Nursing Ethical Issue and Decision Making Process The end-of-life is the most crucial time where conflicts can occur between heath care professionals such as doctors, nurses and other specialists, between family and the patient, and between nurses themselves. These conflicts can be created because of different values and beliefs among different people. Although patients and their families are living together, there are still chances that values can be different amongst them. The end-oflife in the adolescents have same situation where values of children differ from values of their parents and families.
My stance on this ethical issue is to support my patient’s wish. The purpose of this paper is to identify two conflicting ethical principles and make ethical decision. In this paper, I will discuss how seventeen-year-old girl’s decision about treatment is different from her parents (see appendix). I will also discuss ethical issue in broad aspect and then I will discuss how two ethical principles can conflict with each other at the same time in case of Lucia. I will also describe the relational ethics and how they differ from traditional ethical theories.
In the last part, I will use Oberle and Raffin model to make an ethical decision in case of the Lucia’s treatment. Ethical Issue: End-of-Life Care Decision Making in Adolescents Nurses work in different types of environment and end of life care is one of the health care facility where nurses inevitably involve in the care of patients. End of life care is relevant to nursing because nurses are with their patients for most of the time and play a major role in how patient’s lives will end. However, nurses encounter some challenges while choosing care for their patients.
With advancement of technology, nurses face the dilemma whether the wishes of the patient regarding withhold or withdraw the treatment in end of life should be followed, or the wishes of family should override the wishes of a patient when parents consider physical existence with help of technology and advanced treatment is worth living (Azotam, 2012, p. 581). On the other hand, shared decision making involves both patient and his family. The family involvement in end of life is one of the important aspects in which nurses face conflict in ethical decision m making.
The patients indicate the extent to which they wish to involve their families. The another option is that family members did not wish to stay with a decision that was not supported by other family members (Nolan et al. , 2008, p. 278-279). Ethical Principles Conflicting With Decision Making Process The principle of respect for autonomy (Burkhardt, Nathaniel, & Walton, 2014a, p. 50) means freedom to make own decisions. The principle of beneficence (Burkhardt, Nathaniel, & Walton, 2014a, p. 59) means to do good for the patient by providing appropriate treatment.
The principle of non-maleficence (Burkhardt, Nathaniel, & Walton, 2014a, p. 62) means to avoid causing harm to the patient. The principle of justice (Burkhardt, Nathaniel, & Walton, 2014a, p. 76) means fair, equal and appropriate treatment given to the patient. Nurses find ethical conflict when she is following one principle and at the same time she can conflict with another principle in the end-of-life care decision-making process. Relational Ethics Relational ethics requires us to focus on relationships as a central aspect of proving care to the patients.
Relational ethics allows nurses to create a moral or ethical space. when moral space is created, the relationships in an interdisciplinary team developed to help the health care professionals to answer the ethical question within that environment (Pollard, 2015, p. 362). The four main themes of relational ethics are mutual respect, engagement, embodied knowledge, and the environment. The mutual respect is characterized by respect and make attention to differences among persons. The engagement is the relationship quality in which there is strive for genuineness and relationship among persons.
The embodiment means a person not only treated holistically but there are concerns of emotions and personal experiences. The environment refers to relationships that connect persons to the larger social groups and societies (Burkhardt, Nathaniel, & Walton, 2014b, p. 42). The relational ethics focus has changed to the philosophy of human science with the pattern of relations rather than philosophy of natural science, where there is pattern of control (Wright, & Brajtman, 2011, p. 22).
On the other hand, the theory of Utilitarianism (Burkhardt, Nathaniel, & Walton, 2014b, p 30) and Deontology (Burkhardt, Nathaniel, & Walton, 2014b, p. 34) focus more on rights of person and justice rather than patterns of relationships. The Oberle and Raffin model (as cited in CNA [Canadian Nurses Association], 2008, pp 37-38) is an ethical decision-making model which helps nurses to make a decision when there is an ethical dilemma. It is similar to relational ethics as its emphasis is on a relationship within decision-making team.
The Oberle and Raffin model enable the discussion among health care team members by creating a moral or ethical space for everyone who are participating in that relationship for discussion of an ethical problem. Ethical Decision-Making Model The ethical dilemma whether the seventeen-year-old child should go for bone marrow transplantation which is the only hope for cure this disease or to withhold all treatments as per her wish. Thus, the principle of autonomy (Burkhardt, Nathaniel, & Walton, 2014a, p. 49) conflicts with the principle of beneficence (Burkhardt, Nathaniel, & Walton, 2014a, p. 9).
I will use Oberle and Raffin model as a guide for ethical decision making in this ethical dilemma. Understanding the Ethics of the Situation: Relationships, Goals, Beliefs and Values My own values are to provide the best care to my patient in the end-oflife care. I will respect the quality of life and dignity of my patient. I will support my patient’s wishes irrespective of his age when my patient is competent to make her own decision. While, on the other side, Lucia’s parents play an important role in her life.
They want to impose their values on their child as they find their child immature to make her decision (see appendix). They want their child to go under every treatment she needs for the intent of doing good for their patient. The Lucia wants only palliative care (see appendix). Palliative care means dying with comfort (Burkhardt, Nathaniel, & Walton, 2014, p. 241). The doctor told the family that there is only ten percentage of chances that transplant will be successful (see appendix). But doctors also declared that the patient has enough capacity to make a decision regarding her health.
The family hopes to achieve good prognosis of disease through bone marrow transplantation. But Lucia considers this treatment is not worth for her. The family reflects a good outcome is to take a chance for bone marrow transplantation which is not the good outcome according to Lucia. Lucia has the level of knowledge that she understands the treatment option, its risks, benefits, and consequences as per reasonable person standard (Burkhardt, Nathaniel, & Walton, 2014d, p. 275), which means a reasonable person would understand in a similar situation.
The relationship of parents with Lucia is good but, parents are not able to understand the needs of their child. On the other hand, health care providers are respecting the Lucia’s decision in regards to her health. Reflecting on the Range of Available Choices In the case study (see appendix) there are two possible choices. First, Lucia can go for bone marrow transplantation. The bone marrow transplantation would mean exposing her to intensive chemotherapy, total body irradiation and put her in isolation after the transplant. She has the second option to withdraw from transplant and can stay on palliative measures only. As a
