Ethical and Legal Issues in Decision Making

Ethical and Legal Issues in Decision Making

Influence of values on the interpretation of ethical dilemmas?

The ethical dilemma revolves around patient autonomy. In this case, the patient named Ann has decided her medical care without the influence of any patient and stated she would not prefer to be hooked to a breathing machine in case her survival probability goes down.

It is the right of a patient to make an autonomous decision about their healthcare, and the nurses and the medics are supposed to respect these decisions. However, in this case, it is essential to note the condition the patient has put in her request, which is “if” there is no chance of survival. It, therefore, means that if there is a chance of survival, it is correct to go ahead and hook her to a breathing machine to save her life (Scott, Sochalski,&Aiken, 1999). In this case, the situation presented does not provide for having her hooked to the breathing machine. Instead, she is diagnosed as having pneumonia, and as the process of treatment is being applied, she finds it difficult to eat. The physicians suggest that she needs to be inserted into the feeding tube to allow recovery and make her body strong.

When deciding whether to insert the tube or not, it is crucial to consider patient autonomy. A breathing tube and a feeding tube are two different things. In most cases, the breathing hook is used for an extended period to help a patient breathe properly or breathe for the patient. Considering her condition, coming out of the ventilator may not be secure, and it means that she might be forced to rely on this for her survival(Barnes et al., 1998). On the other hand, the reason for having the feeding tube is to allow her to feed correctly so as the problem of pneumonia can be treated effectively. It is not indicated that the feeding tube will be used indefinitely as her only problem is the failure to eat. The tube might be used until she is able to eat by herself, showing that it is a temporary measure to keep her healthy. Medically, the use of the feeding tube can help the patient recover quickly, and it increases her chances of survival. Ethically, it is right and vital to have her fed through the feeding tube. It is, therefore, clear that the feeding through the tube is not equivalent to the breathing machine. Allowing Ann just to stay and die out of starvation would have been very unfair (Scott, Sochalski,&Aiken, 1999). The feeding tube recommended by the physician is a medical solution that will probably save her life or increase her chances of survival. Failing to offer the medicinal solution and letting her lay down, there is a form of induced suicide. It can also be called a murder because a clear answer to the problem has been identified, and she can benefit from that.

Steps the nurse would use to help the family work through the ethical issue.

The ethical decision-making process follows several steps. The first step is identifying the facts. In this step, the nurse is required to gather information about the facts of the situation and determine the ethical issues facing them. In the process, the nurse should ensure that there is full participation of the family members when solving the ethical problems. Considering the case presented above, identifying the facts includes understanding the wishes of the patient regarding her care and treatment and also finding if the present situation is in any way affected by the decision made previously by the patient regarding her health (Wear, 1998). Discussions of if having a breathing hook is the same as having a feeding tube can dominate the first step.

The second step involves determining the ethical principles. In this step, the nurse is responsible for clarifying the different ethical principles that are in stake regarding the current situation. It is the responsibility of the nurse to explain or remind the family of the patient’s beliefs and values regarding her life. The nurse is responsible for advising the right ethical principles to apply in the situation. By doing so, the nurse is required to present the benefits of applying ethical principles to the case. The harms of not applying the ethical principles in the situation should also be identified and discussed by the parties concerned. The nurse must present options of the fairest thing to do regarding the condition of the patient. In this step, the nurse is also supposed to consider other factors that surround the ethical dilemma. For example, it is essential to recognize any laws that might affect the decision made. The organization may also have different policies regarding the situation. Such policies should be discussed when determining ethical principles.

The third step involves weighing different options. In this step, the identified ethical principles surrounding the case are put on the table. It is essential to ensure that there is full participation in the family (Wear, 1998). The major importance of the nurse, in this case, is to lead on the ethical and legal issues that may surround the situation and offering the right guidance to the solution. The benefits and the burdens of each of the courses of action identified are discussed. For example, in this case, there are two main courses of action that can be taken regarding the issue. One is to fail to insert the breathing tube, and the second is to insert the breathing tubes. Failure to insert may lead to her death, while inserting it may save her life. Such are the options to be weighed in this case. The step is crucial as it brings all other steps together and identifies a solution regarding the ethical dilemma.

