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An Ethical-Legal Dilemma of Advance Practice Nurses
Essay Instructions:
-Apply theoretical frameworks and concepts to ethical dilemmas in the advanced practice role.
-Demonstrate integrity through the application of relevant codes of conduct and social responsibility within one's profession.
Note: Please take a moment to read this for an introduction:
As an advanced practice nurse, you will face many dilemmas. It is important to have a clear set of principles to deal with these issues. Knowing the difference among legal, ethical, and moral precepts is a starting point to determine what the right thing to do is.
Ethical models help to delineate and sort through ethical issues. Understanding moral principles such as patients’ right to autonomy, beneficence, nonmalfeasance, veracity, freedom, fidelity, justice, and confidentiality provide guidelines to make decisions.
Many times, families want to make decisions for patients. Knowing when a health care proxy or directive is in effect is important. Advance care directives have legal, health, and financial implications. Many confuse the power of attorney as a health care directive. It is not; it is a legal document that directs the finances of a client or patient. It does not give the power of attorney the right to make end of life decisions.
Heath care directives usually come into effect when the person is incompetent and cannot make decisions on their own. Many families try to make decisions for their loved ones before they are rendered incompetent. As nurses, it important to respect the autonomy of our patients and respect their dignity and ability to make their own decisions.
Essay Sample Content Preview:
Euthanasia versus Non-Euthanasia – An Ethical-Legal Dilemma of Advance Practice Nurses
Unforeseeable situations that often end up in dilemmas that are either ethical, legal or moral are commonly experienced by advanced practice nurses regularly. Nurses follow an International Code of Ethics. The code was first adopted in 1953 by the International Council of Nurses with the most recent revision completed in 2012. This helps the nurses be guided in their everyday work. The Four Principal Elements of the ICN Code of Ethics are, first, Nurses and People, second, Nurses and Practice, third, Nurses and the Profession, and fourth, Nurses and Co-workers, (International Council for Nurses, 2012). These four elements are reiterated in the nine Provisions in the Code of Ethics of the American Nurses Association, a member of the International Council of Nurses. Nurses who do not pay attention to the Code may face legal issues. An advanced nurse practitioner’s professional role is to identify ethical issues and should act as resource or mediator of patients and their families as well as co-workers experiencing these dilemmas (Ethical Issues in Advance Practice Nurse, n. d.).
The ethical legal dilemma that the essay will discuss is about a 75-year-old, mentally competent female, diagnosed with metastatic spinal tumors that spread to the lungs and liver. She refuses to undergo surgery and chemotherapy treatment that could extend her life for at least a year. Without these medical interventions, she barely has a month to live. She opted to have an Active Euthanasia as she does not want to endure the pain, but her husband disagrees with her decision. Her husband would like to proceed with the surgery and chemotherapy treatment. In this case, whose decision should the physicians and nurses obey? Will it be ethical to proceed with Active Euthanasia? Before we discuss the ethical principle and law that could be violated in this dilemma, let us first discuss some ethical concepts and define Euthanasia and its types.
Ethics
The word Ethics is from the Greek Word Ethos which means custom, habit, disposition or character. It is simply a system of moral principles. This influences people on how they should make their decisions and direct their lives. It concerns the individual and society and what is good for them (“Ethics: a general introduction”, 2014). A technical distinction between Morality and Ethics was stated in the Code of Ethics of the American Association of Nurses. The character and personal values, as well as the conduct of individual or groups, refers to Morality. The formal study of morality is what we define as ethics. Ethics is also referred as moral theology or moral philosophy. The Field of Ethics is further branched to applied ethics, metaethics and normative ethics (“The Code of Ethics with Interpretative Statements”, 2015).
Metaethics is a branch of ethics that delve to figure out what is right and wrong in moral standards. Normative Ethics, on the other hand, tries to produce a general theory on how we are supposed to Live. Applied Ethics is the practical aspect of ethics where you implement the theories of Normative ethics to particular issues stating the right or wrong thing to do (Holt, 2009).
