Part 1
While technical and scientific developments in the fields of medicine and biology have brought significant progress, they have raised a considerable number of ethical issues. The keys issues that arises include the protection of individuals as well as their fundamental rights and freedoms. However, it is vital to differentiate what can be technically feasible and what can be considered as morally acceptable. In this case, it is essential for individuals to be aware of the ethical issues that arise from the technical and scientific developments. On the same note, professional nurses should attend to the ethical responsibilities that they encounter in their line of duty because of their unique relationships within the professional nursing practice.
The bioethical issue considered relates to the issue of eugenics. Caplan, McGee and Magnus (1999) focus on the determination of what could be viewed as immoral and unacceptable regarding eugenics in their article "What is Immoral about Eugenics?" The authors introduce the article by stating that sensible individuals cannot argue in favor of eugenics. The fundamental reason they cite is based on the presumption that scientists in the 20 th century have been engaging in numerous undesirable activities in the name of eugenics (Caplan et al ., 1999). Even though individuals might question the morality behind eugenics, it is vital to investigate in order to clearly understand the beneficial elements of some of the experiments such as the improvement of genetics to a particular group of the population.
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The main points that the authors cover in the article are inclusive of the horrible abuses that are influenced by eugenics, which occur through government-imposed policies and projects. On the other hand, the authors acknowledge the provision that eugenics is vital to the generation of very important genetic knowledge, which can be a factor that determines the manner in which the knowledge is shared and utilized ( Caplan et al ., 1 999). In the article, the authors also pursue the moral case against eugenics. They posit that when some form of genetic changes can be ethically defensible if they are undertaken voluntarily ( Caplan et al ., 1999 ). They conclude that there might be nothing wrong when parents choose to use genetic knowledge in the pursuit of the improvement of the health and wellbeing of their children as well as their own.
Genetic engineering, as well as the identification of genes that might be carrying particular diseases, can create issues related to the concept of confidentiality as well as discrimination. One of the fundamental roles of nurses is to act as advocates for physicians, patients, and families. While executing this role, nurses are likely to find themselves in front-line situations that involve the maintenance of confidentiality and avoiding any form of discrimination against their patients in health facilities. To avoid being involved in possible ethical issues that might arise from genetic engineering, it is vital for them to understand the legalities that govern the new technologies (Blais & Hayes, 2015).
The ethical issue caused by eugenics relates to the identification of professional and personal values. According to Blais and Hayes (2015), in most cases, the professional values of nurses are a reflection as well as the expansion of their personal values. Since nurses are members involved in the care profession, it is vital for them to remain competent as well as compassionate in the delivery of care to patients. For this reason, their behavior is expected to be value neutral, which is an indication that they should not judge or discriminate against other people, particularly their clients (Blais & Hayes, 2015). By embracing such an outlook while engaging in their professional activities, the nurses can be in a better position of establishing good relationships with their clients who have diverse values. The nonjudgmental approach to care can enable them to make suitable ethical decisions, particularly concerning decisions made by clients that might involve volunteering for genetic provisions that might focus on improving the health and well-being of their children.
Nurses have to be aware of the values they hold regarding different concepts such as health, life, diseases, and death. For this reason, they should engage in activities that will make it possible for them to explore their beliefs and values regarding situations that are inclusive of the bioethics of eugenics. By identifying their values, they will be in a better position to understand and appreciate why particular circumstances might bother them. The knowledge that the nurses derive from understanding their values will assist them in determining whether they are willing to accept differences in the values held by other people and most importantly the patients with whom they interact with every of their professional duty. Blais and Hayes (2015) emphasize the importance of self-awareness, primarily because nurses deal with people that make decisions that conflict with their personal and professional values.
Part 2
Ethical and Legal Issues in the Case Study
As identified from the case study, the recommendation from the neurosurgeon is that the outcome of the patient, even with surgery, was poor . This recommendation introduces the ethical dilemma that relates to the concept of the futility of care. According to Grant, Modi and Singer (2014), the topic of futility has been debatable for numerous years. Care providers usually face difficult questions in instances where surgery is critical. The ethical principles that characterize medical futility are primarily greater in surgical care.
In most cases, the obligation of a physician to provide treatment and care to the sick and the autonomy of a patient causes serious questions. In the case example, the neurosurgeon is faced with the dilemma of balancing the ethical principles of non-maleficence and beneficence (Grant et al ., 2014). The ethical principles dictate that the physician should not harm the patient intentionally and should provide benefits that are likely to contribute to the welfare of the patient.
