An advanced practice nurse (APN), will be faced withdifferent types of ethical-legal dilemmas that in most cases will require theAPN to make urgent decisions that will include both moral and ethicalattention. Ethical dilemmas are conditions that have to scenarios course ofactions to take that will contradict each other (Westrick, 2014, pp 258-265).The APN will have to choose between the two urgent decisions because each ofthese choices is deemed to be equally right and urgent.
This is the reason thatmakes dealing with ethical-dilemmas very stressful for the APN and otherexperienced caregivers involved. It isvery noteworthy that an APN has many medical responsibilities to provide care,and are also in the position to make urgent medical decisions that isindependent because of being the person in authority at that time. Many of theexisting ethical dilemmas will fall in with a variety of treatment withdrawalvs maintenance, the quality of life vs the quantity of life, euthanasia vsnon-euthanasia, and pro-choice vs pro-life (Westrick, 2014b, pp.
77-83).This paper will address the ethical dilemma of informedconsent vs the right to refusal of treatment by the patient. I will show thepatient’s autonomy, human rights, informed consent, and refusal will be writingabout (Appelbaum, 2007). Informed consentcan be described as a situation where a patient beyond question is informed andparticipate in the decisions that are being made on the patient behalf while onthe other hand informed refusal, happens when the risks appertaining to acertain mode of treatment or the treatment itself are rejected based on therisks they pose to the patient’s health and well-being in general (Appelbaum,2007).
In such a case, the ethical aspects of deontology and consequentialismare to be explored before the process of decision making commences.The ethical dilemma for this paper will involve aseventy-year-old man that is admitted to the hospital and is currentlyexperiencing an ischemic attack. The patient is still in sound mind and canmake his own decisions but has exhibited characteristics of continuouslybecoming weak and cannot effectively swallow after being affected by thestroke, and so he is very uncooperative when it comes to taking treatment. Hispower of attorney, who is his son has agreed to a Percutaneous EndoscopicGastrostomy (PEG) through phone but the man declines the PEG tube insertionbecause of the health risks posed by these tubes and prefers to have homecarewith hospice. He does not want to contract ventilator-associated pneumonia ashe is well informed of the health risks these tubes have on patients. Theassessment done by the nurse indicates that the patient can make his owndecisions. Additionally, his son also agrees with the decision made by thepatient.
From the ethical perspective, the consequentialist theory anddeontology can be applied in the decision making of this case. According todeontology as Bingham (2012) puts it, an emphasis is placed on some actions asbeing inherently wrong or right based on what an individual ought to do as pertheir obligations and duties without considering the outcome. Theconsequentialist theory, on the other hand, looks at the consequences of theactions and chooses one that yields the least bad and the best. Legally, therights of the patient, in this case, are protected by the Patient’s SelfDetermination Act of 1990 given the fact that he is in a position to make hisown decisions (Hamric et al.
, 2013). The violated principle or ethical theory, in this case, wouldbe the theory of consequentialist and that of deontology if PEG tube insertionis done. Consequentialism can be used to justify ignoring the patient if theoutcomes of the decision are to cause more bad than good. Also, the PatientSelf Determination Act of 1990 which includes the patient’s right to refusebeing treated if the patient has been determined to be able to make his owndecisions. The offences would thus be a tort of battery if a procedure is doneon the patient without their consent.
The Applied Legal Principles and Related CaseFor a consent that is legally valid, the decision makingcapacity is a very important condition. The right of treatment refusal andconsent laws is underpinned by the respect for autonomy principle. Dealing witha patient without their consent is a criminal offence referred to as the tortof battery or assault (Bingham, 2012). The decision made by a competent patientthat has been determined to be in a position to make their own decisions has to,therefore, be respected regardless of whether or not it seems irrational oruninformed. The related real case in this patient’s situation is that ofLane v Candura (1978), where Candura was a 77 year old widow that suffered fromgangrene in her lower right foot. Her physician recommended that the leg be amputatedbut she failed to consent to that decision (Relman, 1978). This forced herdaughter Lane to file a petition in court with an aim of being appointed as anauthority on her mother’s behalf in order that she consents to the amputationprocedure.
It was established by the court that Candura was in a position tomake her own decisions and so her leg was not to be amputated unless she agreesto it (Relman, 1978). In my case above, the patient is in a position to makehis own decisions and is even supported by his son who happens to be his powerof attorney.Legal and Ethical Reasoning and Solutions to the Ethical- Legal DilemmaUsually, legal reasons are derived from the law while moralreasons are as a result of moral reasoning or the results of a moral conflictdeliberation. The two have been established to generate broad unendingdiscussions and usually enhance decision making that is autonomous according tothe patient’s human rights (Blair, 2015). They are also the genesis of allethical dilemmas in advanced practice nursing.
Dilemmas occur when the nurse isforced to respect the autonomy of the patient even if the decisions that arebeing made by the patient could result in serious damage. In this case, it canalso be argued that the patient’s decisions have to be ignored because theresults of the patient’s decisions are extremely harmful. It is however notethically right for a nurse to override the decisions made by a patient thathas been established to be competent enough to make his own decisions.
According to Oliver & Jochen (2011), nurses are obligated to respect the patient’sautonomy and one of the ways in which this can be done is by acknowledging thatthey have the right to act on their health as they please based on theirbeliefs and values. An advanced practice nurse should, therefore, include thepatient’s perspective in their analysis of the conflict there is betweenethical principles has to be considered. RecommendationsOne of the recommendations towards the resolution of moraldistress for nurses could be the involvement of the patient’s family, explainto the patient clearly the benefits and risks of the procedure in place so thatthe patient makes a decision from a well-informed point of view and lastly amultidisciplinary team has to be put in place to work alongside with the nurseso that the moral distress is significantly reduced by the help rendered by theteam during decision making. ConclusionIn conclusion, it is noteworthy that thorough training onethics and legal principles are paramount for all advanced practice nurses asit governs all their decision making scenarios when dealing with patients.
Theknowledge is also important as it enables the nurses to respect the patient’srights while identifying the moral conflicts and issues at play in most cases.
