...Introduction Ethical decision-making is a process where one decides on a course of action based on ethical and professional principles. The ethical principles of autonomy, beneficence, justice and nonmaleficence are often brought into consideration in ethical dilemmas. Healthcare professionals often use these ethical principles as a premise to make morally sound judgements on care provision. Ethical dilemmas surface when these principles conflict with one another. The correct course of action is not clearly defined and the decisions made may be challenged. Decisions made on moral grounds are often intrinsically complex and intricate. This essay will cover the principles of distributive justice, autonomy, and beneficence. Drawing from personal experience, three individual case pertaining to each principle are provided to illustrate how each principle is either observed or breached. A conclusion is presented at the end of each case study to summarize the ethical reasoning and concepts discussed. A final conclusion will also be presented at the end of the essay to provide closure to the discussion. Distributive Justice Case Study: Dr Adams is a physician working in an acute medical ward. During his shift, he reviewed two critically ill patients. Patient A was an 80-year old lady with thrombocytopenia secondary to lymphoma with a low haemoglobin level. She had been receiving palliative care prior to admission. Patient B was a 50-year old man with an actively bleeding...
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...Ethical Principles Violated In 1990, Terri Schiavo suffered cardiac arrest leading to a persistent vegetative state. Over the next 15 years, her case received international attention as her husband and parents argued over how to fulfill Terri's end-of-life wishes. Although tragic, the plight of Terri Schiavo provides a valuable case study. The conflicts and misunderstandings surrounding her situation offer important lessons in medicine, law, and ethics. Despite media saturation and intense public interest, widespread confusion lingers regarding the diagnosis of persistent vegetative state, the judicial processes involved, and the appropriateness of the ethical framework used by those entrusted with Terri Schiavo's care (Fine, 2005) On March 31, 2005, Terri Schiavo (born December 3, 1963) died -- the final complication of a cardiac arrest on February 25, 1990. Her death was preceded by the withdrawal of artificially administered hydration and nutrition through a feeding tube. Prior to her death, Terri's saga was the focus of intense medical, ethical, and legal debates in the United States and elsewhere. These debates were characterized by confusion about the facts, ethical principles, and laws relevant to the case. Much of the confusion revolved around a number of ethical and legal questions including: Is it ethically and legally permissible to withhold or withdraw life-sustaining treatments from patients who do not want the treatments? Is withholding or withdrawing...
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...According to Sundean and McGrath, ethical concerns of care are starting to come first before interventions while there is no constant practice on ethics decision-making occurs in the neonatal intensive care unit (NICU). Ethical struggles in the NICU are usually related to implementation and withdrawal of treatment. As a results, differences on ethical decision making involves the interdisciplinary team (IDT) and parents, whether individually or in joining. Nevertheless who will make the decisions, ethical considerations in NICU effect greatly the IDT, families and the society. Thus, contexts for ethical decision making must be based on four ethical principles that are autonomy, beneficence, nonmaleficence and justice (2013). Autonomy Sundean and McGrath noted that the ethical principal of autonomy includes the right for self-determination, truth telling,...
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...Knowledge Area Module VI Contemporary Issues and the Ethical Delivery of Health Services Student: Harold Taitt, harold.taitt@waldenu.edu Student ID # A00293212 Program: Ph.D. Health Services Specialization: Health Management and Policy Faculty Mentor: Dr. Robert Hoye, robert.hoye@waldenu.edu Faculty Assessor: Dr. Jim Goes, jim.goes@waldenu.edu Walden University May 10, 2013 Abstract Breadth Component In this age of rapidly evolving technological advances, many of the legal and ethical issues that are challenging the delivery of health care and the health care profession are new. As we confront the legal, moral, and ethical aspects of health care, we are seldom faced with decisions that require or are resolved by simple right or wrong answers (Edge & Kreiger, 1998). In the Breadth component of KAM VI, I focus on several ethical theories and how those theories influence the way ethical issues and concerns are addressed and managed in the allocation and delivery of health care services. I critically assess and evaluate those theories, concepts, and derivative principles as they impact important decisions and the implications of those decisions within the context of social change and with special emphasis on health care management and policy. In addition, I discuss the key assumptions on which the selected theories are constructed, compare and contrast the writers’ interpretations across theories, and conclude by providing a critical commentary on the merits of the selected...
