Discuss about the Foundations of Couples, Marriage, and Family.
face a range of ethical conflict during their daily work. No matter where they function in their roles, they are faced with ethical decisions that can affect them as well as their patients. Ethical conflict in healthcare and nursing is ranked as the top ethical challenge facing health care today. Ethical dilemma occurs when a person is not able to act on one’s ethical choice. Therefore, constraints interfere with acting in a way that an individual believes to be right. According to Canadian Nurse Association, ethical conflict is a situation where nurses cannot fulfill their ethical duty thus failing to pursue their right course of action (In Lundy, In Janes, & Lundy, 2016). Ethics involves doing well and not causing harm. Nurses encounter many ethical issues in their workplace. The ethical conflict that happens in their day-to-day work entails them making a decision (Harvey & Land, 2016). The decisions they make are affected by many factors including principles, values, as well as experiences.
Harry Nelson is a patient who is ailing from end-stage cancer. He is receiving palliative care at his home where he has brought up his family. Harry has not prepared an advanced care directive, and his condition is worsening, and he is aware that his death is imminent. Harry wishes to die in his home, but his daughter Stacey is stressed because of his father’s condition. Therefore, she calls an ambulance because she believes his father can live longer if he receives further treatment. When the palliative care crew gets at Harry Nelson home, they find considerable conflict, and this becomes complex on how to solve it. Harry has the desire to stay at home, and on the other hand, Stacey wants him to go to the hospital for further treatment. The ambulance transports Harry because according to its guidelines, Harry meets the criteria of medical treatment and transport. Therefore, Harry is taken to hospital despite his objections.
According to the case study above, it is clear that there is a considerable conflict. Critical medical issues like Harry Nelson condition involve far-reaching decisions about the life and the death of a severely sick patient, and this is very challenging for the healthcare staffs. Furthermore discussing such serious decisions with the patient becomes impossible due to their stubbornness thus resulting in an increased need to communicate with the relatives or legal representative. Trust and confidence, therefore, become challenged thus inviting conflict. According to the case study, the considerable conflict occurred between the palliative care and Harry Nelson’s daughter Stacey in the matter of whether or not to limit the life-sustaining treatment and the patient’s death due to Harry Nelson wish to stay at home.
According to the actions of the palliative care crew, they acted in accordance to the relevant principles of healthcare, code of ethics as well as the code of conduct in healthcare professional. According to research, critical medical issues present the major ethical theories and application in healthcare as part of the foundation for the study of ethics. The foundation shows how principles are used in healthcare and how they are applied in care of ethical conflict. The principles that are commonly used in healthcare ethics are non-maleficence, beneficence, and autonomy. The nurses use these principles to make decisions in case of serious illness in patients like that of Harry Nelson.
This principle relates to the first ethical requirement in healthcare that procedure done by any healthcare professional should not harm the patient or others in the community. In healthcare ethics, there is no clear evidence whether a health care professional want to do harm or avoid doing harm. Nevertheless, the debate comes in when we consider the word harm. Different ethical theories give the various meaning of harm. For example, a deontologist would define harm as that which prevents people from performing their duty or that, which is opposed, to the formal condition of moral law. On the other hand, a consequentiality would define harm as that which prevents the good thus leading to less good. However, in healthcare, harm is that which worsens the condition of a patient (Evans, 2017). In many fields, they may say harm include pain, inconvenience, expense or even discomfort. Nevertheless, in healthcare settings, harm is considered physical harm.
According to the case study, the palliative care crew acted in non-maleficence. The crew did not mean to harm Harry Nelson despite his wish to stay at home. First, his health was deteriorating, and therefore, it is the duty of the healthcare crew to look after him without neglecting him. Even though in clinical setting non-maleficence can occur due to negligence and as a violation of autonomy, a patient needs to have a legal document that specifies what actions should be taken for their health (Maville & Huerta, 2013). In harm as a violation of autonomy, a patient may elect not to receive treatment because of their condition as they are aware they are about to die. Therefore, imposing treatment on a person who desires to lose life quality then it is wrong. According to the case study, Harry is very weak and fully aware that his death is nearing thus he wishes to remain at home with no further treatment and die in his home. However, the palliative care crew transports him against his will upon his daughter’s insistence. This, however, is not wrong because the crew was taking Harry to the hospital for further treatment they did not mean any harm. Second, Harry had not prepared an advanced care directive. Therefore, their actions are not questionable as they acted in best of interests and reasonable decision (Smith, 2016).
