Assignment OneMuslim ShahNU 542: Ethics in Health CareDr Keith CashAga Khan University School of Nursing and MidwiferyPledge:” I have fully acknowledged the work of others in a proper way. I have neither used nor received any material without permission, while wrote this assignment. I affirm that I have maintained the principles of honesty and integrity in my academic work.” Assignment has run through viper. I have used APA 6th edition for my assignment.
Introduction
The application of ethical principles and basic ethical concepts become an essential part of medical practices since advancement in medical sciences. During the clinical practices, situations occur on daily basis, where we come across many ethical issues, which need to be solved correctly on the basis of ethical principles and ethical rights of the patients. In the scenario, the patient is terminally ill, the medical staff and family is insisting that she is not to be told. But on the other hand the patient is asking, ” Am I dying?” In this kind of situation, what should the nurse do? I felt big flaw in this case, the patient is dying and she is unaware of her condition because of family decision not to tell the patient. Understanding the obligations referred by these principles, there are certain dilemmas related to such scenarios, which arise due to conflicts among these ethical principles. There is a need of discussion of the ways in which respect for autonomy, obligations of beneficence and non-beneficence, can clash with the principle of justice, that would guide us to reflect on the above issue and in general. These four moral principles are not sufficient all alone, however, together with other moral considerations, health care ethics can be originated. These principles are binding together unless conflict occurs among these, if it does, then we have to select one according to situation. The ethical principles provide common moral commitments and ethical language for health care professionals. The purpose of this paper is to highlight conflicts, comparisons and differences of the four ethical principles approach to healthcare ethics developed by Beauchamp and Childress (1989).
Respect for Autonomy Verses Beneficence and Non-beneficence
Ethical problems usually the nurses are facing in the clinical practice, originate from clashes between obligations of respect for autonomy on one side, and obligations of beneficence and non-beneficence on the other. In the case provided, one of the main problems arose is that, not telling the truth to the patient about her condition. In the scenario, decision has been made by the family, and patient respect for autonomy has put aside. This scenario shows a conflict between the principle of respect for autonomy and the principle of non-beneficence, because respect for autonomy obliged one to be truthful to the patient. As the patient is terminally ill and her family and medical staff believe that telling her about her condition might adversely affect her. Moreover, it will make her depressed and enhance her sufferings. By telling the truth may make the patient to gives up all hopes of her recovery. Here, the patient family is informed and they mutually decided with medical staff, not to inform the patient. Now the conflict arises between the moral principles of ethics, whether to tell the truth or hide from the patient, as the patient is conscious and asking about her condition. If the nurse tells the truth, and might it would harm the patient by distressing or worsen her condition, then there is a moral dilemma. However, respect for autonomy obliged nurses not to deceive the clients, and requires supporting care, well communication, and especially listening and telling the truth. But on the other hand, obligations of non-beneficence include obligations not to harm the patient. In our context, it is important to consider the principles of beneficence and non-beneficence together. We cannot separate one at a time, because if we have no obligation of beneficence to other, but we are also obliged not to harm others. In order to respect for autonomy of patient by telling her the truth, the nurse must reflect on net benefits and the moral principle of not harming the patient. In such situation, we need to be clear about the consequences that how much harm and benefit will produce, and we must assess the harm and benefits. In this case the nurse should measure the consequences and avoid bad consequences by telling the truth to the patient. Moreover, basic professional obligations should be avoided, and preference should be given to obligations for non-beneficence on other moral principles.
Justice
The decision was made by the family and medical staff, that conflict with the obligations of respect for autonomy. It was paternalistic act, which is usually taken in clinical scenarios for the respect of beneficence and non-beneficence to others. However, it is essential to justify the decision for others within moral boundaries, including respect for beneficence and non-beneficence for the clients. As nurses do not have any justification for imposing their own or professional views about justice on patients, they need to recognize the ethical concerns. The principle of justice requires nurses to expressive towards the needs of patient. In the scenario the patient is asking about her condition, however, the nurse should avoid truth because the decision is made by the family and staff members, and the nurse is the part of medical profession and member of that society. So, the nurse should adopt those steps, which are beneficial for client and producing no harm to others.
