Nurses experience frequently in the current fast-paced healthcare system. As a result, ethical principles are essential in clinical practice. They enable nurses to arrive at informed decisions when assessing the repercussions of their course of action. In the case study, the Appalachian patient who has bone cancer wants to stop treatment for the disease, but his family insists that he continues with treatment. Also, they have verbally abused nurses for agreeing to stop treatment as per the wishes of the patient. The conflict between the patient’s wishes and those of the family causes a clinical dilemma, and an ethical framework needs to be applied to make an ethical decision and implement appropriate actions.
The ethics committee to be convened would comprise of two physicians, an oncologist in the facility, the physician attending the patient, and three nurses who have attended the patient. To begin with, it would be essential to understand and consider the major principles of nursing ethics. These are autonomy, nonmaleficence, beneficence, and justice. Patients should be accorded respect in an equal manner with no discrimination. Also, they are expected to allow patients to make their own decisions about whether to accept or reject treatment even when the decision made by patients is not for their good. Non-maleficence requires healthcare staff to cause no intended harm to their patients. Such include establishing both risks and benefits associated with a certain treatment. The principle of beneficence requires nurses to be compassionate and implement positive actions. They should be guided by the desire to do good while justice requires them to treat all patients in a fair and equal way. The decision to be made should be centered on these ethical principles.
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After revisiting the ethical principles, the next step would be identifying the ethical problem. Identifying the specific ethical aspects of the dilemma would be conducted at the beginning of the decision making process. It is important to identify if the problem is beyond legal boundaries or what would be considered efficient. There are situations in which a dilemma may seem like an ethical issue, while in the real sense, it is a dispute between facts or ideas. All the parties involved should be considered too. In this case, the Appalachian patient and the family members are key parties, and it would be important to consider how the final decision would affect them. If the wishes of the patient would be granted and treatment discontinued, how would this decision affect both the patient and his family? On the other hand, if the patient’s wishes were ignored and treatment continued as per the wishes of his family, how would such a decision affect both the patient and his family? Both the benefits and harms of the various options available would be considered to make an appropriate decision.
The second step would be to gather all the relevant facts. The ethics committee would gather all the relevant information related to the issue at hand by consulting every potential source. This step includes identifying all the known and unknown facts about the issue and determining if the committee has adequate facts to arrive at a decision. All the facts related to either the patient quitting or continuing treatment would be collected and analyzed at this point. These facts should help identify the possible outcomes of the various courses of action available. The third step of the decision-making process would be to develop actions and assess alternatives. In evaluating options, five approaches would be considered. These approaches are utilitarian, rights, justice, virtue, and common good approaches. From a utilitarian perspective, ethical action is the one that generates more good than harm. To determine which action would generate more good than harm, the facts gathered in the previous step would be applied. Therefore, ethical action in the case of the Appalachian patient would be the one that generates the greatest amount of good for both the patient and his family. The focus from this perspective would be the consequences of the action taken. An ethical action from a rights approach is the one that respects the rights of the parties involved. The ethics committee in this step would be required to acknowledge that people have dignity, and they should be allowed to choose how they want to live. For example, from a rights perspective, the patient has the right to refuse treatment, and both the healthcare staff and family should respect the patient’s rights.
From a justice perspective, an ethical decision should be the one that treats all people equally or fairly, while according to a common good perspective, an ethical action should serve all the people involved and not some of them. This means that the right action to be taken in the Appalachian patient case should not favor one of the parties involved but all the parties involved. It should not serve the interests of the patient alone or the family alone, but both and any other relevant party involved. Respect and compassion for the parties involved should be put into consideration. The last approach in alternative actions is the virtue perspective, which states that ethical action is the one that is consistent with human values. As such, the ethics committee members would ask themselves what kind of people they would be if a particular action is implemented and if the action aligns with acting at their best. The fourth step of the decision-making process would be to arrive at a decision after considering all the alternatives and identify the one that best suits the situation. After the ethics committee picks the most appropriate action, the action would be implemented and a reflection of the results conducted.
