Response to scenario
The question asked by Mr. Newcomb is very complex and has a lot of ethical implication. The reason why I believe that the question is complex is because Mr. Newcomb could be indirectly trying to see if I can predict the time he will die. Alternatively, he could be genuine that he needs to meet her. The basic ethical principle of nursing is respect for the life, dignity and rights of the patient. The ethical duties of a nurse in the process of working with a patient are a certain range of actions that are unconditional to perform (for example, to respect the patient and his right to self-determination, that is, to reveal his will regarding something; not to harm, keep his word; cooperate with the patient) (Ranse, Yates & Coyer, 2012). All patients deserves respect, attention, compassion. Particular attention acquires the value of self-determination (autonomy) of the patient in the treatment process, protected by consent to treatment, which he gives after he receives information about his state of health. As a trained nurse, one of the reasons why Mr. Newcomb made the request is that he is trying to find out from me the tentative time he may die. Another possible reason is that he genuinely needs to meet her. Based on ethical principles I have acquired and my personal beliefs, I will first convince Mr. Newcomb that he still has several months to live, I will then inform him that presence of his mistress will lengthen his lifespan. After convincing him this way, I will then tell him that he is free to meet his mistress because the meeting would be for his benefit. This means that I will be obliged to tell Mrs. Newcomb that will be busy for a few hours tomorrow so she can meet with Mr. Newcomb but only after giving him adequate information.
Ethical principles to apply
As a nurse, it is important to note that the quality of health services consists in the application of medical science and technology in a way that yields maximum health benefits without increasing its risks; it is to put the available resources in function of achieving the best results in the patient and the satisfaction of the external and internal user (Gillon, 2015). The relationship of nursing with the quality and effectiveness of treatments in patients goes back to the past, as can be seen in Florence Nightingale's postulate , when she stated: "the laws of the disease can be modified if we compare treatments with results”. However, Mr. Newcomb case is terminal and any attempt to apply science and technology may not yield maximum health benefits. In fact, they have agreed that the medication be withdrawn. This means that the case will require me to seek other ethical principles that are relevant.
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Principle of beneficence
The first ethical principle I should consider is beneficence. It is based on the need to do no harm, to always do good, the nursing staff must be able to understand the patient in their charge, and see the patient as the same. The ethical practice on beneficence has been employed in determining what to dispatch to the family members and what retain in accordance to the nursing practice. Beneficence in nursing practice is the principle of “doing good”. It can be viewed in diverse spectrums such as the act of not inflicting evil or harm, the act of preventing evil or harm, removal of evil or harm, and doing good or rather promoting good (Ranse, Yates & Coyer, 2012). In determining beneficence in Mr. Newcomb’s case, we are obligated not to cause harm in favor of doing or supporting something that benefits the patient. Denying him opportunity to meet his mistress may cause harm. Accepting his request and allowing him to meet his mistress may also cause harm. The best thing therefore is to first explain to him how his life is precious and how meeting his mistress will lengthen his survival. Even if it is true that he is almost dying, it will be better to divert his mind towards positive aspects so that he cannot imagine that the presence of his mistress is an indication that his time is over. Consequently, to ensure that I do not harm him psychologically, I will first let him know how we care for him. I will then tell him that I will accept his request of telling Mrs. Newcomb that will be busy for a few hours tomorrow so she can meet with Mr. Newcomb.
Principle of non-maleficence
Closely related to beneficence is the principle of non-maleficence. It is precisely about avoiding harm, avoiding imprudence, negligence. Physical, mental, social or psychological harm must be prevented (Gillon, 2015). By accepting Mr. Newcomb’s request, I will be violating the principle of non-maleficence. This is because I will cause unnecessary psychological harm and make him anxious because he will just wait for his mistress to come in order to conclude that his time for death has arrived. Nevertheless, declining his request will mean that I will be showing some form of negligence. To solve the issue, I will discuss with him about his situation, the role of his mistress on his health and then assure him that he still have several months to live and that his meeting with his mistress will be one way of increasing his survival time.