Application of Moral Principles
Nurses still disagree about the application of four ethical principles, yet they may agree on moral and professional commitments, and their moral obligations in terms of respect for autonomy, beneficence, non-beneficence, and justice. It is also important to argue that nurses professional role is not only to benefit everyone, however, it is clearly understood that nurses primary obligation is not to harm anyone. While discussing the nurse’s professional or ethical role, certain questions come in one’s mind, those are; whom should be benefited? How much the nurses should benefit everyone? In which situation nurses are obliged not to harm to others and also avoiding respect for autonomy and justice in specific situation? It is difficult to find answers for these questions. But it is clearly stated that nurses ought most duty is to no harm to their clients in any situation. The health care professionals have obligations to do better for their clients and have to weigh the beneficence against possible harms and trouble. The basis virtue of medical decision making is not avoidance of risks, but the cautious assessment of benefits and harms, in relation to other moral principles of respect for autonomy and justice (Meulen, 2005).
It is argued that telling the real situation and condition to the patient will make them disappointed and confused, and in such bad situation or condition information regarding their health status should be hidden from patient. According to Jawaid, Afsar, and Jawaid (2003) that hope is considered essential component for coping and this could be maintained by avoiding communicating negative information to the patient. However, without informing patients about their condition, then how both health care professionals and patients could decide proper future plans for patients’ care. It might be contended that disclosing information to the patients creates negative psychological symptoms. However, researches have proved that sharing such information is even helpful to decrease psychological fears of patients. People who are against of sharing information with patients regarding their health status may also argue that as patients are already in anxiety due to their health condition, and telling them truth will make them worse. But they might fail to understand that sharing all information with the patients will be helpful, as they can ventilate their feelings, concerns, and quarries, which could also relieve their anxieties. Furthermore, telling the terminally ill patients about their condition would enable them to take important decisions in their life regarding their families, business, making a will, and emotional adjustment to situation. So, the nurses should avoid all those statements those are based on myths and assumptions, and hence, sharing information regarding patient condition is important. This will decrease negative symptoms and would give inner satisfaction to patients. Patients have full right of knowing all information about their disease and prognosis, and informing them about their health status is healthier, as they can share their wishes and plans with family and other closed ones. Beside these, the most important, they can have their rituals at the end of their lives. The term autonomy means having the freedom to make choices about issues of one’s life, deliberated self rule (Burkhardt & Nathanial, 2001). It can only be achieved by sharing all information to patients, which could make them able to decide about their lives’, and after that the right of autonomy will be fulfilled. Now, it is the ought most responsibility of health care professionals to maintain the safety of patient’s rights, which includes the right of providing all information to the patient regarding their health condition. However, the health care professional to be clear about the obligation to produce beneficence and non-beneficence to the patients, while maintaining safety of patients rights in critical situations and must justify their decision. The health care organizations should make such measures in order to ensure the safety of patient rights and also should make ethical laws in regards to providing information to patients. But all these measures and laws should be formulated by reference of the four moral principles of ethics. It is necessary for implementation of such laws, that specialized courses should be introduced for both medical and nursing professions with practical applications regarding solving ethical issues confronting in health care settings. Health care professionals should become competent in assessing patient condition and provide all information to patients, as they are having in contact with the patients. However, the four moral principles must be given consideration before making any decision, and the health care organization should have ethical committees who can maintain the surety of patients’ rights and should measure the consequences of decisions.
Conclusion
In conclusion, while making important decision, such as hiding truth from the patient, the nurse needs to consider the values of patient rights and conflicts between the moral principles. On the level of clinical practice no one knows in advance whether the decision made is right, or has violated the rights of patient, or the best decision for the patient. The decision must reflect respect for autonomy, obligations of beneficence and non-beneficence, and principle of justice. It is very difficult to come to a conclusion by using these principles. As in the situation of truth telling, conflict stems between obligations of respect for autonomy on one hand, and obligations of beneficence and non-beneficence on the other. Our decision need to be based on bioethical principles and humans rights. We also need to measure the consequences of our decision and should avoid bad consequences. Therefore, before telling the terminally ill patient about his/her condition, the nurse need to balance her decision in the light of ethical principles, professional obligations, and human rights.
