In the field of medicine, it is required that all medical practitioners practice ethics as they interact with their patients or while performing their objective tasks. This is seen in a case study presented by Furlong (2008) on the decision making processes among nurses in the state of Nebraska. In 2006 a group of individuals residing in states out of Nebraska had financially funded a petition that sought to obtain signatures of citizens to seek amendment of the Nebraska state constitution. In this proposed amendment titled “Nebraskans for a Humane Care” medical practitioners would have the legal mandate to ensure medical intervention, food and water is provided and none of it is withdrawn even in terminal conditions. However, there was a statement within this proposal that advance directives of an individual with fully expressed language will be respected about the withholding of food and water in terminal cases. However, the opponents were concerned that numerous ethical dilemmas would be created in the process of decision making for patients, their families and the health care professionals as it did not incorporate the medical nor ethical best practices.
Ethical Implications
Had the proposed amendment been pushed through, the nurses of Nebraska would have faced significant ethical implications in their work environment. Nurses will usually speak on the significant of the Nebraska case study as they discuss the ethical dilemmas that may involve patient care. Despite the many challenges that can take place in the hospice environment, it is the ethical and moral dilemmas of patient care that cause the most anguish among care providers. This is where the nurses identify the shortage of nurses in a hospital and are mandated to work overtime so that they do not abandon their patient all while risking lawsuits due to the errors that may take place when fatigued (Furlong, 2008). However, in making these ethical decisions a nurse will incorporate the ANA code of ethics, ethical principles and ethics of caring. This will prove valuable in ensuring the appropriate action in care is provided to the patient.
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The ANA Code of Ethics as revised in 2001 is used to identify whether a nurses actions are according to standard practice. In this way failure to perform one’s objective to the required nurse’s practice is considered substandard. Hereby, a nurse is required to alleviate pain from the patient and in reference to the Nebraska proposed amendment the nurse would be working contrary to the ANA Code of Ethics. To understand further the ethical practices required in the medical profession one must look into the ethical principles. These include nonmaleficence, fidelity, justice, beneficence, veracity and autonomy versus paternalism (Murray, Kendall, Boyd, & Sheikh, 2012). These are some of the core terminologies that identify the practices of the nurse while providing care to the patient. The terminologies will be important when healthcare providers are trying to work out an ethical dilemma and propose the most important action to take.
For instance there is the principle of nonmaleficence which is identified as doing no harm. Through their practices nurses are required to take into consideration the effect of their action on the patient in question. It is one of the most upheld ethical principles in nursing practice as the nurses aim to abide by it. They view themselves as ethical and as healers and by following the ethical principle they will avoid lawsuits (Furlong, 2008). However, in the case study of Nebraska, the proposed law would require nurses to make a choice between following the law or their medical experience in the risks and complications that a patient may face. Research has found that provision of food and water in an end-of-life patient has significant risks where the aspiration pneumonia and bloating may occur (Furlong, 2008). As a result, the proposed amendment law that has been set may force the nurses to act contrary to their ethical principles.
Recommendation
It is required that the state or federal policies that are set in regards to the medical profession incorporate the outlook and input of these practitioners. A law should not require the nurse or physician to inflict harm on the patient. The multitudes of ethical situations that require nurses to make ethically sound decisions on a daily basis clearly identify the need for nurses as a last defense for the patient. Nurses will practice preventive interventions, use critical thinking and revalidate orders in a bid to prevent harming the patient. Through the input of medical practitioners who have the appropriate qualifications, policy makers can draw effective conclusions on ways to care for the patient. The policy makers will be able to receive the highest level of response on how best to care for the patient in end-of-life.
The current modern technology can only do so much in preventing the death of a patient. However, cases such as terminal illnesses and severe injuries will usually lead to the death of the patient. Sprung et al., (2014) identifies that nearly 20% of patients die in the ICU therefore, it is important that a consensus of end-of-life practices around the world is realized to ensure that patients are well taken care of before they die. Though withdrawing of life-prolonging therapies is a common practice around the world, terminal sedation is a possible practice that could ensure the patient in question receives a painless death. The state should also ensure autonomy whereby the family members may make a choice whether or not to continue prolonging the patient’s life.
References
Furlong, E. (2008). Right or wrong: legal and ethical issues and decision making. Decision-making in nursing: thoughtful approaches for practice. Sudbury, MA: Jones and Bartlett Publishers , 29-46.
Murray, S. A., Kendall, M., Boyd, K., & Sheikh, A. (2012). Illness trajectories and palliative care. Int Perspect Public Health Palliat Care , 30 , 2017-19.
Sprung, C. L., Truog, R. D., Curtis, J. R., Joynt, G. M., Baras, M., Michalsen, A., ... & Bulpa, P. (2014). “Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill: The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study,” American journal of respiratory and critical care medicine , 190 (8), 855-866.
