moral, ethical and legal issues in nursing
Introduction
Every individual often faces moral, ethical and legal issues every day in their personal lives and their professional lives. In the nursing profession, nurses often face questions that concern the morality of the clinical technologies that get used to prolong human life and many other ethical, moral and legal issues. These issues have significant implication in the profession and even determine how nurse perform their duties in the clinical environment. Additionally, it is psychologically taxing to deal with a myriad of moral, ethical and legal issues in the workplace. The basic questions that nag all individuals are how exactly we should think? What questions should we answer? What factors should we consider? As the moral agent or a leader, an individual is required to have profound knowledge in the moral, ethical and legal context of the issues they face in the work environment. It is essential to point out that many organizations have their ethical, moral and legal standards spelled out so as to guide in the decision making in cases where their employees are faced with such issues. The paper presents an ethical dilemma I encountered in the clinical setup and details the role that I advocated for as a moral agent.
The ethical constructs conceptual framework has various steps that an individual ought to follow. According to Gardner, Chang, and Duffield (2007), the first step is an analysis of the ethical issues. The primary purpose of analysis of the ethical issues is to get the facts on the case in the right manner. Continuous monitoring and revision of the ethical aspects of the organizational behaviors and operations are required to determine the changes that are required in determining the changes that ought to be applied. There is also continuity in the conceptual framework since many organizations are mutually interdependent and hence the need for continuous attention to the ethical issues happening in other health care institutions. Morrison and Furlong (2014) point out that the basic reason why controversies are often created when solutions get provided for the ethical issues is that we often assume the relevance of the facts. The solutions that provide comprehensive answers to the ethical issued should also appeal to value and therefore, one should consider diverse approaches to the value that concern the ethical, moral or legal issues (Ozolins & Grainger, 2015).
Ethical issue
The ethical issue that I faced regards the conflict between the need to continue providing care for the critically ill patient who had advanced directive on do not resuscitate order and euthanasia. The ethical dilemmas cause me to be in distress especially in the case where the moral problem has legal consequences. Dehghani, Mosalanejad, and Dehghan-Nayeri (2015) argue that the nursing profession fundamental values include the preservation of life and the alleviation of pain and suffering. Ethics has its basis on beneficence, nonmaleficence, veracity, justice, and autonomy. Servitude and obedience create different types of ethical dilemmas for nurses (Gardner, Chang & Duffield, 2007). Each decision I made had consequences for patients. I had an obligation to intervene on behalf of a patient who was helpless, powerless, dependent, vulnerable, and has limited control of self. I acted as the patient’s advocate in the case of a change in diagnosis, malady, or hospitalization. There are few resources that aide a nurse in the making of decisions on the ethical issue of euthanasia and assisted suicide.
I had the duty and responsibility to act with beneficence as they advocate for patients who cannot advocate for themselves. An essential aspect I considered is the quality of life of the patient during the sickness. The ethical dilemma that arises is whether the best option is the extension of life while disregarding any other circumstance or only the provision of comfort measures without delaying death. The moral question is when termination of the life of a patient is the homicide.
Legal Implications and Role as Moral Agents
In order to consider the legal implications, I had to refer to the state laws regarding Patient Assisted Death. The first step would be to get the facts about the advanced directive. A document called an advance directive enables patients to make decisions concerning their care in choosing whether to accept or refuse surgical treatment. The material allows the individual to inform medical practitioners in the case where they cannot communicate their desires. Gardner, Chang, and Duffield (2007) asserts that the types of advance directives include a do not resuscitate order, a living will and a durable power of attorney. They serve as legal avenues for patients to make decisions before going through a medically incapacitating procedure. According to the Patient Self-Determination Act of 1990, health care professionals that receive Medicare or Medicaid reimbursement have an obligation to inform their adult patients on advance directives.
Gardner, Chang and Duffield (2007) also point out that in the Durable Power of Attorney for Health Care, the patient names an individual who will be responsible for making decisions regarding healthcare in the case of incapacitation. The person will be under obligation to answer any circumstances not contained in the living will. A do not resuscitate order is a statement by the patient ordering physicians not to give the patient cardiopulmonary resuscitation in the case where the patient stops breathing within the hospital. As a moral agent, I had to ensure that the patient orders were followed to the letter. Since the patient had requested for either euthanasia, I told my colleagues that the best option was to provide optimal care in the best way we could and in case the patient situation deteriorated, we were not to resuscitate.
It was a requirement that I address a request for a do not resuscitate order or euthanasia openly. It is crucial that I also involve the health care team in the decision-making process. The ethical implications of nonadherence to the patient advanced directive would have resulted in the legal suits against the nurses involved in the care of the patient and the hospital (Gardner, Chang & Duffield, 2007).
Leadership styles
The leadership styles used in my self-assessment was participative. Participative leadership style is also referred as democratic leadership (Marquis & Huston, 2015). I was democratic, and I valued the opinions of the other members who were involved in the care of the patient. However, I had the responsibility of making the final decision. My colleagues in practice and other team members such as physiotherapist, physicians, and nutritionist participated and gave me lots of ideas on the best way to manage the patient in light of the present ethical issues. There being a do not resuscitate order or euthanasia option, we all agreed that we would follow a do not resuscitate order. The participative leadership style facilitated timely, appropriate and needed solution to the ethical issue.
References
Dehghani, A., Mosalanejad, L., & Dehghan-Nayeri, N. (2015). Factors affecting professional ethics in nursing practice in Iran: a qualitative study. BMC Medical Ethics, 16(1). http://dx.doi.org/10.1186/s12910-015-0048-2
Gardner, G., Chang, A., & Duffield, C. (2007). Making nursing work: breaking through the role confusion of advanced practice nursing. Journal of advanced nursing, 57(4), 382-391.
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Morrison, E. E., & Furlong, E. (2014). Health care ethics: Critical issues for the 21st century. Burlington, MA: Jones & Bartlett Learning.
Ozolins, J. T., & Grainger, J. (2015). Foundations of healthcare ethics: Theory to practice.
