In the nursing field, the safety of patients depends mainly on the ability of nursing professionals to make ethical decisions effectively. Thus, despite an individual’s expertise and clinical knowledge, a healthcare practitioner that lacks ethical standards should be deemed unfit to practice. Therefore, to uphold ethical decision making, healthcare practitioners try to achieve morally-justifiable resolutions by prioritizing patient interests (Park, 2012). Thus, the author will focus on the analysis of an ethical issue based on an ethical decision-making model, to highlight the essentiality of making moral decisions in nursing. The model that will be used will encompass the exploration of the issue in five stages including; stating the issue, analyzing the problem, determining possible solutions, picking the best solution and justifying it, and establishing the strategies for successful implementation of the selected solution.
Ethical Issue
Mr. Burns is a seventy-year-old African American patient that has been undergoing cancer treatment at the hospital for about two years. When the cancerous cells in his throat were discovered, the tumor had grown beyond the throat and spread to a lymph node. Mr. Burns and his family agreed that surgery would be too strenuous for him. They settled on radiation and chemotherapy treatment. On the occasion in question, Mr. Burns was admitted to the hospital having, lost weight, swallowing difficulty, ear pain and unstable vitals (Smith et al., 2016). After three days and there was no improvement; it came to the nurse’s attention that is family could not agree on whether he should be resuscitated or not. Since Mr. Burns’ condition was deteriorating, the resuscitation decision would be crucial to guide his end of life care.
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Analyzation of Information
The issue described above is one that affects patients and families dealing with terminal illnesses. Patients like Mr. Burns undergo palliative care, which allows them to access special medical treatment that focuses on relieving the stress and symptoms that accompany serious diseases, like cancer. Patients that receive palliative care access the same with the goal of the practitioners being to improve the quality of both their lives and those of their families (Fitch et al., 2015). The key stakeholders in Mr. Burns’ case are the patient (Mr. Burns), his wife (his next of kin) and his children.
Overcoming the problem would require the establishment of Mr. Burns’ decision-making capacity. The said judgment is one that can be made by an attending physician required to determine Mr. Burns’ capacity to understand, appreciate, reason and express choice. In case the patient is deemed incompetent to make decisions, other options like shared and surrogate decision making should be explored to establish the best course forward (Palmer & Harmell, 2016). Hence, based on the additional information required, the previously stated problem is what the nurse and Mr. Burns’ family should work towards resolving.
Alternative Programs
Therefore, to resolve the resuscitation issue, it is crucial for the nurse to determine whether Mr. Burns has a do-not-resuscitate order (DNR) order. Mr. Burns’ possession of a DNR order would mean that the health care providers would not require to perform cardiopulmonary resuscitation (CPR) in case he stopped breathing or his heart ceased to beat (Dzeng et al., 2015). Additionally, crucial to the problem resolution process would be the determination of whether any of Mr. Burns’ family members have the medical power of attorney, which would allow them to make crucial treatment decisions in case the patient was incapable of making them. Thus, if the medical power of attorney is inexistent, the next of kin (M. Burns’ wife) would be required to make the said crucial decision (Fetherstonhaugh et al., 2017). Moreover, the shared-decision making option should also be explored, where physicians and Mr. Burns’ family would jointly determine the best course of action for the patient (Gjerberg et al., 2015).
Justification
Since the family expresses no knowledge of a DNR order, the solutions that remain on the table are surrogate and shared decision making. Mr. Burns’ firstborn son expresses that he has his father’s medical power of attorney and produces the documents to prove it. Thus, the solution becomes surrogate decision making. The decision that Mr. Burns’ son, Sam, would make would be what guides the healthcare practitioners on the type of care to deliver. However, the issue of Sam’s mother and sister disagreeing with his directive not to resuscitate Mr. Burns would also require to be resolved. Surrogate decision making is crucial in end of life care because it allows expression of the patient’s wishes through someone they trusted enough to accord the power to do the same (Fetherstonhaugh et al., 2017).
Strategies for Implementation
It would be crucial to ensure that despite the pre-determined moral supremacy of the medical power of attorney, all family members agree with the decision not to resuscitate the patient. The latter can be achieved by explaining to them that the medical power of attorney is only accorded to someone that the patient trusted to make medical decisions on their behalf, in case of their incapacity to make the said decisions themselves. Thus, Sam’s decision would be, by extension, Mr. Burns’ own decision (Fetherstonhaugh et al., 2017).
Conclusion
Ethical decision-making in the nursing field is not easy, and practitioners must dedicate themselves to trying to resolve ethical issues that arise on their watch to the best of their abilities. Moreover, the application of decision-making models in problem resolution is crucial as it facilitates the disintegration of the problem and enables the realization of the most viable resolution option.
References
Dzeng, E., Colaianni, A., Roland, M., Chander, G., Smith, T. J., Kelly, M. P., ... & Levine, D. (2015). Influence of institutional culture and policies on do-not-resuscitate decision making at the end of life. JAMA internal medicine , 175 (5), 812-819.
Fetherstonhaugh, D., McAuliffe, L., Bauer, M., & Shanley, C. (2017). Decision-making on behalf of people living with dementia: how do surrogate decision-makers decide?. Journal of Medical Ethics , 43 (1), 35-40.
Fitch, M. I., Fliedner, M. C., & O’Connor, M. (2015). Nursing perspectives on palliative care 2015. Annals of palliative medicine , 4 (3), 150-155.
Gjerberg, E., Lillemoen, L., Førde, R., & Pedersen, R. (2015). End-of-life care communications and shared decision-making in Norwegian nursing homes-experiences and perspectives of patients and relatives. BMC Geriatrics , 15 (1), 103.
Palmer, B. W., & Harmell, A. L. (2016). Assessment of healthcare decision-making capacity. Archives of Clinical Neuropsychology , 31 (6), 530-540.
Park, E. J. (2012). An integrated ethical decision-making model for nurses. Nursing Ethics , 19 (1), 139-159.
Smith, M. M., Abrol, A., & Gardner, G. M. (2016). Assessing delays in laryngeal cancer treatment. The Laryngoscope , 126 (7), 1612-1615.