Euthanasia
In an article published by The Center for Bioethics of the University of Minnesota, Euthanasia was identified as part of the end of life issues with ethical concerns. Euthanasia is the act of termination of a person’s life by a third party usually, by the physician. It can be passive or active. Passive Euthanasia is the act terminating a person’s life by refraining or stopping any form of treatment or medical intervention. An example would be, to stop a dialysis of a patient or to remove the life support machine of a coma patient in a vegetative state. The patient will then allegedly die “naturally” because of the illness. Active Euthanasia involves performing an action that leads to the termination of the person’s life. An injection of a lethal dose of drugs by the physician is one example (“End of Life Care: An Ethical Overview”, 2006).
Ethical and Legal Violations
In the dilemma presented above, the patient chose to refuse treatment and opted for an active euthanasia which her husband disagrees. He wants her to have the surgery and chemotherapy treatment to prolong her life for a year. On the Ethical Side, Normative ethics could be violated, specifically in the area of Deontology, which centers on the idea of rightness or wrongness of the act. The rightness of a choice depends on its compliance to a moral norm. In this situation, we need to check if the choice of active Euthanasia will be according to the standards of the moral norm. The goodness or badness of the situation is also dependent on the action that made it. This means that Rightness overrules Goodness. For Example, in a situation where you kill a drug robber to reduce or eliminate the crime of robbery in the neighborhood. A Deontologist would dispute that having zero robberies in the neighborhood is a bad state because of how it was achieved. (Mastin, 2008). In this case, the termination of the life of the patient will be in a bad state even if it will end her suffering. This is because of how it would be brought about, for Euthanasia could still be comparable to murder. The Ethical arguments on Euthanasia according to the Center for Bioethics of the University of Minnesota are as follows: First, termination of life is always unethical because of the moral belief that life should deliberately not be taken is violated. It also violates the basic right of a human not to be killed. Second, it is unethical because there is no adequate protection for a fair and just practice of euthanasia. Yet some moral positions would agree to the termination of life as requested by the patient. They think that it is not immoral as the patient has the right to decide. It could also be justified when there is compelling evidence that it would be harmful to the person to continue living than dying (“End of Life Care: An Ethical Overview”, 2006).
As an Advanced Practice Nurse, the code of ethics in the American Nursing Association provision 1.1 states that a nurse should respect Human Dignity. This means that the right to healthcare is universal and exceeds any individual differences. This disagrees with the patient’s request to terminate her life and her refusal for treatment. On the other hand, we should also consider the human right and dignity of the patient to decide for herself. The Self Determination Act of 1990 necessitates hospitals, hospice programs, home health care agencies, health maintenance organizations, and skilled nursing facilities to inform patients that first, under state law they have the right to make decisions concerning medical care. Second, they should also repeatedly ask if patients have an advance directive. They should then put into writing the wishes of patients regarding their medical care. Third, persons who have advance directive should not be discriminated by these facilities. Fourth, they should make certain that the documented medical care wishes and legally valid advanced directives will be carried out to the extent permitted by the state of law. Lastly, these facilities should also provide the patients, staffs and the community, educational programs on ethical issues regarding advance directives and patient self-determination act (H.R.4449 – Patient Self Determination Act, 1990). Although the Patient did not have an advance directive, she has clearly stated her wishes and had been documented by the hospital. This would mean that it will be considered as a violation of this act if the chemotherapy treatment is carried out. The patient’s wishes should be the one granted and not the husband’s because the patient has the sound mental capacity to decide for herself. Her wish to die was voluntarily and consciously stated and should have been documented by the attending nurses.
Legally speaking, the nurses and the husband could be legally accused of Tort more specifically Civil Battery if they continue with the treatment. Tort is defined as any manner of wrongful acts that would cause harm to another. It involves a broad range of actions and is split up into a lot of different subcategories in the legal field. One of its subcategories is Battery (“What are Intentional Torts?” n. d.). The civil battery (tort) can be defined as a battery that is an intentional tort. The Elements to build the tort of civil battery case are similar to the criminal battery case as long as there is no presence of criminal intent. Intent, contact, and harm are the three elements of civil battery. The intent, that is, to carry out the act even if not causing injury, will already state that tortuous battery has occurred. Contact that is non-consensual even just touching the clothing is already considered battery. This states, that the intent to administer the treatment to the patient without her consent will indeed make the nurse, physician and the husband be liable to a civil battery case. Their sincere intention of helping the patient prolong her life will be cast aside. There will be damages if the victim will be harmed physically, emotionally or mentally. The harm does not necessarily be severe to be considered as damage. It could be a slight touch or even an unwanted hug. (“Battery Basics”, n. d.).
