Ethics and Values Paper: Family Conflicts

Within the vocation of nursing, a trial upon ethical codes of conduct are placed and in question when the personal ethics of the nurse are appropriate in the deliverance of healthcare. According to Potter, Perry, Stocker and Hall (2017), “ethical dilemmas almost always occur in the presence of conflicting values. To resolve ethical dilemmas, one needs to distinguish among value, fact, and opinion”. In this paper, the author will discuss an ethical dilemma and resolve the issue using the 7-Step Process described by Potter et al.

The author will also discuss their own personal philosophy of nursing and how this would influence their decision making.

The Ethical Dilemma

This paper will dissect the End-of-Life Nursing Education Consortium’s (ELNEC) (2013) case study of Mr. B, a 21-year-old male diagnosed with metastatic Burkitt’s Lymphoma. He has recently confided in the he has already received unsuccessful rounds of treatment and has already refused to receive a bone marrow treatment. He has disclosed “he was pressured by his mother to have the evaluation – “It’s really hard to say ‘No’ to her.

Mom told me she’d take the hospital to court if they don’t do a full court press. She’s already contacted a lawyer. My wife can’t stand up to her, so I guess I’ll end up doing it even though I don’t want to” (ELNEC, 2013). The dilemma the nurse faces within this situation are the principles of autonomy and advocacy. If the nurse does not intervene and allows Mr.

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B to have the discussion with his mother, the patient is not educated in their legal right to refuse treatment and that the legal press his mother is pursuing is in violation of said right.

According to Potter et al., autonomy refers to the process that, “Providers are obligated to inform patients about risks and benefits of treatment plans and then to ensure that they understand and agree with their plan. In many cases (e.g., surgery and diagnostic procedures), the consent of a patient must be documented by the patient’s signature.”. (pp. 292). In this case autonomy refers to the patient’s right to refuse treatment. Mr. B is over the age of 18, the legal age of adulthood, and is not obligated to consent to any treatment and has the legal right to refuse. While the mother may be concerned for the wellbeing of Mr. B, he is legally not under her care. In addition to autonomy, the nurse has the obligation of advocacy. Advocacy according to Perry et al., refers to the nurse’s professional obligation to advocate for the health, safety, and rights of patients, including their right to privacy and their right to refuse treatment. In this case, the nurse must advocate the wishes of the patient not to receive treatment with the healthcare provider despite the mother’s legal influences for the hospital to proceed.

Processing the Dilemma

The first step involves determining what exactly the problem is. The ethical dilemma located within the nurse’s scope of practice lies in the patient’s right to autonomy and the role of patient advocacy. The nurse is aware of the mother’s legal influence on her son and this may convince Mr. B to consent to a treatment that he ultimately does not want. A dilemma occurs in the position of the nurse when they do not express the information, to the health care team, the patient disclosed previously before being influenced to consent.

This step involves gathering information pertinent to the ethical dilemma. The patient’s clinical history of metastatic Burkitt’s Lymphoma, recent hospitalization due to sepsis in result of chemotherapy treatment, and recent evaluation for bone marrow treatment are all included in this. His disease has continued to progress through second/third line treatment, and he has been hospitalized almost continuously for the last two months for dehydration and fevers, among other problems. The Patient’s mother is involved in the case, “wanting a full court press” for the patient to receive a bone marrow transplant. This step involves the nurse examining and determining their own values about the issues.

The nurse’s personal belief is that the patient has total control over the situation. The patient has the complete right to refuse treatment Verbalizing the problem is the 4th step of the process. Does the nurse have the ethical obligation to advocate for the patient’s right to refuse treatment while the mother of the patient seeks legal action? The possible courses of action are in the 5th step of the process. The nurse has the legal obligation to inform the patient of their rights and that include the right to refuse treatment. The nurse is also obligated to inform the charge nurse and the provider The next step is to negotiate the outcome. This involves the process of sitting down with the patient and educating them that they have the legal right to refuse treatment, while it may be against medical advice. The provider and charge nurse would be aware of said refusal and the patient would sign a document.

The final step is to evaluate the action. In this situation, with the health care team notified of the patient’s wishes, the patient is able to leave the hospital at their own risk. The provider and the nurse are able to inform the patient of hospice care institutions if they wish to indulge in such end of life care. My personal philosophy of nursing is based on my belief that you cannot force a person to decide. I believe that any person or patient has the right to know their options for treatment and allow them to decide what is the best course of action for themselves; while they may ask for a professional and medical opinion to influence their choice, ultimately it is their decision whether or not to receive or refuse a line of treatment. This personal philosophy aligns with the published nursing philosophy of casuistry which is case-based reasoning, finding consensus more than an appeal to philosophies (Perry et al., 2017). The personal philosophy that the nurse has does impact their view of treatment but is ultimately in the legal bounds of their scope of practice compared to a philosophy that would steer the nurse into convincing the patient that they need to receive treatment because it is their only option to save their life.

References

1. End-of-Life Nursing Education Consortium (ELNEC) (2013). Ethical issues in palliative care
2. nursing. AACN, p. M4-39. Retrieved from: https://elnec.academy.reliaslearning.com/
3. ELNEC-core-module-4-ethical-issues-in-palliative-care
4. Potter, P., Perry, A., Stockert, P., Hall, A. (2017). Fundamentals of nursing (9th ed.). Elsevier: St. Louis, MO