Context
By any standards, the nursing profession has encountered many bioethical issues due to the nature of duties involved. Under the principle of beneficence, it is the duty of professional nurses to enhance goodness, kindness, quality care, and charity to all patients, their health status notwithstanding (Mosby Inc., 2002). In addition to abstaining from causing injury to patients, nurses must also help their clients to further their well-being by offering interventions that will remove them from danger. In this particular case, however, there is an intricate discrepancy between the demands of beneficence on the one hand and the demands of the health care facility and code of conduct on the other. According to the case, Mrs. Corrine Worthen’s actions of enhancing goodness and kindness to the patient by performing dialysis on him results in more harm. This is the bioethical issue
The factual information relevant in this case is the patient’s experiences and health status when a dialysis procedure is perfumed on him. The nurse has a duty not to inflict harm to patients, and must, under all circumstances, abstain from injuring clients (Mosby Inc., 2002). Yet the procedure that Mrs. Worthen is supposed to administer has, on the previous occasion, caused the patient to suffer cardiac arrest and haemorrhaging.
Stakeholders
The stakeholders in this particular case include the patient, family members, nurse, treating physician, and the trans-disciplinary team. The patient is guided by the personal value and belief that his well-being will be furthered, while the nurse is guided by the values of altruism, aesthetics, freedom, respect for human dignity, justice, and truth (Mosby Inc., 2002). The treating physician’s decisions about the patient may be guided by values towards paternalism, otherwise referred to as involuntary treatment. On their part, the trans-disciplinary team, led by the head nurse, is guided by the values of offering the greatest good to the patient, information disclosure, and an overriding desire to conform to the set Code of Professional Ethics. The family members have the values of decision-making and compulsion to protect their relatives (Konishi, 2003).
A terminal illness, more often than not, leaves stakeholders with very limited priorities to choose from. The patient, however, has the priority of self-regulating and self-directing himself instead of waiting for decisions to be made by relatives. In other words, he has the priority of self-determination based on the information received from caregivers (Konishi, 2003). The nurse has the priority of thinking autonomously beyond the Code of Professional Ethics for Nurses and other concerns related to authority and reverence, but basing her thinking on altruism and respect for human dignity. The nurse also has the priority of being well informed about the underlying consequences that her decisions or approach may attract (Johnstone, 2009). Family members have the priority of giving the terminally ill patient a chance to make his own decisions. Lastly, the medical professionals and trans-disciplinary team have the immediate priority of benevolent paternalism and enforcement of rules respectively.
Alternatives
Judging by the complexity of the matter, morally and professionally, the available alternatives may not have the capacity to please all stakeholders. One of the alternatives is to allow the patient, who is an adult, to make an informed decision on what he wants. Treating the patient for the simple reason of pleasing the family rather than ensuring the well-being of the patient is not ethically right. The other available alternative, of course, is to follow the family’s wishes and continue dialysis on the patient despite the fact that it has already proven counterproductive.
If the patient is left to make his own informed decision, the odds are that he will have the dialysis procedure stopped. This way, the family members will not continue to contribute to needless costs of medical care, especially with the full knowledge and understanding that the patient is suffering from a terminal illness. The nurse will stop worrying that she might be causing the premature demise of the patient by administering dialysis, not because of the well-being of the patient, but to comply with set rules and please the family members. Other stakeholders will be affected positively by these alternatives through reduced psychological anxieties. The opposite is true for the second alternative
Solution
The best solution is to let the patient take his own decision about treatment procedures based on objective and credible information provided by the attending nurse and the treating physician rather than going by the family’s wishes. The nurse, of course, does not want to live with the guilt of causing death to the patient prematurely by continuing to administer dialysis. The family members should be convinced on the basis of superfluous costs and anxieties raised. The treating physician should be convinced on the basis that benevolent paternalism, that is, involuntary treatment of patients, may indeed be considered morally wrong (Johnstone, 2009). The trans-disciplinary team should be convinced on the basis of utilitarianism, that is, individuals should always endeavour to do what is morally right despite the rules and institutions of authority.
Reference List
Johnstone, M.J. (2009). Bioethics: A Nursing Perspective, 4th Ed. Victoria Avenue, Chatswood: Elsevier. ISBN: 9780729538732.
Konishi, E. (2002). Physician Non-Disclosure & Paternalism in Terminal Care: Ethical Issues for Japanese Nurses. Eubious Journal of Asian & International Bioethics, Vol. 13, pp. 213-215. Web.
Mosby Inc. (2002). Ethical and Bioethical Issues in Nursing and Healthcare. Web.