The final step is the act and evaluate. It is in this step that the best course of action selected in the previous step is applied. The nurse and the family must agree to the action to be applied, considering all the legal and ethical issues(Barnes et al., 1998). In applying it, the desires and needs of the patient, as presented by patient autonomy, must also be considered to be fulfilled. All parties subject to the ethical dilemma must feel comfortable with the decision. The outcome should be evaluated, and if there is any need for making amendments, it should be done as appropriate to ensure that all laws, policies, and ethics have been followed. Such decisions must be made with commitment, consciousness, and competency

 Legal and political issues involved in this issue?

            The issue presented in the above case covers the issue of patient autonomy. All healthcare providers should respect patients’ autonomy at all times. The issue of patient autonomy also brings about the issue of consent (Scott, Sochalski, &Aiken, 1999). As per law, consent to perform any medical operation on a patient should be gotten either from the patient or the family of the patient. Legally, the actions of medicare limited to the needs of the patient. The patient has the right to sue a physician who conducts a medical test or treatment to a patient without considering the needs of the patients or prior failure to discuss the matter with the patient or patient’s family. In this case, due to the age and the medical issues surrounding the treatment of Ann, the physician responsible for her health must consult with the family putting into consideration the wishes of the patient. If the physician does not follow these rules, and the treatment goes wrong, the patient or family can sue the medic for negligence, failure to obtain consent, or failure to observe patient autonomy. Being sued for medical malpractice can lead the patient of the family can claim damages for the injury suffered, if any.

However, there are times when the needs of the patients or the family are not in line with the medical practitioner practices, and the physician may oversee some legal implications if they apply when the patient of the family wants. For example, in the above case, the family may make a decision not to have a feeding tube on their member (Barnes et al., 1998). It may be against the medical rules to have the patient denied her medical rights, which could save her life. In such a case, it is the responsibility of the physician to advise and to educate the family on the right treatment. Litigation from any of the problems can be achieved by issuing a consent form to the patient or the family. Signing the litigation form may protect the medic from any legal actions.

Journal articles in which the same ethical issue was addressed and how the issue resolved

The Journal article by Subramani, published in January 2017, talks about patient autonomy within real or valid consent. The writer talks about a woman name Kohli who was 44 years and unmarried but had a problem of prolonged menstrual bleeding. The patient signed a consent form before that indicated she would be undergoing a laparoscopic examination (Subramani, 2017). After the examination, the surgeon obtained another consent form from a mother while the patient was unconscious of having hysterectomy, which involved the removal of the reproductive organs. It was against her wish to have her reproductive system removed, and she had not consented to that. She later sued the surgeon, and the Supreme Court ruled that the doctor was unethical and liable for malpractice. Violation of patient autonomy led to legal liability.

The article by Brazier discusses the issue of patient autonomy and informed consent. The case scenario is of a patient who was operated on, and her wishes neglected by the surgeon. Schloendorff v. Society of New York Hospital Case of 1914 raised the issue of patient informed consent and autonomy in the practice of medicine. In this case, the plaintiff was Schloendorff, who was admitted to New York Hospital. The patient placed a wish and consented for the examination to determine if she had a fibroid tumor and if it was malignant. The patient, however, did not approve of its removal (Brazier, 1987). The physician found the tumor and discovered that it was malignant. Without discussing how to deal with it with the family, the doctor decided to remove the tumor. By removing it, the doctor had violated the wish of the patient of not having it removed. The court decided that the action by the physician constituted a medical battery as he did not heed to the wish of the patient who was an adult of sound mind. However, the plaintiff had sued the institution, and it could not be held liable for the action of its employees. The article describes a case where the failure to observe patient autonomy and consent led to legal action.

References

Barnes, D. M., Davis, A. J., Moran, T., Portillo, C. J., & Koenig, B. A. (1998). Informed consent

in a multicultural cancer patient population: implications for nursing practice. Nursing Ethics, 5(5), 412-423.

Brazier, M. (1987). Patient autonomy and consent to treatment: the role of the law?. Legal

Studies, 7(2), 169-193.

Scott, J. G., Sochalski, J., & Aiken, L. (1999). Review of magnet hospital research: findings and

implications for professional nursing practice. Journal of Nursing Administration, 29(1), 9-19.

Subramani, S. (2017). Patient autonomy within real or valid consent: Samira Kohli’s case. Indian

J Med Ethics, 2(3), 184-190.

Wear, S. (1998). Informed consent: Patient autonomy and clinician beneficence within health

care. Georgetown University Press.