethical basis for informed consent. this examination of informed consent helps to show why respecting Jane Doe’s wishes is the greater ethical good even though there is a health-risk associated with acknowledging her right to consent. In Lachman’s estimation, “The ethical theory for informed consent emanates from two, sometimes competing, bases: deontological (rule-based) and teleological (right and duty in terms of good and that which produces good consequences) ethics.” (Lachman, 2006, p. 25). The key to fusing the two ideals is, as previously described, the Kantian vision which stresses the greater good that is accomplished by respecting individual rights. The reason that this is the case is because the preservation of individual rights is, in fact, the whole goal of establishing a free and democratic society.

If the nurse in the scenario went ahead with her impulse to test Jane Doe’s baby without Jane Doe’s consent she may very well have found out information that allowed for needed medical care for the baby and which also helped in some way to reduce the number of infections of HIV. However, in doing so, the nurse would have fundamentally altered the nature of the relationship between the patient and health-care provider. While the role of advocate is the most important role to be played by a nurse, the advocacy that is associated with nursing extends beyond the advocacy for protecting patients from diseases, to protecting them from the potential harm of medical tyranny. Part of any nurse’s advocacy toward their patients is first and foremost to respect the patient’s bill of rights. Among these rights is the right to refuse treatment or to give consent medical tests.

Seeing the scenario from this viewpoint, it is easy to understand why the rule of law is so important in terms of regulating medical treatment and the interaction between health-care providers and patients. The role that nurses play in the process of medical treatment includes the necessity of making very difficult ethical decisions such as the one outlined in the HIV scenario that is presently under discussion. The reason that the EAH checklist is so useful in terms of guiding nurses through complex ethical decisions is because it brings together so many resources, including interdisciplinary information, rules and protocols, ethical and moral frameworks, as well as stressing the collection of facts and the practical application of solutions. By using the checklist to address ethical decisions from a rational viewpoint, the most advantageous decisions are facilitated.

One of the confusing aspects of the previously examined scenario is that it seemed to put the needs of a single person: Jane Doe, above the welfare of collective society. A careful examination of the proposed solution and its underlying legal and ethical reasons shows conclusively that this is not the case. However, the justification for respecting Jane doe’s right to refuse testing might appear to some observers as being a negative application of oral and ethical theory. After-all if one of the consequences of respecting Jane Doe’s right to consent is that her baby dies for lack of diagnoses and treatment, then the pragmatic result of the nurse’s decision will have been contrary to her role as an advocate of her patients. On the other hand, a greater threat to the collective happiness and welfare of society exists in the nurse breaking the rules and failing to respect Jane Doe’s right to consent.

Grote mentions in his study An Examination of the Utilitarian Philosophy (1990) that a certain misconception about the nature of goodness and ethical correctness pervades modern society. The author suggests that “There is perhaps a disposition in our age to accept a morality of happiness as better, more like what we expect morality to be, than one of rule” (Grote, 1990, p. 45). this kind of perspective allows for the specious belief that it is better to break rules in order to serve the potential greater good. in fact, in the role of nursing, it is understanding and being able to rationally follow and accept the regulations and rules of the heal-care providers is mandatory. Doing so is, in effect, a measure of one’s competency and moral worth. This vision goes quite against that which is suggested in the quote from Grote above. Instead of de-valuing adherence to rules and the approach of advocacy to both patients and the health-care system itself, the idea of nursing is to be an advocate within the existing rules.

The end-result of this approach is that a practical and consistent model of ethical decision-making can be used by a prospective nurse to deal with an extensive range of problems that are certain to be encountered on the job. the application of what was earlier identified as Kantian Consequentialism allows for the simultaneous embracing of responsibility by the nurse along with a submission to the parameters of rules and respect for individuals. As Grote oints out “The submission and self-resignation of the former becomes in many cases noble self-devotion, whether to a cause or to individuals: duty is by no means necessarily regard to abstract law or right, it is regard to individuals or to societies to whom our duty is due, or whom we consider worthy of our service or our devotedness. (Grote, 1990, p. 156). In other words, a nurse draws a sense of both duty and pride from being able to rationally integrate ethical systems and the rule of professional regulations and standards.

It is important to understand that the nurse in the HIV scenario is not shirking any level of responsibility for her patient in respecting Jane Doe’s right to consent. instead, by respecting Jane Doe’s rights, she is helping to establish and maintain the credibility and trust of the health-care system as a whole. She is also advocating on behalf of all patients who may come under the care of any physician or nurse. In this sense, rather than avoiding responsibility of taking cover under laws, the nurse is actually embracing a greater sense of responsibility. Part of embracing this greater sense of responsibility is being able to put the rights of the individual and the greater good of collective society above one’s personal desires and emotions. The need to be an advocate for all patients is the single most important quality that any nurse can have when called upon to make an ethical decision. It is this ability to selflessly understand that real world impact of decisions and actions that defines an exceptional ethical sense in any nurse.