Principle of autonomy
The other principle that is applicable to Mr. Newcomb’s case is principle of autonomy: is defined as the ability of the person to make decisions in relation to their illness. This implies having information about the consequences of the actions to be carried out. The principle of autonomy also means respect for people, treat them as what they are (Ranse, Yates & Coyer, 2012). The maintenance of the autonomy of the patient supposes considering it capable for the decision making; for that, it is necessary to establish an interpersonal relationship without coercion or persuasion, where information, doubts and consideration of the aspects of their daily life prevail. The objective of the information is not to convince the patient of the proposal made, but that the patient may have more arguments to make decisions related to their health (Baumann et al., 2013). According to this principle, I will be obliged to tell Mrs. Newcomb that will be busy for a few hours tomorrow so she can meet with Mr. Newcomb. However, I will do so after giving him all the necessary information about the possible consequences.
My values
Personally, I am a strong proponent of utilitarianism. I believe that the right choice is based on the consequences. The choice I will make has consequences. If I decline Mr. Newcomb’s request, I will not be improving situation because it is just a matter of time before he succumbs to cancer. As far as my medical knowledge is concerned. patients diagnosed with stage 4 cancer rarely manage to survive in the long run. Thus, the rationale of cessation of medical intervention on Mr. Newcomb was justifiable because according to utilitarian approach, if the burdens imposed on the patient by the disease outweigh the benefits that he/he she may eventually attain through medical attention, then it is better to withdraw and reconsider hospice care.
I strongly believe on value of honesty and integrity and in order for me to be honesty, I will just let Mr. Newcomb meet his mistress because even if I deny him, I will not be solving the issue. I also believe on value of fairness. Based on the current situation, it would be fair to allow Mr. Newcomb to meet his mistress even if the action will violate beneficence because his condition is terminal. In fact, I believe that by meeting her, he will be dying a dignified death.
Principle of Justice
Justice is a process of ensuring that the scarce resources is distributed based on the degree of need and urgency (Gillon, 2015). Mr. Newcomb is currently worried that he is about to die. His worries come mainly because he doesn’t have any other alternative. As a nurse, I will be doing justice by encouraging him and convincing him that he still several days if not months to live. Even if his days are numbered, the goal is to preserve his life as much as possible. Consequently, the best course of action is to give him such assurance then allow him to meet his mistress
Promoting self-care strategies
Developing self-awareness is the first step in the self-care process. This aspects aids an individual in identifying their strengths and weaknesses and in developing an understanding behind their reactions in certain situations (Trotter-Mathison & Skovholt, 2014). This value enables them to manage emotions and reflect on their responses in stressful situations.
Social support is another element of self-care. Social support is materialized in work in social support networks. Social networks make up the main natural support system that a person has. Social support at work increases personal fulfillment at work, decreases emotional exhaustion and improves the subject's negative attitudes and behavior toward others (Trotter-Mathison & Skovholt 2014). This support can come from different sources: teammates, informal groups and even bosses. In the labor context it is important to differentiate the support network that make up the other members of the organization with whom the professional shares the daily work space, of the friends with whom he could count.
The second strategy is having good professional network. Efficiency and professional competence depend on capacity to organize in networks (Trotter-Mathison & Skovholt 2014). The development of healthy professional networks should also be considered as a basic instrument to avoid professional fatigue. The professional networks should be characterized by internal coherence, structural plasticity and capacity of association.
References
Baumann, A., Audibert, G., Lafaye, C. G., Puybasset, L., Mertes, P. M., & Claudot, F. (2013). Elective non-therapeutic intensive care and the four principles of medical ethics. Journal of medical ethics , medethics-2012.
Gillon, R. (2015). Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics. Journal of medical ethics , 41 (1), 111-116.
Ranse, K., Yates, P., & Coyer, F. (2012). End-of-life care in the intensive care setting: a descriptive exploratory qualitative study of nurses’ beliefs and practices. Australian Critical Care , 25 (1), 4-12.
Trotter-Mathison, M., & Skovholt, T. (2014). The resilient practitioner: Burnout prevention and self-care strategies for counselors, therapists, teachers, and health professionals . Routledge.