Laws regarding Euthanasia and Assisted Suicide Around the World
There are different laws around the world regarding euthanasia and physician-assisted suicide around the world. The Netherlands is the first country that allowed both of these to be...
Unforeseeable situations that often end up in dilemmas that are either ethical, legal or moral are commonly experienced by advanced practice nurses regularly. Nurses follow an International Code of Ethics. The code was first adopted in 1953 by the International Council of Nurses with the most recent revision completed in 2012. This helps the nurses be guided in their everyday work. The Four Principal Elements of the ICN Code of Ethics are, first, Nurses and People, second, Nurses and Practice, third, Nurses and the Profession, and fourth, Nurses and Co-workers, (International Council for Nurses, 2012). These four elements are reiterated in the nine Provisions in the Code of Ethics of the American Nurses Association, a member of the International Council of Nurses. Nurses who do not pay attention to the Code may face legal issues. An advanced nurse practitioner’s professional role is to identify ethical issues and should act as resource or mediator of patients and their families as well as co-workers experiencing these dilemmas (Ethical Issues in Advance Practice Nurse, n. d.).
The ethical legal dilemma that the essay will discuss is about a 75-year-old, mentally competent female, diagnosed with metastatic spinal tumors that spread to the lungs and liver. She refuses to undergo surgery and chemotherapy treatment that could extend her life for at least a year. Without these medical interventions, she barely has a month to live. She opted to have an Active Euthanasia as she does not want to endure the pain, but her husband disagrees with her decision. Her husband would like to proceed with the surgery and chemotherapy treatment. In this case, whose decision should the physicians and nurses obey? Will it be ethical to proceed with Active Euthanasia? Before we discuss the ethical principle and law that could be violated in this dilemma, let us first discuss some ethical concepts and define Euthanasia and its types.
Ethics
The word Ethics is from the Greek Word Ethos which means custom, habit, disposition or character. It is simply a system of moral principles. This influences people on how they should make their decisions and direct their lives. It concerns the individual and society and what is good for them (“Ethics: a general introduction”, 2014). A technical distinction between Morality and Ethics was stated in the Code of Ethics of the American Association of Nurses. The character and personal values, as well as the conduct of individual or groups, refers to Morality. The formal study of morality is what we define as ethics. Ethics is also referred as moral theology or moral philosophy. The Field of Ethics is further branched to applied ethics, metaethics and normative ethics (“The Code of Ethics with Interpretative Statements”, 2015).
Metaethics is a branch of ethics that delve to figure out what is right and wrong in moral standards. Normative Ethics, on the other hand, tries to produce a general theory on how we are supposed to Live. Applied Ethics is the practical aspect of ethics where you implement the theories of Normative ethics to particular issues stating the right or wrong thing to do (Holt, 2009).
Euthanasia
In an article published by The Center for Bioethics of the University of Minnesota, Euthanasia was identified as part of the end of life issues with ethical concerns. Euthanasia is the act of termination of a person’s life by a third party usually, by the physician. It can be passive or active. Passive Euthanasia is the act terminating a person’s life by refraining or stopping any form of treatment or medical intervention. An example would be, to stop a dialysis of a patient or to remove the life support machine of a coma patient in a vegetative state. The patient will then allegedly die “naturally” because of the illness. Active Euthanasia involves performing an action that leads to the termination of the person’s life. An injection of a lethal dose of drugs by the physician is one example (“End of Life Care: An Ethical Overview”, 2006).