As the preceding discussion has clearly shown, the right course of action for the nurse in the HIV scenario to take is to respect Jane Doe’s right to consent. This decision is based on the point by point criteria as laid out in the EAH list. It is also based in a solid foundation o ethical philosophies that incorporate elements of both Consequentialism and the deontological approach. Any nurse who must make an ethical decision that involves the potential loss or saving of one life or many lives should understand that the incorporation of rules and regulations into the decision making process is as mandatory and decisive as the need to make the decision itself. Ethical decision-making and pragmatic application of professional standards and protocols are inextricably tied together in nursing.

References

Cassells JM, Redman BK. Preparing students to be moral agents in clinical nursing practice: report of a national survey. Nurs Clin North America 1989; 24(2): 463-473.

Cummiskey, D. (1996). Kantian Consequentialism. New York: Oxford University Press.

Grote, J. (1990). An Examination of the Utilitarian Philosophy. Bristol, England: Thoemmes.

Lachman, V. D. (2006). Applied Ethics in Nursing. New York: Springer.

Narita, I. (2009). Paradoxes of Consequentialism. Journal for the Study of Religions and Ideologies, 8(23), 36+

Powell, J. (1996). AIDS and HIV-Related Diseases: An Educational Guide for Professionals and the Public. New York: Insight Books.

Time is precious

Time is precious

don’t waste it!

Get instant essay
writing help!
Get instant essay writing help!
Plagiarism-free guarantee

Plagiarism-free
guarantee

Privacy guarantee

Privacy
guarantee

Secure checkout

Secure
checkout

Money back guarantee

Money back
guarantee

Related Essay Samples & Examples

Voting as a Civic Responsibility, Essay Example

Voting is a process whereby individuals, such as an electorate or gathering, come together to make a choice or convey an opinion, typically after debates, [...]

Pages: 1

Words: 287

Essay

Utilitarianism and Its Applications, Essay Example

Maxim: Whenever I choose between two options, regardless of the consequences, I always choose the option that gives me the most pleasure. Universal Law: Whenever [...]

Pages: 1

Words: 356

Essay

The Age-Related Changes of the Older Person, Essay Example

Compare and contrast the age-related changes of the older person you interviewed and assessed with those identified in this week’s reading assignment. John’s age-related changes [...]

Pages: 2

Words: 448

Essay

The Problems ESOL Teachers Face, Essay Example

Overview The current learning and teaching era stresses globalization; thus, elementary educators must adopt and incorporate multiculturalism and diversity in their learning plans. It is [...]

Pages: 8

Words: 2293

Essay

Should English Be the Primary Language? Essay Example

Research Question: Should English be the Primary Language of Instruction in Schools Worldwide? Work Thesis: English should be adopted as the primary language of instruction [...]

Pages: 4

Words: 999

Essay

The Term “Social Construction of Reality”, Essay Example

The film explores the idea that the reality we experience is not solely determined by objective facts but is also shaped by the social and [...]

Pages: 1

Words: 371

Essay

Voting as a Civic Responsibility, Essay Example

Voting is a process whereby individuals, such as an electorate or gathering, come together to make a choice or convey an opinion, typically after debates, [...]

Pages: 1

Words: 287

Essay

Utilitarianism and Its Applications, Essay Example

Maxim: Whenever I choose between two options, regardless of the consequences, I always choose the option that gives me the most pleasure. Universal Law: Whenever [...]

Pages: 1

Words: 356

Essay

The Age-Related Changes of the Older Person, Essay Example

Compare and contrast the age-related changes of the older person you interviewed and assessed with those identified in this week’s reading assignment. John’s age-related changes [...]

Pages: 2

Words: 448

Essay

The Problems ESOL Teachers Face, Essay Example

Overview The current learning and teaching era stresses globalization; thus, elementary educators must adopt and incorporate multiculturalism and diversity in their learning plans. It is [...]

Pages: 8

Words: 2293

Essay

Should English Be the Primary Language? Essay Example

Research Question: Should English be the Primary Language of Instruction in Schools Worldwide? Work Thesis: English should be adopted as the primary language of instruction [...]

Pages: 4

Words: 999

Essay

The Term “Social Construction of Reality”, Essay Example

The film explores the idea that the reality we experience is not solely determined by objective facts but is also shaped by the social and [...]

Pages: 1

Words: 371

Essay