This is a solution of Nursing Practices Assignment which discuss ethical principles in nursing and the conflict between these principles and the legal aspects.
The case suggests that the Patient of 70 yrs of age, Vicky stays with her daughter Helena. Vicky is an immigrant 20 years back however her inability to speak in English is been made the chief translator in the case where Vicky had to express her condition to others. Vicky was been hospitalized after she has down with fever, cough that had blood in the mucous and a shortness of breath. The Doctor found her to be pale, hypertensive and tachycardia whereby she was hospitalized soon after with an Ambulance service. The treatments were given in an emergency basis to make Vicky comfortable, but the further diagnosis on the patient showed that she had cancer and needed immediate treatment that may extend her life expectancy. However, Helena the daughter of the patient did not with her mother to go through the traumatic experience but wished she die peacefully.
Ethical Problem and Dilemma
The Ethical problems and dilemma for the case are been elaborated has been identified. Vicky was admitted to the hospital with fever, shortness of breath and blood in her cough mucus. The condition was made stable and comfortable with emergency treatments with oxygen, blood test, and chest x-ray followed. Nevertheless, the care provider asked Vicky about her experience in the clinic but discovered that she was unable to speak English. With an interpreter, it was discovered that Vicky was longing for her home and she wished to live a longer life. However, the first mistake committed by Ben was that she did not document the patients will in the first place which he decided to do a day after(Nmc, 2015). While documentation of the patients will her desire to go back home and a wish for longer life was omitted. The chest and blood reports suggested that she was suffering from lung tumor which caused the problems. The cancer health care facilities were good that’s why the lung cancer was detected where the Doctor’s opinion was that she could have a longer life if the treatments were done. However, the daughter Helena decided that she would not like to have any further treatment for her mother and wished Vicky a peaceful death as the treatment was long and distressing.
The daughter, however, wanted to keep it away from the patient’s knowledge with a request to not give her active treatments that way prolong her life. The wish of the Patient Vicky was to have a longer life which the entire point missed. The next morning the patient was on morphine for a stable breathing, but the Doctors insisted that the patient had only 24 hours to live. The ethical point of the wish of the patient was overlooked here where the daughter wished that she would not let her mother the trauma to treat cancer but would rather let her die peacefully. The ethical view would suggest that the patient had the wish to go back home and get a longer life which were both missed in the process. Ben, the care provider remembered that that this was not Vicky’s with to die so soon. However, Ben was unsure if the patient wished to die early or as per will and since she had Dementia she was reluctant to decide whether Vicky should die given the treatment or be left to die as per her daughter’s will. Since the patient was seduced in morphine, during the change of shift Ben was unsure if the patient was to be left in the same way where death was evident in next 24 hours or the treatment should be on. Hence, the will of the patient was not taken into special consideration which asked for a longer life but it was addressed as per her daughter’s will. This dilemma was a great one as the patient was not informed about her case. The patient being unaware of the lung cancer could not make a decision and was left to die.
Ethical Principles for the case
The patient Vicky was unaware of her condition so she had no say about it. The Ethical principal suggests that the patient’s decision is of prime importance in ethical decision making their treatment. Since the patient’s daughter wanted her to die peacefully the needed procedural requirements were bypassed. Since the patient had dementia the conclusion was drawn that she would not understand the cancer treatment processes. This was another breach as the care providers had to explain it to the patient without a preconceived notion that a person with dementia would be unable to understand and give a concrete feedback about her own will and wish. The treatment staff did not put down the patient will live longer in the log as he was in haste. These ethical and procedural mistakes made the problem acute(Nursingworld.org, 2015). The ethics suggest that the patient should be the one to decide about the future treatments when the cause I been explained to them. Further, the notation of the patients will be missing too in the case which presented another dilemma as it was hazy from the log about how the patient expressed her will and want. From the management’s part, it was needed to give both the mother and daughter an idea of the life expectancy of the patient with proper treatment. The medical staffs kept quite after a request from Helena, which again is a great ethical mistake committed(Nmc.org.uk, 2015).