Ethical and Legal Violations
In the dilemma presented above, the patient chose to refuse treatment and opted for an active euthanasia which her husband disagrees. He wants her to have the surgery and chemotherapy treatment to prolong her life for a year. On the Ethical Side, Normative ethics could be violated, specifically in the area of Deontology, which centers on the idea of rightness or wrongness of the act. The rightness of a choice depends on its compliance to a moral norm. In this situation, we need to check if the choice of active Euthanasia will be according to the standards of the moral norm. The goodness or badness of the situation is also dependent on the action that made it. This means that Rightness overrules Goodness. For Example, in a situation where you kill a drug robber to reduce or eliminate the crime of robbery in the neighborhood. A Deontologist would dispute that having zero robberies in the neighborhood is a bad state because of how it was achieved. (Mastin, 2008). In this case, the termination of the life of the patient will be in a bad state even if it will end her suffering. This is because of how it would be brought about, for Euthanasia could still be comparable to murder. The Ethical arguments on Euthanasia according to the Center for Bioethics of the University of Minnesota are as follows: First, termination of life is always unethical because of the moral belief that life should deliberately not be taken is violated. It also violates the basic right of a human not to be killed. Second, it is unethical because there is no adequate protection for a fair and just practice of euthanasia. Yet some moral positions would agree to the termination of life as requested by the patient. They think that it is not immoral as the patient has the right to decide. It could also be justified when there is compelling evidence that it would be harmful to the person to continue living than dying (“End of Life Care: An Ethical Overview”, 2006).
As an Advanced Practice Nurse, the code of ethics in the American Nursing Association provision 1.1 states that a nurse should respect Human Dignity. This means that the right to healthcare is universal and exceeds any individual differences. This disagrees with the patient’s request to terminate her life and her refusal for treatment. On the other hand, we should also consider the human right and dignity of the patient to decide for herself. The Self Determination Act of 1990 necessitates hospitals, hospice programs, home health care agencies, health maintenance organizations, and skilled nursing facilities to inform patients that first, under state law they have the right to make decisions concerning medical care. Second, they should also repeatedly ask if patients have an advance directive. They should then put into writing the wishes of patients regarding their medical care. Third, persons who have advance directive should not be discriminated by these facilities. Fourth, they should make certain that the documented medical care wishes and legally valid advanced directives will be carried out to the extent permitted by the state of law. Lastly, these facilities should also provide the patients, staffs and the community, educational programs on ethical issues regarding advance directives and patient self-determination act (H.R.4449 – Patient Self Determination Act, 1990). Although the Patient did not have an advance directive, she has clearly stated her wishes and had been documented by the hospital. This would mean that it will be considered as a violation of this act if the chemotherapy treatment is carried out. The patient’s wishes should be the one granted and not the husband’s because the patient has the sound mental capacity to decide for herself. Her wish to die was voluntarily and consciously stated and should have been documented by the attending nurses.
Legally speaking, the nurses and the husband could be legally accused of Tort more specifically Civil Battery if they continue with the treatment. Tort is defined as any manner of wrongful acts that would cause harm to another. It involves a broad range of actions and is split up into a lot of different subcategories in the legal field. One of its subcategories is Battery (“What are Intentional Torts?” n. d.). The civil battery (tort) can be defined as a battery that is an intentional tort. The Elements to build the tort of civil battery case are similar to the criminal battery case as long as there is no presence of criminal intent. Intent, contact, and harm are the three elements of civil battery. The intent, that is, to carry out the act even if not causing injury, will already state that tortuous battery has occurred. Contact that is non-consensual even just touching the clothing is already considered battery. This states, that the intent to administer the treatment to the patient without her consent will indeed make the nurse, physician and the husband be liable to a civil battery case. Their sincere intention of helping the patient prolong her life will be cast aside. There will be damages if the victim will be harmed physically, emotionally or mentally. The harm does not necessarily be severe to be considered as damage. It could be a slight touch or even an unwanted hug. (“Battery Basics”, n. d.).
Laws regarding Euthanasia and Assisted Suicide Around the World
There are different laws around the world regarding euthanasia and physician-assisted suicide around the world. The Netherlands is the first country that allowed both of these to be...
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