Beneficence principle advocates that any performance should be done with the intention of doing well for the patient. It demands that healthcare staffs develop and maintain skills and knowledge, considers the circumstances of all patients and strive for overall benefit. Beneficence involves more than just avoiding harm (Dossey, Keegan, & In Barrere, 2016). It involves a level of altruism that is not present from just refraining from harm. The healthcare ethical guideline of having to involve in beneficent acts means that the healthcare professionals are ethically required to take optimistic steps to assist the patients. Concerning the ethical theories, the principle advocates for the maximum good for an utmost number just as the principle of consequentialism (Shafer-Landau, 2012). The beneficence principle is important in healthcare ethics and therefore, ethical egoism, which is the belief that our basic obligation is a virtue, is not connected from healthcare (Maville & Huerta, 2013). Therefore, in the case study, the healthcare professionals transported Harry to the hospital because they wanted to help him. They did not hold the negligent or deficient action to perform a beneficent act.
Healthcare workers are expected to portray the act of kindness and courtesy as it is part of the common morality of healthcare. Nevertheless, the principles of beneficence together with non-maleficence are not sufficient in healthcare actions due to the people who defined harm and good. Many patients are ignorant of why physicians are doing certain treatments n them. This is evident in the case study, as Harry does not want any further treatment thus having self-interest of just staying at his place and having a wish of dying at his own home. Therefore, the palliative care crew who is avoiding harm has no say in Harry Nelson wish. However, according to (Tobin, 2012) competent patients have the assertion of making decisions for themselves, which now brings the conflict of Harry being taken to the hospital and his desire to stay at home. Thus, due to the inadequacy of the two principle health professional can include the principle of Autonomy in their decisions concerning a patient who has a critical condition.
This principle necessitates that the patient has the sovereignty of intent, deed, as well as thought when making verdict concerning healthcare procedures (Fletcher, 2015). Therefore, the decision taken must be free of coaxing for the patient to makes fully choice. In addition, the patient must be aware of the risks and likelihood of success in the procedures. However, in most times when a patient is in a critical condition, it is always difficult t expect the patient to operate under fully informed consent.
In the case study, Harry has the right to make any decision he wants without anyone going against him. On the other hand, the palliative care crew has the obligation of acting a way that benefits Harry without harming him. Therefore, due to the conflict of his desire and the best interest of the palliative crew, the healthcare professionals should be considerable in extending Harry Nelson quality life by doing further treatment. However, Harry is competent and understands that his condition is critical and he is aware that his death is about to happen and that is why he does not want any further treatment. This makes it difficult for the palliative crew to decide whether to act upon Harry or upon his daughter insistence. It is therefore at this point the principles of healthcare ethics non-maleficence, beneficence and autonomy are important for the healthcare professionals in making decisions in any healthcare conflict.
Since 1953, the code in healthcare has served as the standard for nurses globally (In Capuzzi & In Stauffer, 2015). The code of ethics for nurses is a channel for action based on social standards and morals. The code of ethics makes it clear that inherent in nursing is respect for human rights which include, right to life, dignity and to be treated with respect (In Friberg & In Creasia, 2016). The code of ethics directs nurses in daily choices thus supporting their denial to perform in activities that conflict with caring and healing. In the case study, the palliative care crew strived to guard the health and the safety of the patient. The nurses do not only focus on giving care to a patient but also to promote safety and protection as well as the rights of the patient (Butts & Rich, 2016). In the case, Harry, being taken to the hospital against his will was to protect his health.
Even though he had wished to remain at his home, the lack of an advanced care directive makes the palliative to focus on their actions and encounters with Harry Nelson. Therefore, their act drives protocols and promotes the wellbeing, protects his life (In Gerrish & In Lathlean, 2015). Also in the code of ethics in the case study, the healthcare professionals conducted themselves professionally thus practicing care regardless of the unrestricted consideration, nature of health problem and Harry Nelson wish. Besides, the palliative crew owed Harry Nelson commitment of care. The ethical codes in nursing say that the nurse’s responsibility is foremost to their patients. Even though the crew was overcome by the considerable conflict, in the code of ethics, the nurse must always recall that their primary responsibility is to be an advocate to and for their patient and not any influence like in the insistence of Stacey Harry Nelson daughter.