Conflict of Ethical Principles
The conflicts of ethical principle are in the case are evident when the patients records were not been documented at the very first go. The belief that the patient had dementia was another major mistake which dis- allowed the communication in the first place about the patient’s condition and treatment formulation for the best of patient’s health. Although the cancer treatment was traumatic, the will of the patient to go back home were being missed in the decision making as well as longer life expectations and will be been subdued in this case. Further, it was the ethical duty of Ben to have explained it to the patient and not take Helena’s words and decision as final. The delay in the documentation of the will of the patient was another that had to be done with no further delay as it would have paved the road for Vicky’s treatments for the Lung cancer, further(Chally & Yorker, 1989).[ See Rural Health Nursing]
The legal principals suggest that the will of the patient is final and that they are to decide upon their future health care needs. The words of Helen are not final in this case legally so this was one of the breaches of legal principle(Radzyminski, 2007). Ben did not note the patients will on time who had dementia so the actual will of the patient got subdued in the process, legally which is not been permitted. Nevertheless, the patient who had lung cancer that was curable was not being touched due to the patient’s daughter’s will. The curable diseases that may give a patient a longer life with proper medication were not undertaken. A legal mistake was committed since the patient wished to have a longer life which the non-treatment made worse were the expectancy of life for Vicky was reduced to 24 hours(Vidder, 2015).
Options and Possibilities of Ben
Ben should have documented the will of the patient before forgetting the same so he should have noted it down. The same would have made a ground for the medical staffs to ensure that the patient can return home with a completed treatment and thus a longer life. The option for Ben was to convince the patient’s daughter that the full treatment would enhance the life expectancy of the patient. This led to the outcome of the dilemma where the patient was ‘left to die’ without the necessary procures to cure the ailments fully(Icn.ch, 2015).
Actions required of Ben
A thoughtful Nursing Management is required for this case. The action of should have been to convince the daughter, Helena that the trauma would be worst like death within 24hours if the treatment were not provided. The cancer treatment was an issue that Helena feared of but convincing her that her mother wished to have a longer life would have made the decision making easy for the daughter. The dose of Morphine was not the solution which led to patients’ temporary well-being(Nortvedt et al., 2011). The Dementia was not the matter that should have stopped Ben from going ahead with the decision of full treatment. Again, Ben should have ensured that the patient is ready for the trauma of further treatment so that the daughter had a better choice to take instead of letting the patient die without even letting her know that she had cancer and it was curable.
The ethical perspectives of the treatment are been discussed as in the case where the dilemma of the provider and client shows a significant gap. The best way forward was to inform the daughter that her mother wished to live longer and thus convince her in the processes needed for cancer treatment, and the legal discourse in the same matter. The procedural mistake is evident where documentation was not done while the excuse of dementia too is not the blocking factor for the full treatment of cancer that could have made the wish of longer life possible for Vicky. [ Also read Civil Engineering Assignment]
- Chally, P., & Yorker, B. (1989). Legal Parameters for Expanded Roles in Nursing. Journal Of Neuroscience Nursing, 21(4), 258-260.
- Health Care Ethics Lessons from Intensive CareHealth Care Ethics â€“ Lessons from Intensive Care. (2005). Nursing Standard, 19(31), 36-36.
- Icn.ch,. (2015). CODE OF ETHICS FOR NURSES. Retrieved 5 December 2015, from http://www.icn.ch/who-we-are/code-of-ethics-for-nurses/
- Nmc.org.uk,. (2015). The Code for nurses and midwives. Retrieved 5 December 2015, from http://www.nmc.org.uk/standards/code/
- Nortvedt, P., Hem, M., & Skirbekk, H. (2011). The ethics of care: Role obligations and moderate partiality in health care. Nursing Ethics, 18(2), 192-200.
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