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...Tuskegee Syphilis Study Dr. Joseph Costa, D.H.Sc, PA-C Health Policy and Management MPH 525 Jessie McCarty April 2013 Table of Contents Chapter Page 1. Tuskegee Syphilis Study 2 2. Tuskegee Basics 3 3. What Went Wrong? 4 Informed Consent 4 Vulnerable Populations 4 Medical Profession Pursued 5 4. Personal Opinion 7 5. Basics of Research 8 Informed Consent 8 Individual Autonomy 9 Beneficence 9 6. Current Policies 11 Policies 11 Exceptions 11 7. Problems with Waving Consent 13 Flexibility 13 Vulnerable Populations 13 Ethical Dilemmas 14 8. Conclusion 16 Chapter 1 Tuskegee Syphilis Study Throughout the years, numerous research studies have taken place. In the United States, on a daily basis thousands of research studies are being conducted. Some of these studies will greatly influence science, while others will make little impact. Historically, some studies have been remembered not for the results, but for ethical dilemmas surrounding the study. The Tuskegee syphilis study is a prime example of a study which made many people aware of the ethical problems surrounding research. The Tuskegee syphilis study made the government begin to analyze how research was performed in the country, and the study opened many eyes to what changes needed to be made. Analyzing the Tuskegee syphilis study allows for one to understand what went wrong with the study and how this study lead to great changes in the world...
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...PATIENT AUTONOMY Respecting patient autonomy is dominant to nondirective counseling. It has no requirement to value-neutrality. The counselor’s values are expressed to undermine patients’ ability to make decisions for them. Autonomy respect in genetic counseling requires no greater circumspection about values than in any other counseling in health care (Robert Wachbroit & David Wasserman, 1995). Value neutrality is argued to be neither possible nor desirable but arises from conceptions of fewer objectives and less suitable values for public discourse. Nondirectiveness requires the counselor to adopt the most effective methods in ensuring that the choices of the patients about genetic testing are well informed and voluntary. Patients should be made to understand and appropriately respond to the results of genetic tests and diagnoses. The nondirective approach stipulates that the appropriate response is the one from the patient herself as long as it results from the fact that she understands the facts and reflects her values truly. Nondirective genetic counseling ensures that patients are well aware of genetic risks and their freedom of choosing whether or not to go for testing and ways of responding to positive test results. This is the respect for patient autonomy. On the contrary, value neutrality...
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...This essay is based on adult case study two a 70 year old male patient called Mr James. All names have been change in this essay in order to comply with the NMC (2008). Code professional conduct on confidential. The case study highlights a number of principle, legal issues and professional value. These will be identified and some will be discuss in details. Ethics is concerned with the study of social morality and philosophical reflection of norms and practice (Burckhardt and Nathaniel 2003). These ethical issues are those based on basic and essential to social values that include respect for life, liberty and to be cared for. There will be a demonstration of understanding the theory of deontology while recognizing the importance of ethical principles in relation on the delivery of individual patient care. Informed consent will be highlighted in detail to provide validity and factors involved. A reflection will be provided to detail the understanding of how ethical theories contribute to the ethical decision making process in clinical area. Also a brief discussion will be given to show what has been gained from producing this essay. Consent can be defined as an agreement to allow something to happen based on full disclosure of facts needed to make an intelligent decision (Hazel 2002). This includes the knowledge of risks involved, benefits and consequence of refusal. Informed consent not only requires that a person be given all relevant information required...
