Principles Of Bioethics And Practice Discussion Paper
Ethical Dilemmas In Nursing
Principles Of Bioethics In Nursing
I was working on a mixed ward for more able intellectually disabled residents. Mary was 54 years of age and approximately two stone overweight according to her height-weight ratio. She enjoyed her food and had no medical problems. However, the ward sister decided that she should be placed on a reducing diet. Mary was generally well behaved and was capable of going into town on her own, dressing herself and maintaining her own hygiene. However, after a few days of being on her diet, she was caught stealing food from other residents and on more than one occasion, taking food from the rubbish bins.
On one particular Friday, it was fish on the menu. All of the other residents had fried fish and chips, but Mary was given boiled cod. She expressed her dislike of the food and said she did not want to eat it. One of the qualified staff forced her back into her seat and repeatedly shouted at her saying, ‘You will eat this food’. When Mary still refused, the nurse attempted to force feed her.
Mary became very distressed over the incident and gradually appeared withdrawn and depressed. I spoke to the ward sister, saying that I felt it was unkind, that Mary should have some choice in the matter of her diet especially as she was a voluntary resident, and that force feeding isn’t even allowed in prison.
The sister brushed aside my complaints saying, ‘It will be good for Mary to lose weight and anyway we can’t let her get the better of us, can we?’. The sister’s attitude was made much worse by the fact that she herself was at least three stones overweight. Principles Of Bioethics And Practice Discussion Paper
Identify and discuss at least one of the ethical issues that arise in this case with reference to appropriate ethical principles and values or any relevant duties imposed by professional and legal standards.
A young mother, whom the High Court ordered should be given a blood transfusion against her will in a bid to save her life, was recovering at a Dublin maternity hospital last night. The 23-year-old Congolese woman suffered massive blood loss following the birth of her first child at the Coombe Women’s Hospital early yesterday. However, speaking in French and through an interpreter, she told hospital staff she did not want a blood transfusion as she was a Jehovah’s Witness.The hospital’s master, Dr Chris Fitzpatrick, rushed to the High Court for direction and, at an emergency lunchtime sitting, Mr Justice Henry Abbott was told the woman, known only as Ms K, had lost 75-80 per cent of her blood and was likely to die within hours unless a transfusion was authorised by the court. The judge directed the hospital to do everything in its power to save the life of the woman and said staff could restrain her if she physically attempted to stop doctors administering to her a life-saving transfusion. He said the interest of her newborn child, a boy, who he was told was ‘in good shape’, was paramount and the baby could be left with no one in the State, as far as was known, to look after its welfare, if its mother passed away. (Eithne Donnellan, The Irish Times, 22 September 2006)
Identify and discuss at least one of the ethical issues that arise in this case with reference to appropriate ethical principles and values or any relevant duties imposed by professional and legal standards.
Principles Of Bioethics In Nursing
The nursing profession is an epitome of love, care and affection. It provides the best to people who are ill and need support to get back into lives and thereby help them to enjoy better quality lives. In order to help such patients, every nurse has to maintain important principles of bioethics. These are beneficence, autonomy, dignity as well as justice. However, nurses often face ethical dilemmas while performing their practices according to the principles. Often principles of beneficence and non maleficence clashes with autonomy and dignity or with justice. The nurses in such situations have to critically analyse the situations so that they can understand the needs and demands of the situation.
Following this, they need to perform all interventions which will be in accordance to different codes of ethics. It should also ensure that the nurses develop strategies which will rightly meet up the needs of the situations. This means that the interventions will help to provide the best care to the patients at the same time of maintaining the autonomy and dignity of the patients. The care that they provide to the patients should represent a service full of care and affection which will make the patients feel that they are respected and cared for irrespective of their cultures, ailments and situations. Principles Of Bioethics And Practice Discussion Paper However at the same time, the nurses should ensure that while maintaining dignity, their intervention should be in accordance to maintenance of justice as well as beneficence and non-maleficence. The issues that may arise due to improper amalgamation of the principles have been reflected in the cases below:
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The profession of nursing mainly portrays the features of compassion, love, care, affection and attention. A nurse who does not portray the mentioned characters is not holding true to her oath and in a way is not performing her duties responsibly. The nurse should respect the resident’s autonomy and her right to have control over her own life. By the term autonomy or patient autonomy, one denotes the right that is enjoyed by the patients to make decisions without their healthcare staffs trying to influence the decision of the patients (Lindberg et al., 2014). The nurse in this case, disrespects the nursing profession and hampered the culture of nursing in the department by performing an inhuman attitude towards disabled residents.
The nurse who should have properly made the patient understood that since she is overweight she should try to have a balanced diet as researcher’s state that patient education in a proper systematic way often brings out positive results on the patients. If the nurse had been compassionate in her approach and provided empathy in her behaviour the situation would have been different (Raab 2014). This also reflected her lack of knowledge over the principle of justice. The principle of justice states that it is the duty of the nurse to provide care and treatment without discrimination any patient on social gradient, racism, and ethnicity as well as on personal biasness (Johnstone 2015).
Conflicting Principles And Ethical Dilemmas
This activity made the resident feel depressed and lonely. This implied to her as an act of discrimination which could have affected her mind negatively and could have made her rude and unmanageable. Therefore a nurse not only have to be emotionally intelligent and empathetic towards her patients but her activities should be such that it promotes social inclusion which makes a patient happy and jovial that has positive impact on the health of the patients. The most unethical behaviour was forcing the patient to have the food which she disliked as she was violating the principle of dignity and was forcing the patient to have food which was not liked and wished by her (Dunn and Moore 2016).
