Ethical Issues in Professional Nursing Practice

Chapter 14 Ethical Issues in Professional Nursing Practice Relationships and Professional Ethics • Nurse–physician relationships • Nurse–patient–family relationships – Unavoidable trust – Boundaries – Dignity – Patient advocacy • Nurse–nurse relationships The National Council of State Boards of Nursing’s Professional Boundaries in Nursing Video https://www.ncsbn.org/464.htm Moral Rights and Autonomy (1 of 2) • Moral rights are defined as rights to perform certain activities – Because they conform to accepted standards or ideas of a community – Because they will not harm, coerce, restrain, or infringe on the interests of others – Because there are good rational arguments in support of the value of such activities Moral Rights and Autonomy (2 of 2) • Two types of moral rights – Welfare rights – Liberty rights • Informed consent • Patient Self-Determination Act • Advance directives – Living will – Durable power of attorney Social Justice • Sicilian priest first used term in 1840; in 1848, popularized by Antonio Rosmini-Serbati • Center for Economic and Social Justice definition • John Rawls’ concept of veil of ignorance • Robert Nozick’s concepts of entitlement system Allocation and Rationing of Healthcare Resources • Does every person have a right to health care? • How should resources be distributed so everyone receives a fair and equitable share of health care? • Should healthcare rationing ever be considered as an option in the face of scarce healthcare resources? If so, how? Organ Transplant Ethical Issues • Moral acceptability of transplanting an organ from one person to another • Procurement of organs • Allocation of organs – Justice – Medical utility Balanced Caring and Fairness Approach for Nurses (1 of 2) • Encourage patients and families to express their feelings and attitudes about ethical issues involving end-of-life, organ donation, and organ transplantation • Support, listen, and maintain confidentiality with patients and families • Assist in monitoring patients for organ needs Balanced Caring and Fairness Approach for Nurses (2 of 2) • Be continually mindful of inequalities and injustices in the healthcare system and how the nurse might help balance the care • Assist in the care of patients undergoing surgery for organ transplant and donation patients and their families Ethical Issues in Professional Nursing Practice

• Provide educational programs for particular target populations at a broader community level Definitions of Death • Uniform Determination of Death Act definition of death: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem is dead. A determination of death must be made in accordance with accepted medical standards.” • Traditional, whole-brain, higher brain, personhood. Euthanasia • Types of euthanasia: – Active euthanasia – Passive euthanasia – Voluntary euthanasia – Nonvoluntary euthanasia • Blending of types may occur • “Is there a moral difference between actively killing and letting die?” Rational Suicide • Self-slaying • Categorized as voluntary active euthanasia • Person has made a reasoned choice of rational suicide, which seems to make sense to others at the time – Realistic assessment of life circumstances – Free from severe emotional distress

– Has motivation that would seem understandable to most uninvolved people within the community Palliative Care • Approach that improves the quality of life of patients associated with life-threatening illness, through prevention and relief of suffering • Do-not-resuscitate order: – There is no medical benefit that can come from cardiopulmonary resuscitation (CPR) – The person has a very poor quality of life before CPR – The person’s life after CPR is anticipated to be very poor Rule of Double Effect • Use of high doses of pain medication to lessen the chronic and intractable pain of terminally ill patients even if doing so hastens death • Critical aspects of the rule: – The act must be good or at lease morally neutral – The agent must intend the good effect not the evil – The evil effect must not be the means to the good effect – There must be a proportionally grave reason to risk the evil effect Deciding for Others • A surrogate, or proxy, is either chosen by the patient, is court appointed, or has other authority to make decisions • Three types of surrogate decision makers: – Standard of substituted judgment – Pure autonomy standard – Best interest standard Withholding and Withdrawing Treatment:

3 Cases • Case 1: Karen Ann Quinlan • Case 2: Nancy Cruzan • Case 3: Terri Schiavo Terminal Sedation • “When a suffering patient is sedated to unconsciousness…the patient then dies of dehydration, starvation, or some other intervening complication, as all other lifesustaining interventions are withheld” • Has been used in situations when patients need relief of pain to the point of unconsciousness Physician-Assisted Suicide • Act of providing a lethal dose of medication for the patient to self-administer • Oregon Nurses Association special guidelines related to the Death with Dignity Act – Maintaining support, comfort, and confidentiality – Discussing end-of-life options with patient and family Ethical Issues in Professional Nursing Practice

– Being present for patient’s self-administration of medication and death – Nurses may not administer the medication – Nurses may not refuse care to the patient or breach confidentiality End-of-Life Decisions and Moral Conflicts with the Nurse • Communicating truthfully with patients about death due to fear of destroying all hope • Managing pain symptoms because of fear of hastening death • Feeling forced to collaborate relative to medical treatments that in the nurses’ opinion are futile or too burdensome • Feeling insecure and not adequately informed about reasons for treatment • Trying to maintain their own moral integrity … Ethical Issues in Professional Nursing Practice