Moral and Ethical Framework Appraisal
Introduction
Nurses across the world are continuing to experience ethical challenges as they attempt to improve the health status of their patients. Communication, science, spirituality, autonomy, patients’ needs, resource allocation, and informed consent are major factors causing decision-making problems in the nursing docket. To address ethical challenges in their workplace, nurses have to reconcile their own values with their professional obligation to address the needs of patients successfully. As such, nurses find themselves in situations in which they may not consider every decision as right and proper guidance in achieving the appropriate action. This discussion shall majorly focus on “informed consent” as a major ethical problem that nurses continue to encounter while exercising their professional services.
Summary of Ethical Problem
Informed consent in the treatment of the patient is a major challenge causing ethical problems and dilemmas in the healthcare environment. Concerns often arise where patients and their families are not fully informed about their medical treatment is a huge concern in the nursing field. While nurses are expected to take actions that enhance the outcome in the health of a patient, the actions may be regarded as harmful to a patient and their family if all parties were not consulted when certain medical procedures or prognosis were undertaken. It is common for patients to ask nurses to elaborate doctor’s statements, but the extent of disclosure of such information brings ethical concerns for the nurse (Barry, 2012). Honesty against withholding of such information is a great ethical dilemma that requires to be critically analyzed.
The legal basis of informed consent requires that patients and their surrogates be informed about the risks and benefits of undergoing a certain treatment. It also requires that patients and their surrogate be mad aware of alternative forms of treatments available for the patients’ condition. An ethical consent in nursing pertains to the issue of patient autonomy, where the patient understands and agrees willingly to the type of treatment being administered on their body. Either a written or unwritten consents are required to ensure that nurses have come to terms with patients and their family depending on the underlying treatment options (Menendez, 2013). Written consent is required in critical medical decisions such as surgery, while nurses may opt for unwritten consent, especially during nursing interventions such as holistic care where spiritual therapeutic or mind and body practices.
The ethics of informed consent are, however, compromised by aspects such as culture spirituality, science, healthcare needs against the allocation of resources, autonomy against beneficence, and honesty against withholding of information (Cook, 2014). Nurses may want to balance their professional values and patient outcome, but the barriers that arise from informed consent issues continue to pose ethical challenges in their professionalism. Knowing the right approach to the treatment of a patient is not enough for a nurse because they have to be quite sure of the ethical implications of their procedures. Ethics and consent are proving to go hand in hand in the nursing department because a discordant in either consent or ethics tends to raise ethical and moral concerns regarding a nurse (Cook, 2014). As such, nurses are extremely challenged by knowing the right action, especially in emergencies.
Ethical theories
Constructed Consent Theory
Theories of consent emerge from social and personal beliefs regarding the nature of the human person. Consent adopts principles of modern democracy, which is an act of the will. The theories have been adopted into clinical practices to ensure a healthy relationship for the parties involved. Constructed consent refers to varying social constructs that are not universal but are applied for a professional assessment of adequate information. In the clinical setting, the desires and feelings of a patient may confuse their understanding of treatment options (Lemonidou et al., 2013). Patients may initially choose to avoid dangerous and unpleasant forms of treatment but may slowly agree to undergo the treatments after winning the trust of their caregivers.
Constructed consent brings together the way people have constructed their social identities regarding a particular procedure or thing. In the nursing environment, some patients may have fixed personal attributes gained from the society that influence their response to medical procedures. The reality of consent tends to imply that influences on decision making are potentially convincing, and autonomy is extremely individualistic (Lemonidou et al., 2013). In the absence of numerous social and personal influences, people would not have options or the ability to make choices. As such, families, friends, media, and hospital staff influence a patient’s autonomy, which largely determines their response to consent.
Functionalist Consent Theory
In functionalists’ theories, consent is being regarded as a polite way of taking responsibility and transferring risks from a clinician to an informed patient. Functionalists believe that the treatment of a patient can proceed without posing serious risks or litigation. Courts have been seen coming in defense for doctors facing serious litigations involving consent because the criminal justice system adopts a functionalist interpretation of consent in clinical care (Barry, 2012). Functionalists are not bothered with the social, cultural beliefs, and spirituality of a patient, which may influence consent but are focus on the outcome of the procedures. As long as the consent does not pose legal consequences on doctors and nurses, they can highly influence the choice to undertake a particular medical procedure on the patient. Most people are partly functionalists because they ought to belong to a particular society with useful knowledge and employ their professionalism and legal perspective in establishing treatment causes for their patients (Barry, 2012).
Patients’ autonomy can be viewed as greatly limited by the functionalists because of the influence they have on the decision-making capacity of a patient. As long as the expected outcome of a certain medical procedure is positive to both the patient and his/her family, the decision to undertake a certain medical procedure on the patient becomes quick. The advice by nurses or doctors to have patients accept certain medical measures by giving the patients alternatives can also be considered a functionalistic approach to consent where nurses are trying to bring on board a variety of choices for the benefit of their patients (Barry, 2012). Functionalists believe that they are experts and have the right advice to offer to patients and their families for the most positive outcome. Consent, according to the functionalists’ view, may be viewed as a decision based on clinical evidence suggesting that the outcome of such a decision is the best of any other option that the patient tends to prefer.