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...Contents: Topic Page Number Glossary Of Terms 1 Introduction 2 Aspect Of Care 3 The DNACPR Policy 4 Ethics 7 Patients Consent 9 Withholding Information 14 Informed Choice 17 Forcing Information Upon Patients 20 The Nurses Role 22 Conclusion 25 References 26 Appendix 27 Glossary of terms CPR: Cardiopulmonary Resuscitation. DNACPR: Do Not Attempt Cardiopulmonary Resuscitation. NMC: Nursing & Midwifery Council. GMC: General Medical Council. BMA: British Medical Association. GP: General Practitioner Introduction The Aim of this module is to encourage me to enhance my personal and professional skills, to increase the efficacy of patient care and interaction. Also to make me more aware of the legal, professional and ethical implications of practice. The module allowed me to further develop my knowledge of these topics: Ethics & Accountability, Legal Aspects of Practice, finally Accountability & Professional Practice. I was then asked to submit an essay of 4500 words based on the following: “Critically analyse an aspect of care from your practice setting that encompasses the ethical, professional & legal role of the nurse. Issues of accountability should be incorporated into this essay”. Aspect of care The aspect of care I have chosen to include in my essay is the “Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)” Adult Policy...
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...Ethics in Nursing Practice, Values and Decision Making Name Name of College Abstract Nurses work with a wide range of patients, and each patient presents their own economic, social and cultural differences. While nurses work to provide care for the sick, injured and dying, they are always working within the boundaries of their professional codes of ethics. The nursing code of ethics is more than laws and common etiquette, and upholding the code of ethics is understood and agreed upon by people in the nursing profession. The two kinds of ethical theories discussed most in nursing are consequentialist and nonconsequentialist theories. By examining these two theories, nurses are able to evaluate the principle of confidentiality and how to apply the principle within reasonable limits. Further understanding of these normative theories gives nurses the abilities to evaluate conflict avoidance and resolution. As nurses further navigate the world of ethics, they discover how the code of ethics is influenced by a person’s culture, and they acquire a solid foundation for current ethical decision-making models used in their industry. Ethics in Nursing Practice, Values and Decision Making Nurses who take care of patients are encouraged to do so with a certain level of politeness. Other than being polite, nurses are required to be skilled, and they must follow the laws which govern them in their field of practice. Between all of the skills, politeness and laws...
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...jurisdiction to jurisdiction, nurses must be prepared to help manage individual cases, as well as participate in shaping the end of life field. If we understand the history of practicing jurisdictions and the evolution of euthanasia and PAS, we can help develop and manage a prudent course of action. Regardless of the nurse’s personal views, this polarizing ethical issue requires a commitment to comprehending the laws of the jurisdiction and adherence to professional responsibilities. Pereira, J. (2011) Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Current Oncology, 18, e38-e45. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/pdf/conc-18-e38.pdf The bioethics article offers an extensive body of work that empirically analyzes the effectiveness of boundaries with euthanasia and PAS. The author contends that policy dictates mandatory reporting of euthanasia in practicing countries, but warns of several “transgressions” that occur within the current procedural structure. The main body of the article provides examples and studies to fortify the significant frequency of these transgressions. The slippery slope argument is also addressed. Where by the author documents the historical progression and expansion of the inclusion criteria for those who may be legally euthanized or have PAS. Initially, these measures were only offered as a last resort and terminal cases. The author maintains that the door was opened more liberally to euthanasia...
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...CASE SCENARIO Leo R. is a 45-year-old patient with diabetes and is a widower with three young children. Two of Leo’s children suffer from chronic medical conditions. His oldest daughter, like Leo, has insulin-dependent diabetes. His only son suffers from grand mal epilepsy, which is poorly controlled by a plethora of medications. Leo works for a small printing business, a job he enjoys, but one that makes it difficult for him to make ends meet. With only six employees, the company’s owner cannot afford to offer health insurance. Leo’s annual salary of $30,000 allows him to purchase only the most basic of health plans, one that does not include coverage for prescription medications. Leo frequently must decide between medications and food, often opting for cheap junk food that is neither nutritious for his young family nor appropriate for a diabetic diet. Leo has recently applied for and been offered several other jobs, but at a lower salary and with no health insurance coverage. Recently, Leo’s diabetes has worsened. He has developed a serious infection that has led to lost wages and, far worse, the loss of his right leg below the knee. Leo is weighing his options. He has heard about a new clinical research trial open to insulin-dependent diabetics that pays $100 a week to research subjects. He has also been quite depressed and begun to wonder if his children might not be better off without him. He has several life insurance policies that would pay off generously if something...