According to the International Patient Charter, codes sets out the customary of behavior that nurses are expected to maintain in their professional practice (Fowler & American Nurses Association, 2015). The code of conduct advises nurses on what is expected of them. The codes are in line with the statutory to maintain the health and safety of patient (Sorkin, August, & Fischer, 2017). According to the case study, the healthcare professionals acted in agreement with the code of conducts for nurses which include integrity, improving health and accountability (Waddill-Goad & Sigma Theta Tau International, 2016).
In the case study, the crew acted in full honor to safeguard the life of Harry. Also as the healthcare services are in agreement with promoting health. Therefore, the palliative care crew did just to take Harry in the hospital as the code of conduct acts nurses to support and empower those with chronic conditions. Besides accountability comes in when Stacey asks the crew to take her father for further treatment. The crew agrees since it is their duty to address people’s concerns.
Other national healthcare charters like “you and Your Health Service” is created through efforts from many concerned individuals. The parties include advocacy groups, individual supporters who assist in the enhancement of the National policy for health services. The charter is an element of the program of quality enhancement initiatives developed to involve service users in influencing optimum healthcare (In Lundy, In Janes & Lundy, 2016). The International Charter for Human Values in Healthcare is another healthcare charter. It is an inter-professional collaborative involving people globally working together to restore core human ethics to health care (Tobin, 2012). The human values consist of respect for people, integrity, justice, as well as a commitment to excellence.
Different ethical theories exist, and they are applied in different situations to help in healthcare professional thinking as well as making decisions. The theory of ethical principals is mostly used in approaching ethics in healthcare. The ethical principal is viewed as a tool of making a decision as well as solving problems, which is relinquished by appealing to good moral principles (Brixey et al., 2015). The theory emphasizes the four ethical healthcare principles, which are autonomy, justice, beneficence, and non-maleficence. These principles are accepted in healthcare as they assist in providing sound moral reason while taking actions. This theory is increasingly acceptable as a reliable and practical framework for solving moral problems in health care. The principal ethical theory has therefore gained contemporary discussions on ethical issues in healthcare. Therefore, it is essential for nurses to have knowledge and understanding of this model.
Conclusion
In conclusion, it is essential for the healthcare professionals to have the full competence of the health care principles, code of ethics, as well as the code of conducts to help them in their professional practice. The principles of healthcare ethics can assist health care at the time of handing critically ill patients, as mostly they have to make decisions that are in agreement with promoting health and preventing harm in the patient. The commitments of the nurses in their care include providing safety, competent and ethical care. However, the healthcare professionals get frustrated in their efforts to enact their professional in the way that is acceptable to them. Due to that then ethical conflict is created. If however, palliative care crew like in the case study were not able to identify the ethical conflict and dilemma then they would not have been able to make any right decision and resolve the situation while as well building up of moral residue.
References
Brixey, J. J., Brixey, J. E., Saba, V., & McCormick, K. (2015). Essentials of Nursing Informatics Study Guide.
Butts, J. B., & Rich, K. L. (2016). Nursing ethics: Across the curriculum and into practice. Burlington, MA : Jones & Bartlett Learning
In Friberg, E. E., & In Creasia, J. L. (2016). Conceptual foundations: The bridge to professional nursing practice.
Dossey, B. M., Keegan, L., & In Barrere, C. (2016). Holistic nursing: A handbook for practice.
Evans, D. R., Hearn, M. T., Uhlemann, M. R., & Ivey, A. E. (2017). Essential interviewing: A programmed approach to effective communication.
Fletcher, S. N. E. (2015). Cultural sensibility in healthcare: A personal & professional guidebook.
Fowler, M. D. M., & American Nurses Association. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application.
Harvey, M., & Land, L. (2016). Research methods for nurses and midwives: Theory and practice.
In Capuzzi, D., & In Stauffer, M. D. (2015). Foundations of couples, marriage, and family counseling.
In Gerrish, K., & In Lathlean, J. (2015). The research process in nursing.
In Lundy, K. S., In Janes, S., & Lundy, K. S. (2016). Community health nursing: Caring for the public’s health. Burlington, MA : Jones & Bartlett Learning
Maville, J. A., & Huerta, C. G. (2013). Health promotion in nursing. Clifton Park, NY: Delmar, Cengage Learning.
Smith, G. M. (2016). Practical introduction to mental health ethics. Place of publication not identified: Routledge.
Sorkin, C., August, E. V., & Fischer, C. (2017). Adult-gerontology and family nurse practitioner.
Tobin, J. (2012). The right to health in international law. Oxford: Oxford University Press.
Waddill-Goad, S., & Sigma Theta Tau International,. (2016). Nurse burnout: Combating stress in nursing.
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