A rude and violent approach for making her have food was the most disgraceful and humiliating activity that could be conducted by the nurse. Moreover, the nurse should have properly made her understand the rationale behind her providing her boiled fish due to her weight as chips and fried fish might have contributed to her gaining calories. She should have properly educated her patient in way and should have provided strategies that could have helped her in managing her weight skillfully without disrupting her love for feeding as well as not making her steal food. In such a scenario, the nurse should have properly maintained justice and autonomy and should have practiced her profession after a thorough critical analysis (Grace, 2017).
Respecting the autonomy of the patient is one of the essential guidelines of clinical ethics. According to Entwistle (2010) mentioned that the principle of respect for autonomy is related to enabling patients to make decisions about what kind of health care they will receive. The ethical dilemma presented is whether to ignore the patient’s desires in an attempt to save her life or to respect the patient’s autonomy and compromise standards of care. The main ethical dilemma was that by honoring the autonomy of the patient and religious beliefs, the healthcare professionals were faced with compromising their moral duty to manage high care in accordance with established standards (Ghua and Tham, 2006).
The case which is reported in the case study is one of the most critical and complicated case that had been reported in the esteemed daily called the Irish Times. The healthcare profession is usually assigned the job of protecting human rights and they are advised to follow the treatments that will be in accordance to their culture and religion. The woman who was talked about in the case was a believer of Jehova. Hence, in this scenario, the bioethics states that the healthcare professional should plan the interventions in such a way so that it does not result in conflicts with their religious beliefs and demand of their ethnicity. However in this case, there arose an ethical complication where the healthcare professional has to maintain the cultural ethics of the patient and also protect the life of the patient at the same time. In this case there arise an obligation hat in order to save the life of the patient; her cultural beliefs would have been neglected. This gives rise to a conflict between the principles of beneficence and performing treatments that align with cultural aspects of the patient.
Importance Of Emotional Intelligence And Empathy In Nursing Practice
Ethical dilemma arose here for the mother was not giving consent for blood transfusion as her religion did not support that. In this case, the consent should be given to the patient, because it is the central pillar of patient autonomy and has to be acquired before any procedure could be carried out (Ghua and Tham, 2006). In such a situation, it becomes a dilemma where the doctor cannot decide whether to save the life of the patient or whether to maintain the autonomy or dignity of the patient (Stuart, 2014). The principle of the beneficence should be considered in this case. This case was very different as well as sensitive, as it made the court involved who took the decision on behalf of the doctor and healthcare professionals and even suggested to physically restrain her if she interrupts in the process.
‘ However, although it is done thinking of the benefits of the woman as well as the life of the baby, it was a human right violation as it completely neglected the maintenance of the freedom of human rights and human speech (Makaroff et al, 2014). Therefore, it is extremely important for the healthcare department of every nation to conduct researches over such serious issues that arise in the nation due to conflict between patient culture and patient life. Policies and guidelines are very much important so that the nurses do not have to suffer from such dilemma and follow the guidelines in order to overcome any dilemma that occurs during practice (Chadwik and Gallagher, 2016).
Conclusion:
Healthcare professionals usually facing ethical dilemma that making them suffer from confusion. Nurses are influenced by social, personal and cultural factors. The responsibilities of the healthcare professional remains constant, prevent illness, remove suffering, being to promote health, and extend services beyond the individual to their family and the community. It is essential that the physicians and nurses respect the autonomy in both cases and decisions made by each Jehovah Witness patient, although it may not be in their interests in the healthcare professional’s beliefs. Families and friends can help to find solutions and ways that assist the patient and the healthcare professionals to override any ethical dilemmas.
References:
Chadwick, R. and Gallagher, A., 2016. Ethics and nursing practice. Palgrave Macmillan.
Chuta, R. and Tham, K.F., 2006. Will” no blood” kill Jehovah Witnesses?. Singapore medical journal, 47(11), p.994.
Dunn, H. and Moore, T., 2016. ‘You can’t be forcing food down ‘em’: Nursing home carers’ perceptions of residents’ dining needs. Journal of health psychology, 21(5), pp.619-627.
Entwistle, V.A., Carter, S.M., Cribb, A. and McCaffery, K., 2010. Supporting patient autonomy: the importance of clinician-patient relationships. Journal of general internal medicine, 25(7), pp.741-745.
Grace, P.J., 2017. Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.
Holloway, I. and Galvin, K., 2016. Qualitative research in nursing and healthcare. John Wiley & Sons.
Johnstone, M.J., 2015. Bioethics: a nursing perspective. Elsevier Health Sciences.
Lindberg, C., Fagerström, C., Sivberg, B. and Willman, A., 2014. Concept analysis: patient autonomy in a caring context. Journal of advanced nursing, 70(10), pp.2208-2221.
Makaroff, K.S., Storch, J., Pauly, B. and Newton, L., 2014. Searching for ethical leadership in nursing. Nursing ethics, 21(6), pp.642-658.
Raab, K., 2014. Mindfulness, self-compassion, and empathy among health care professionals: a review of the literature. Journal of Health Care Chaplaincy, 20(3), pp.95-108.
Rees, C.E., Monrouxe, L.V. and McDonald, L.A., 2015. ‘My mentor kicked a dying woman’s bed…’Analysing UK nursing students’‘most memorable’professionalism dilemmas. Journal of advanced nursing, 71(1), pp.169-180.
Stuart, G.W., 2014. Principles and Practice of Psychiatric Nursing-E-Book. Elsevier Health Sciences. Principles Of Bioethics And Practice Discussion Paper
