Ethics in Nursing: The Case of Laura
Introduction
Ethics is commonly understood as the philosophical study of right action and wrong action. We oftentimes equate ethics with morality. In the field of nursing, one encounter many ethical problems and questions that nurses, as professionals must deal with. These ethical issues according to Lachman (2006) include questions of confidentiality, patient rights, questions of life and death. An understanding pf ethics can help a nurse get a clearer view in these difficult cases of the issue at hand, the possible courses of action, and the principles underlying right action.
Husted and Husted (2005) defines ethics as the branch of philosophy that is concerned with right and wrong – the determination of what actions ought to be taken, and what changes ought to be brought about in common and uncommon situations.
Body
Ethical Issues
Three coinciding ethical issues are present in the case of Laura. These are personal autonomy, informed consent, and the right to refuse treatment.
1. Patient Autonomy
Autonomy according to Gillon (1997) is the capacity to make deliberated or reasoned decisions for oneself and to act on the basis of such decisions. The three components of autonomy are the ability to think for oneself, to make decisions for oneself, and to act for oneself on the basis of such autonomous thought and decision (cited in Tschudin 2003). The problems with the concept of autonomy arise mainly in the care of children, severely mentally ill patients, and elderly patients who may no longer be able to decide for themselves because of dementia.
2. Informed Consent
The doctrine of informed consent requires that patients be provided sufficient information before consenting to a test, treatment, or procedure, in order to make a competent, informed, voluntary, and understanding decision whether or not to consent. At a minimum this means that patients must be told of the risks and benefits of the proposed treatment or procedure; any side effects or complications; the likelihood of improvement with and without the treatment, including an explanation of the kinds of improvement that should be expected; and any alternative treatment methods.
3. Right to Refuse Treatment
Thorazine, the drug prescribed for Laura is an antipsychotic drug. Antipsychotic drugs are most frequently used to treat major mental disorders. These drugs have been hailed as shortening hospital stays, reducing symptoms, and enabling individuals who would otherwise have spent much of their lives in institutions to live in less restrictive community settings. Their purpose is to alter the chemical balance in a patient’s brain, leading to changes, intended to be beneficial, in his or her brain processes. They are widely used to treat psychoses, particularly schizophrenia. Generally, these drugs can be administered by pill, by liquid, or by injection – which permits staff members to administer medication over a person’s objection 9Levy and Rubenstein 1996).
Ethical Question
As the nurse taking care of Laura, I am faced with an ethical question – should Laura’s rights (patient autonomy, informed consent, and right to refuse treatment) be upheld, considering her mental condition? My answer for this question is this.
The answer to the question will be determined by Laura’s ability to make a competent decision. In this regard, Levy and Rubenstein (1996) offers a strong argument. According to them all adults are presumed competent and remain so unless a court makes a finding of incompetence or partial incompetence (p. 104). In order to ensure whether the patient is mentally capable of deciding for herself, her mental capacity must be evaluated. This can be done by a physician, psychiatrist, or neuropsychologist. When the patient is found to be mentally incapacitated, decisions regarding the patient’s welfare can be made by the person holding a Durable Power of Attorney or the person holding Conservatorship (called conservator) over the patient.
My approach to the problem would be first obtain the medical records and reports of the patient and determine whether the patient is competent or incompetent based on the findings of the physician, psychiatrist, or neuropsychologist. If the patient is competent, I will immediately stop preparations to administer medication and notify the physician and nursing supervisor immediately. I will document all actions in the patient record.
Justification for administering a medication against a patient’s will may include incompetence of the patient, protecting the life of the patient, and when refusal endangers the public. Should the patient be found incompetent but refuse the medication, the best thing to do is to notify the nursing supervisor and physician to authorize administration of the medication. I need to pay close attention to details and must be alert when there is a need to acquire a court order to proceed with the administration.
Closing Paragraph
As a nurse, it is first and foremost my responsibility to take care of the patient. I am responsible for ensuring the patient’s safety and well-being. As a nurse, I also need to take an active role in advocating the rights of the patient. The case offers a very complicated scenario, where there is a conflict between my role as a health service provider and the right of the patient to refuse medication. I think that no matter what the situation is, ethics compels me, as a nurse and as a fellow human to ensure that the patient’s rights are valued.
References
Lachman, V D 2006, Applied Ethics in Nursing, Springer, New York.
Gillon, R 1997, ‘Imagination, Literature, Medical Ethics, and Medical Practice’, Journal of Medical Ethics, vol. 23, no. 1, pp. 3-4.
Husted, G L and Husted, J H 2005, ‘Ethics: A Patient-Centered Approach’, in J Daly and S Speedy (eds), Professional Nursing: Concepts, Issues, and Challenges (pp. 175-191), Springer, New York.
Levy, R M and Rubenstein, L S 1996, The Rights of People with Mental Disabilities: The Authoritative ACLU Guide to the Rights of People with Mental Illness and Mental Retardation, Southern Illinois University Press, Carbondale, IL.
Tschudin, V 2003, Ethics in Nursing: The Caring Relationship, Elsevier Health Sciences.
Credit:ivythesis.typepad.com
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