Law, Ethics & Accountability for Nurses

Introduction

In this assignment, I will be discussing about the ethical issues abounded in

nursing practice. Our managed care often brings to the forefront many of the issues with
patient confidentiality, quality care, autonomy, justice, equality, time and cost of care etc.
This paper aims to identify the appropriate ethical decision making model for the case
study. It also identifies how should nurse make ethical decisions relevant to their own
practice or help facilitate patient/family decision making. This also discusses how a
nurse can be prepared to deal with theses issues with thoughtful use of a model to guide
decision making.

Ethical models for decision making provide a tool for thoughtful decisions and
additional benefits as well. It has been noted there are no right answers, only well-
reasoned answers. It helps discard old patterns of thinking. It considers not only
consequences, but forces one to address the issues and processes as well. It helps to
clarify further issues and helps patients affirm their rights as decision makers and can
enhance trust.

Ethics is a systematic approach that uses reason as moral justification to define

what ought or ought not to be done (Thompson, Melia & Boyd, 1983). From the scenario,
Mr. Gray who is not competent to decide because of his hypoxia and underlying disease
condition and it was discussed with medical professionals that nasogastric tube insertion
relevant at this point of time as he refuses antibiotic treatment. It is considered as
delimma in decision making.
 The following will address both guiding principles that are globally valuable in
ethical decision making, and a model that professionals can utilize as they address ethical
questions in our work.

Wallace and Kerridge et al., has identified four moral principles that are viewed
as the cornerstone of our ethical guidelines. Ethical guidelines can not address all
situations that a nurse is forced to confront. Reviewing these ethical principles which are
at the foundation of the guidelines often helps to clarify the issues involved in a given
situation.

According to Kerridge et al, the four principles commonly used in bioethics are
those of autonomy, beneficence, nonmaleficence, and obligation. By exploring the
dilemma in regards to these principles one may come to a better understanding of the
conflicting issues. With these theories and principles in discussion of this case study,
Wallace and Kerridge et a, suggest the comprehensive ethical decision making model of
bioethic model.

Autonomy

Autonomy is the principle that addresses the concept of independence. The

essence of autonomy is the right to self determination (Staunton & Chiarella, 2003). It is
the ability to control what happens to us and how we behave (Leah, 2000). It involves
respect for individuals and their personal space. According to code of ethics in Singapore,
respect the clients' right for self-determination and provide them with whatever
information they require to make informed decisions concerning their own care. When
clients are incapable of making informed choices, consent should be sought from family
members or significant others. From the case scenario, Mr. Gary is incompetent in
making decision and his wife comes in the issue to give consent to go ahead for insertion
of nasogastric tube.
Critique:

According to Kerridge et al, This describes the epidemiologic aspects of antibiotic

treatment withdrawal, the role of patient autonomy and of medical beneficence in the
decision to discontinue antibiotic treatment, and the conditions under which limits may
be placed on patient autonomy. A case is presented that provides insight into the issues
involved in making such decisions and that should provoke further discussion on the role
of “medical guidelines” for treatment refusal.

Clashes between ethical principles often occur in clinical practice. This is most
evident when the wishes of patients conflict with medical advice. This case study
presents with an elderly patient with underlying disease condition who wanted to
discontinue treatment even though those caring for him considered this choice irrational.
This case illustrates the complex issues such as treatment futility and patient
incompetence at surround the placing of limitations on patient autonomy.

Beneficence

Beneficence is the ethical principle of doing good (Maria, 2005). Doing good
such as build rapport with the client so that they have effective care relationship and trust
will develop. Nurses should cooperate and participate in the control process and explain
how to prevent illness and promote and maintain health (Balzer-Riley, 1986). Showing
empathy is the act of doing good to the patients that we can empathies with their situation
(Balzer-Riley, 1986). From the case scenario, Mr Gary’s wife intension is doing good for
her husband to go ahead for nasogastric tube insertion of implementation of antibiotic
treatment.
Non maleficence

Non maleficence is the duty to do no harm (Maria, 2005). Nurses have a duty to
create practice settings in which nurses can deliver safe, quality patient care consistent
with acceptable standards. It requires the institution of meaningful processes to reduce
error (Maria, 2005). From the scenario, the insertion of nasogastric tube to Mr. Gary can
be considered harm to him but it is necessary so that he will able to achieve greater
benefit of continued life.

Critique:

Mr. Gary management raised difficult ethical issues, because respect for his
autonomy appeared to clash with the duties of beneficence (providing care) and
nonmaleficence (doing no harm). To many of those involved in his care, respecting his
wishes by discontinuing antibiotic treatment appeared to be both no harm and do good
respects of issues.
Obligations

Demands made on an individual, a society, a profession or government to fulfill

and honor the rights of others. Moral: based on moral or ethical principles but are not
enforceable under law. Nurses have responsibilities to promote health, to prevent illness,
to restore health and to alleviate suffering.

“Inherent in nursing is respect for human rights, including the right to life, to dignity and
to be treated with respect.” Ann Scott, B., & Nancy J, B. (2000). Nursing care is
unrestricted by considerations of age, colour, creed, culture, disability or illness, gender,
nationality, politics race or social status.

According to Joe Green who achieved the adult moral decision making on
Kohlberg’s scale in Michele, (2005) states that principle that the right moral decision in
any situation is the one that does the most good for the most people. I felt that it would be
ethical the doctor have a family conference with Mr. Gary and his family members and
inform about his condition and diagnosis. The doctor also needs to explain to his that the
nasogastric tube is ideal in this situation and reassurance have to be given to family
member and Mr.Gary that the nurse will teach the family member about nasogastric tube
feeding.

Finally, although Mr. Gary was known to have a history of depression, the
multidiscipline approach needed to be determining that he should have significant
depression and was now mentally incompetent. Under these circumstances, we could not
convince ourselves that discontinuing of nasogastric insertion in lieu of antibiotic
treatment according to his whishes was in his best interest.
Conclusion

The management of Mr.Gary illustrates an area of medical decision making that is

fraught with difficulties. In the care of such a patient, there is an inherent conflict
between the need to respect the patient’s autonomy and freedom of choice and the role of
physicians as providers of expert and compassionate care. In the final analysis, decisions
to provide or withdraw treatment are not merely philosophical, technical or economic, but
are extremely complex and intense personal decisions. In these instances, decision
making is more than merely a summation of ethical principles: Although the concepts of
autonomy and beneficence can be considered individually, they cannot be easily
measured against each other.

We do not believe that it is possible to be dogmatic about these decisions, but,

where all other considerations appear to be in balance, the benefit of the doubt should in
most instances go to the patient. According to Staunton, P. J., & Chiarella, M. (2003),
the physician's role in these circumstances remains to give support, to be compassionate,
and to continue to try to understand patients' perception of their own needs.
 Reference

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