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...Quality of life Name Institution Tutor Date Discontinuation of life support in this case is the actual ending of life. As a doctor, the best thing I will do in this phenomenon is to respect the will of Mr. Miller and discontinue the life support (Martin et al., n.d). There are conflicting issues regarding the moral status of any panorama of this act. The key issues direct us towards the consequentialist conceptualization regarding the quality of life, and responsibility we have for what we consent to happen, and what we cause directly rather than the deontological idea of moral status (Adams and Nys, 2003). The medical resources are accessible and it is possible keeping any personality from biological death for some time. Because of this, we have to decide resolutely when it is permissible to end life. Is there a way of limiting such decisions? If it is permissible to remove or withdraw medication, with the unswervingly foreseeable result that the patient in question will die? In essence, is there an ethically relevant disparity between intentionally withdrawing medication, with the predictable and intended results of the patient’s death with an equal consequence? My first argument has a basis on the deontological perspective. Deontological arguments base on the assumptions of absolute morality and used against the act of euthanasia in health care. These hypotheses forbid actions emphasizing on their physical effects. From a deontological opinion...
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...CASE STUDY Included in section 1300.360 RN Scope of Practice, Title 68 Professions and Occupations of the Nurse Practice Act it clearly states that nurses will advocate for patients. What this means to me is that if a patient is not of sound mental or physical state, that the nurse will act as the patients advocate in any situation that could or would affect the patient’s medical status. In this case in particular, the patient has an “advanced directive” in place that states his medical wishes. The patient also has a diagnosis of a mild mental retardation condition. The case study does not elaborate on the extent to the mental retardation; however he does have the legal advanced directive. Title 68: Professions and Occupations, Section 1300.350: Standards or Professional Conduct for Registered Professional Nurses in Illinois states several items. In reference to this case study, the most important would be to “report unsafe, unethical or illegal health care practice or conditions to appropriate authorities”. In my opinion, Dr. G is overriding the wishes the patient has listed in his “advanced directive”. What good is a document of this nature if a physician can make the choice to override it at anytime? The patient also has a “durable power of attorney”, which is Mr. B. This was also overridden by Dr. G. Both of these instances are unethical and could be challenged in a court of law. This would be a hard situation to be faced with. If I were placed in this situation...
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...Running head: PREGNANCY TERMINATION AT WEEK 27 GESTATION Ethical Dilemma: Pregnancy Termination at week 27 Gestation Ethics: Case study week Ana Alberto Pacific College November 9, 2012 Professional Code of Ethics and client advocacy: The ethical dilemma regarding these two parents pertains to whether or not to terminate this pregnancy at 27 weeks, which is after the 24 weeks fetal viability period. Finding out a child carried to term is harmed is nothing less than jarring, to the parents, family, and physician. In this scenario we have a couple who’ve worked hard to conceive and carry a child to that point; any choices made will be very emotional. They now have to make a very big decision that can be very devastating to the family’s future. This can also be hard for the clinicians working with this family as we also have beliefs and values that can impact our ability to care for the family if the decision being...
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...the People Written assignment Unit 7 Bioethics (HS 4812) Professor: Pankaj Mehrotra. 1. What is the difference between a. and a. What would constitute informed consent in the case of the Tuskegee Study? If such informed consent had been obtained from the subjects, would this remove all questions about whether the study was ethical? Informed consent to participate in the Tuskegee Study would require ensuring that the participants fully understood the purpose, nature, and potential risks and benefits of the study before giving their voluntary consent to participate. This would have included disclosing that the study aimed to observe the natural progression of syphilis without providing treatment, as well as explaining the potential...
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