Critical Theory
The critical theorists regard informed consent as a way of protecting patients from unwanted and harmful medical interventions. This form of theoretical consent often wants doctors and nurses to be accountable for their actions and, hence, enforce the need for a consent between patients and their families to ensure patient protection. Informed consent is not one-way traffic but an exchange of knowledge between patients and their caregivers (Menendez, 2013). As such, the need to engage all parties involved in the health of a patient is important because it eliminates the possibility of complaint and litigation against a medical profession. Critical theorists prioritize the health and life of a patient and always want to ensure that patients do not fall victim to illicit treatments.
The challenge of critical theorists lies in the utilitarian perspective, where the action is regarded as bad if the outcome is harmful. Consent and utilitarianism do not appear to move in the same line of ethical principles. If a patient consents to a particular medical procedure which later turns out to be harmful, then the utilitarian aspect fails to hold waters in the clinical ethics. The critical theory holds to the perception that a patient’s decision can be influenced by a caregiver as long as its outcome is good (Cook, 2014). A nurse may be caught up in an ethical dilemma where a patient’s autonomy results in a bad outcome. The choice of whether to consider the outcome or proceed with a patient’s autonomy over their condition may pose challenges for nurses.
Ethical theories in nursing have the potential of influencing decisions for a patient because of the perceptions they hold regarding certain medical procedures and outcomes. Particularly, end of life decisions requires an intense consideration of ethical values and involvement of family members and health professionals. The decision to end life may or may not require the consent of a patient depending on the underlying social, economic, and health issues. Ending life deliberately through clinical procedures without the consent of the patient is termed unethical, but the dilemma arises where the medical cost of caring for a terminally ill patient overburdens the family to the extent of depleting resources (Lemonidou et al., 2013). In this scenario, a respective family may view no need to consult their ailing member but press the life button to save family resources.
A terminally ill patient may request to end their life for reasons such as pain and the need to save resources of the family. However, this decision is not only unethical but also immoral because many religious beliefs hold that no one has the right to take the life of another person. The dilemma of ending the life of a patient who has authorized their life to be terminated is something that nurses face while trying to administer treatment to their patients. End of life decision making is continuing to be a great dilemma for the nurses because not all cultures and religions accept the action (Menendez, 2013). The healthcare sector is diverse, and coming to a common agreement regarding certain treatment procedures is a difficult task for the health professionals.
The solution to the Ethical Problem
Dealing with ethical dilemmas is something that nurses need to put in practice to avoid legal, ethical, or moral problems brought about by a particular dilemma. Nurses need to understand the uniqueness of ethical problems. Every patient’s case is often unique as their background, such as religious beliefs, and drug addiction may interfere with the decision a nurse takes on their patient. Ethical problems should not be generalized by nurses because each case requires a unique approach to reach a solution (Cook, 2014). Ethical problems also require to be addressed with ethical skills and knowledge acquired through ethical education. The knowledge of ethical education is important in ensuring that ethical problems are solved through standard principles and codes of ethics that govern clinical practices. Resolving ethical problems also require counseling of the parties involved to shed light in the right direction for ensuring a patient’s well-being. Counseling services may be offered by a professional who understands pretty well the issues affecting the patient and his/her family.
Solving ethical problems also requires nurses to reach out to the professional organization for advice on how to handle certain problems regarding patients. Professional nursing organizations often have access to nurse ethicists that can help in addressing the underlying problem for a particular patient. These individuals have deeper experiences that offer insight into certain problems affecting the nurses. While addressing ethical dilemmas in the nursing field, it is also advisable to seek perspective from family members and friends of the respective patient because this may help to offer proper guidance on the final decision that will be made regarding the health condition of the patient. It is also advisable for nurses to speak up when faced with ethical problems regarding the health of a patient (Barry, 2012). Patients expect nurses to be their voice, and whenever they remain silent, they continue to add more problems to the patients. Speaking up to a health profession or family members can be a good beginning to resolving clinical problems and ethical dilemmas around the patient’s condition.
Conclusion
Ethical problems in the nursing field continue to interfere with the practice of delivering quality care to patients. Nurses have to consider the issue of an ethical dilemma with deep concern because it tends to determine their success in attaining patients’ needs. Nurses have an important role to play in understanding ethical procedures in nursing that can assist in addressing patients’ issues promptly. As nurses continue to aim for providing the best form of care to their patients, they should be prepared to face numerous ethical dilemmas that accompany the delivery of health services. Health care departments and health associations ought to join hands in ensuring that caregivers have all that it takes to handle difficult situations between them and their patients. Hence, it is the responsibility of every concerned party to ensure that ethical factors have properly adhered to the health docket.
References:
Barry, M. J. (2012). Shared decision making: Informing and involving patients to do the right
thing in health care. Journal of Ambulatory Care Management, 35(2), 90 – 98.
Cook, W. E. (2014). “Sign here:” Nursing value and the process of informed consent
Plastic Surgical Nursing, 34(1), 29-33.
Lemonidou, C., Merkouris, A., Leino-Kilpi, H., Välimäki, M., Dassen, T., Gasull, M., … &
Arndt, M. (2013). A comparison of surgical patients’ and nurses’ perceptions of patients’ autonomy, privacy and informed consent in nursing interventions. Clinical Effectiveness in Nursing, 7(2), 73-83.
Menendez, J. B. (2013). Informed consent: Essential legal and ethical principles for nurses.
JONA’s Healthcare Law, Ethics, and Regulation, 15(4), 140-144.