nurs490assignmw3

Ethics is a branch of philosophy that explores the ideal forms of human behavior, nursing a field rife with ethical dilemmas, application of nursing ethics can be objective or relative. It is obligatory to maintain a balance between the positive and negative aspects of treatments and options.

Medical indications: principles of beneficence and nonmaleficence

The condition of a patient is to be observed keenly to propose the treatment options. i.e. long-term diseases are treated with steroids. The primary purpose of any treatment should be to heal the underlying cause or alleviate the symptoms causing the agony. Although there are certain contraindications for treatment. According to an article published in the Journal of General Internal Medicine, which says “These decisions are particularly complex when physicians have less experience with these discussions, when families and providers disagree about benefits from treatment, and when cultural disparities are involved in misunderstandings” (Kasman, 2004). The success rate of a treatment or the efficacy of a medical play a rather eminent role, it is requisite to balance the pros and cons. The principle of beneficence plays a vital role in the well being of the patients, while the patient may be flummoxed but nurses and doctors are solely trained and educated for this very purpose.

The patient preferences: the principle of respect for autonomy

Autonomy is the freedom to make uncoated and informed decisions. Patient consent is an obligatory part of autonomy. According to the European charter of the patient's right, "Every individual has the right to access all kinds of information regarding their state of health." (Network, 2002) if a patient is refusing treatment, his wish Is to be respected unless the subject is shown to be mentally or legally incompetent. Legal incapacity is a rather specific matter. A patient has the right to lay out his values that may participate in the assessment of his mental state.

If the patient is competent his choice of treatment that could be suitable should be considered. If the patient is found to be incompetent, we then turn our heads towards a surrogate decision. According to a National study published in the Journal of the American Geriatrics Society, “Currently, up to 70% of community-dwelling older adults have completed an advance directive” (Teno, Gruneir, Schwartz, Nanda, & Wetle, 2007).

Quality of life: The principles of beneficence, nonmaleficence, and respect for autonomy

It takes time to get back to normal life, it is found to be rather arduous, and it comes with mental, physical, and financial stress.

Quality of life of a patient is assessed based on his lifestyle, income, socioeconomic condition. Certain biased behaviors are observed towards patients of lower socioeconomic backgrounds. That may lead to communication breaks, patient’s autonomy being compromised, and ineffective symptoms management.

According to Faber Langendoen's study, “rationales of patient comfort and family perceptions are matters of individual experience” (Langendoen, 1994).

Suicide is considered to be a social and religious taboo. The philosophical debate has been going on for centuries with no clear answer, there is a conflict between the concepts of personal autonomy and societal autonomy. According to a Global review article published in International Journal of Law and Psychiatry, “Copies were obtained of the criminal codes from 192 countries and states; in 25 suicide is currently illegal, and an additional 20 countries follow Islamic or Sharia law where suicide attempters may be punished with jail sentences” (Mishara & Weisstub, 2015)

Contextual features: the principles of justice and fairness

Sometimes, the personal interests of healthcare workers interfere with the welfare of a patient, let alone personal affairs but business and political affairs. Patient confidentiality is supposed to be considered unless it harms the patient or goes against the law. Financial factors play a critical role in decision making, according to a research article published in New England Journal of Medicine, “We conclude that the use of some, but not all, financial incentives, as well as the type of HMO, does influence the behavior of physicians toward patients” (Hillman, Pauly, & Kerstein, 1989) . With the burning issue of a high growth rate, the health facilities are scarce, not available to everyone. Some patients are religiously against surrogacy and life-sustaining interventions, physicians are to listen to them empathetically and help them to find solace. Clinical researches are a means to find new cures, not a dead end. There is a key issue that the nursing role in intensive care has been changed to a great extent, this had made an impact on clinical decisions. During patient management discussion, there can be conflicts between medical and nursing staff. Patient welfare always requires a shared understanding of roles and working practices.

During one of my clinicals I experienced a situation in which a patient was suffering from acute pneumonia, and he was in an emergency but reversible condition. He was suffering from shortness of breath and his chest pain kept getting worse. Although, this disease is reversible it requires proper IV therapy of antibiotics. The goal of treatment is to improve the condition of the patient and to discharge the patient from the hospital after improvement in his condition. But the medical treatment was not indicated as the patient's family has refused from any sort of treatment. The initial treatment for the patient was started from IV antibiotics and to provide correct treatment blood culture/ sputum culture test was performed. The patient's condition was improved within 48 to 72 hours as the doctor suggested him right IV antibiotic with the correct dose and frequency. It defines the principle of nonmaleficence that the actions of nurses may not cause harm to patients and the decisions and actions are being made by considering the patient’s condition. . It guides the nurse in each of their activity that their actions may not cause harm to patients even without any intention. The principle of beneficence is an ethical principle which states that the nurse’s actions should always promote good to patients (LB McCullogh, 2020).

Conclusion

By applying the above listed four principles, better healthcare and treatment can be provided to patient. By considering these principles, better decisions can be taken which will also prove beneficial for patient. It is the valid process to apply in practice because it also considers patient choice and quality of life along with many other factors.

References Hillman, A. L., Pauly, M. V., & Kerstein, J. J. (1989, June 30). How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? The New England Journal of Medicine, 321(2), 86-92. doi:10.1056/nejm198907133210205 Kasman, L. D. (2004, October). When is medical treatment futile? Journal of General Internal Medicine, 19, 1053-1056. doi:10.1111/j.1525-1497.2004.40134.x Langendoen, K. F. (1994, September 1). The Clinical Management of Dying Patients Receiving Mechanical Ventilation. Chest journal, 106(3), 880-888. doi:10.1378/chest.106.3.880 Mishara, B. L., & Weisstub, D. N. (2015, September 13). The legal status of suicide: A global review. International Journal of Law and Psychiatry, 44, 54-74. doi:10.1016/j.ijlp.2015.08.032 Network, A. C. (2002, November 1). European Charter of Patients' Rights. Retrieved from Active Chitizenship Netwrok. Teno, M. J., Gruneir, A., Schwartz, Z., Nanda, A., & Wetle, T. (2007, December 27). Association Between Advance Directives and Quality of End‐of‐Life Care: A National Study. Journal of the American Geriatrics Society, 56(1), 168-168. doi:10.1111/j.1532-5415.2007.01045