Ethical Nursing Discussion Paper
Ethical Nursing
Which standard/provision of the Code of Ethics for Nurses specifically addresses end-of-life care?
The Code of Ethics for nurses contains nine main provisions, of which three specifically address end-of-life care. The first provision is that the nurse’s primary commitment is to the patient. This implies that the needs and preferences of the patient must be considered first and more prominently than all other concerns. The second provision is that the nurse must promote, advocate for and protect the safety, health and rights of the patient. This implies that all care options must be considered when discussing and deciding on end of life care, and that the final decision must be targeted at improving patient outcomes. The third provision is that the nurse has the responsibility, accountability and authority to take action, makes decisions and apply nursing practice that is consistent with the obligation to provide optimal patient care. This implies that every decision made and every action undertaken by the nurse should be targeted at delivering optimal care (Butts & Rich, 2020). Ethical Nursing Discussion Paper
Choose one patient scenario from the video and discuss whether or not the care provided would be supported by the standards/provisions found in the Code of Ethics for Nurses.
The selected patient scenario involves Sarah who was diagnosed with stage four lung cancer at 34 years of age and when nine months pregnant. This was a second cancer diagnoses as she had previously been diagnosed with thyroid cancer for which she was receiving treatment. Sarah’s case was an end-of-life case since stage four lung cancer is not curable. The treatment efforts were further hindered by the fact that she was pregnant and any surgical procedure threatened both Sarah and her unborn baby’s life. Still, the patient and her family held on to the hope that she could be cured. They grappled with the idea that Sarah only had a few months to live, and they needed to make the best of time without giving up on the treatment options. She had a collapsed lung that could not allow her to undergo a cesarean section for the birth, and so she successfully gave birth with only one lung. After the birth and in considering the treatment options, the family had hope that Sarah would be among the 15% of lung cancer cases that survived. As such, the family opted to explore and use experimental therapies. She died three months after the diagnosis even as the family still hoped that the next experimental therapy would be the potential fix for both the lung and thyroid cancers. Having thought about the three-month experience of Sarah’s health deteriorating until she died even as she received therapy, they husband thinks that perhaps it was not the right decision to have Sarah subjected to the therapies as they appeared to make her weaker. Instead, the family should have spent more quality time together (Frontline PBS, 2020).
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A review of the case details reveals that the care provided support the three provisions found in the code of ethics for nurses as previously discussed. Firstly, the medical personnel’s primary commitment was to the patient. Sarah and her family’s preferences were incorporated into the care decisions even when the outcome appeared hopeless. Secondly, the medical personnel protected, advocated for and promoted the safety, health and rights of the patient. All the care options considered and applied were targeted at improving health outcomes for the patient even when the results were to the contrary. Thirdly, the medical personnel had the responsibility, accountability and authority to take action, makes decisions and apply nursing practice that is consistent with the obligation to provide optimal patient care. This was evidenced when the experimental treatments were applied as it was known that established conventional treatments would be hopeless for the case. In this respect, the three provisions applied to the case (Butts & Rich, 2020).
Read the article on The Doctrine of Double Effect. Then, discuss your understanding of the nursing implications in ONE of these sections of the article:
Proportionate use of medication
The doctrine of double effect explains how the bad outcomes of an action can be ethically justified if the original intentions of the action were good. Applied in end-of-life care to the proportionate use of medication, the doctrine justifies the use of experimental therapy when established conventional is known to be ineffective. To be more precise, if there is no known effective treatment for a patient who is facing the prospect of dying, then using a rational therapy option that has significant support would be justified even if it does not improve the patient’s health. That is because the original intention was to improve the patient’s health for which an experimental therapy was ethically justified even if the eventual consequence was the patient dying. It also justifies the case where drugs are given in the hopes of relieving distressing symptoms even if the medication eventually ends up shortening the patient’s life. That is because the medical personnel was not aiming at killing the patient (a bad result) a side effect of the good result of relieving the distressing symptoms (Wholihan, 2017).
A review of the doctrine of double effect reveals five main understandings. Firstly, the patient must be terminally ill. Secondly, the action must be appropriate in terms of giving the right medication for the presented symptoms. Thirdly, the action must be proportional to the cause in terms of offering the right amounts that would not intentionally harm the patient. Finally, a good result must be achieved independent of any bad results (Wholihan, 2017).
Read the article on The Variability of Nursing Attitudes regarding mental illness and watch the video, Breaking the Stigma of Shame. Using those two resources, briefly compare and contrast the findings in them to your personal experiences with the attitudes of nurses towards patients with mental illness.
The two resources explore the typical attitudes towards mental illness, and what a supportive attitude implies. There is a general consensus that there is a wrong and right attitude towards mental illness. The two resources concede that mental illness faces significant misconceptions and stigmatization. This is the wrong attitude as no individual chooses to be mentally ill and should not be blamed for the condition. Instead, they should be accepted without stigmatization or discrimination with a focus on treating the illness like any other health condition is treated. Like other ailments that are caused by changes in the body, mental illness also caused by changes in the brain chemistry. This implies that even as other ailments are treated by targeted the abnormalities in the body, so too should treatment of mental illness target the changes in the brain chemistry. A positive attitude is important for restoring the dignity and hope of persons with mental illness (de Jacq, Norful & Larson, 2016; Murad, 2019; Westin, 2017). In this respect, the two resources call attention to the stigma of shame attached to mental illness and argue that it should be handled like any other medical condition.
References
Butts, J. B., & Rich, K. L. (2020). Nursing ethics: across the curriculum and into practice (5th ed.). Jones & Bartlett Learning, LLC.
de Jacq, K., Norful, A. A., & Larson, E. (2016). The variability of nursing attitudes towards mental illness: an integrative review. Arch Psychiatr Nurs., 30(6), 788-796. https://dx.doi.org/10.1016/j.apnu.2016.07.004
Frontline PBS. (2020, March 17). Being Mortal [Video]. YouTube. https://www.youtube.com/watch?v=lQhI3Jb7vMg
Murad, M. (2019, December 18). Breaking the Stigma of Mental Illness [YouTube channel]. Retrieved July 10, 2021, from https://www.youtube.com/watch?v=1P6EqxYhROg
Westin, K. (2017, October 5). Breaking the Stigma and Shame of Mental Illness [YouTube channel]. Retrieved July 10, 2021, from https://www.youtube.com/watch?v=OsRF8xGgbPA
Wholihan, D. (2017). The doctrine of double effect: a review for the bedside nurse providing end-of-life care. Journal of Hospice & Palliative Nursing, 19(3), 205-211. https://doi.org/10.1097/NJH.0000000000000348