The provision of the futility of care could be looked at from different perspectives. One of the definitions of futility accounts for the qualitative aspect of the intervention. As provided for by Grant et al. (2014), qualitative futility is considered as an intervention that is likely to cause an outcome that is insufficient or unacceptable regarding the functioning of a patient. The medical cultures in a considerable number of countries emphasize the autonomy of a patient, considering the cultural and moral beliefs that he or she holds. For this reason, the identification of a universally accepted understanding of qualitative futility is nonexistent. This provision creates a controversial position. However, physicians are required to make medical decisions after making a careful benefit and risk analysis. Conversely, the patient should be able to make this determination appropriately after receiving guidance from the healthcare professional.
Concerning the qualitative provisions identified, the medical professional is faced with the need to justify the favorability of the balance of the effectiveness of the treatment, including the benefits and the burden of treatment (Grant et al ., 2014). If the balance is favorable, the physician will be ethically justified to provide treatment. However, if the balance is not favorable, the treatment process will not be defensible. The evaluation of burden requires the examination of different factors that are inclusive of the psychological, physical, the costs, as well as the side effects of the treatment process to the patient, which should be assessed by the physician and the patient or surrogate. Based on this provision, the physician is faced with the issue of whether to perform the surgery or not since a patient's request for futile medical care needs not be honored ( Grant et al ., 201 4). However, a medical practitioner can honor futile medical care in cases that require compassion, such as the provision of treatment that can prolong the life of a patient to ensure the fulfillment of his or her spiritual, religious, or personal obligations. However, the medical practitioner should ensure that the treatment process is not excessively burdensome.
The legal issue faced relates to the idea that the patient had signed DNR orders two days before the self-inflicted GSW. By signing the DNR orders, the patient introduced concerns regarding the quality of life that relate with the right-to-die legislative actions. According to Blais and Hayes (2015), the statutes of death with dignity as well as the right-to-die can be used to absolve a healthcare professional from liability when they provide the needed support to a client that does not wish to prolong his or her life. The neurosurgeon faces the legal issue of whether to operate on the patient, as determined by the wishes of the family, or withhold the surgery since the patient had signed DNR orders.
The Legal and Ethical Issues faced by the OR Nurse
The OR nurse also faces legal and ethical issues that relate to the provision of care for the patient. Judith A. Adams, Bailey, Anderson, and Docherty (2011) indicate that nurses act as advocates to patients and physicians. The enactment of the role of advocacy as a nurse might take the form of talking to the medical team on the family’s behalf and speaking to the family on the patient’s behalf. The dilemma that the OR nurse faces relates to the determination of the most appropriate strategy that could challenge the status quo. Family members expect that the health care professionals should pursue aggressive treatments even though the procedure might be futile. In an attempt to advocate for the patient and the physician, the nurse is likely to find him or herself in a position that challenges the physicians and the family members to consider changing their direction of care from curative to palliative (Adams, Bailey, Anderson & Docherty, 2011). The ethical issue that the nurse faces relates to the fear of removing hope or making wrong decisions when acting as an advocate.
The OR nurse also faces legal issues related to the concept of end-of-life. The OR nurse should also familiarize him or herself with the concepts of death with dignity and the concerns related to the patient’s quality of life (Blais & Hayes, 2015). Just as the statutes apply to physicians, the right-to-die legislative actions can absolve the OR nurse from possible liability when the patient does not wish to die, as it is determined by the fact that he signed DNR orders. As it is generally accepted, the nurse can withhold the provision of food and fluids as part of the legal requirement as wished for by the patient (Blais & Hayes, 2015). On the other hand, the nurse is morally and legally obligated to withhold fluids and food, based on the idea that the patient was unresponsive to intubation since the process would be harmful rather than beneficial to the patient.
References
Adams, J., Bailey, D., Anderson, R., & Docherty, S. (2011). Nursing roles and strategies in end-of-Life decision making in acute care: A systematic review of the literature. Nursing Research and Practice , 2011 , 1-15. doi: 10.1155/2011/527834
Blais, K., & Hayes, J. (2015). Professional nursing practice: Concepts and perspectives (7th ed.). Pearson Education.
Caplan, A. L., McGee, G., & Magnus, D. (1999). What is immoral about eugenics? BMJ : British Medical Journal , 319 (7220), 1284.
Grant, S. B., Modi, P. K., & Singer, E. A. (2014). Futility and the care of surgical patients: ethical dilemmas. World Journal of Surgery , 38 (7), 1631–1637. doi: 10.1007/s00268-014-2592-1
