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Myra Cabus

Grace Kim
Clarissa Pak
Asherly Silva
Ray Velasco
NURS 211
March 14, 2013
Dr. Paulette Williams
Ethics Presentation
Ethical dilemma case three is of a 45 year old female who decides not to have live saving
treatments against the advice of her medical team. Ethical principles to be discussed will focus
on the patient, autonomy, and the nurse, beneficence and nonmaleficence (Giddens, 2013). A
nurse is obligated to adhere to these principles, but they can be contradictory. What should a
professional nurse do in this situation?
Patient autonomy is the right to self-determination (Cherry & Jacob, 2011). The patients
own refusal for life-sustaining treatments is evidence of patient autonomy; However, it creates a
dilemma when a medical team is aware of and has faith in the medical advances to preserve life.
Beneficence an ethical principle stating that one should promote goodness, kindness, and
charity and prevent or avoid doing harm (Cherry & Jacob, 2011). Nonmaleficence is a principle
stating the duty not to inflict harm (Cherry & Jacob, 2011). The patients refusal to lifepreserving treatment creates an ethical dilemma because it goes against the main ethical
principles of nursing. Even though the nurse knows the significance of the treatment, he/she must
respect the patients autonomy.
According to McGowan, C. (2011), nurses are at the forefront of the healthcare team and
assisting with end-of-life care is an important component of a nurses skill set. Nurses most
often facilitate the discussion involving end-of-life decisions and in the case of patients who have
some cognitive impairments, nurses are in the best position to assess the patient and their ability

to understand the problem, evaluate options for treatment, and communicate any concerns
(McGowan, 2011). If a patient is incompetent, the nurse assists the surrogate in comprehending
those same issues while still honoring the patients wishes. As stated by McGowan (2011), in
the situation when an consensus for end-of-life care cannot be reached, resolution in the court of
law may be necessary.
In one article, Smith (2012) discusses a number of cases where patients have changed their
minds after signing an advanced directive but physicians refused to comply with the patients
new treatment wishes because they are now considered ill. Smith argues that if they are still
able to make rational decisions, they should be allowed to change their advanced directives.
Also, a question that is commonly brought up is whether patients with an altered level of
conscious should be allowed to change decisions made by their earlier, fully functioning self. Is
it okay to let them change their mind? Is it considered unethical to deny their wishes because
they have an altered level of conscious? Lastly, many patients are not fully informed of all of
their healthcare options, and are left to write an advanced directive without a providers input
and recommendations. There are always new information being discovered, and Smith says that
it isnt fair to leave vulnerable patients to their fate because they are incapable of correcting an
earlier decision which, with the passage of time, now appears mistaken. In the case presented to
us for our presentation, the patient had made an informed decision.
Hopefully this gives insight on an issue that may be encountered as a nurse. Principles
may be used to gain clarity on a situation, but their limitations should be understood. For
example, the principle of autonomy shouldnt be used to rationalize a hands-off approach, when
more information and better communication may result in a plan of care that is acceptable to
both parties.

References

Cherry, B., & Jacob, S.R. (2011). Contemporary nursing, issues, trends, & management. (5 ed.).
St. Louis, MO: Mosby
Giddens, J. F. (2013). Concepts for nursing practice. St. Louis: Mosby Elsevier.
McGowan, C. M. (2011). Legal Issues. Legal Aspects of End-of-Life Care. Critical Care Nurse,
31(5), 64-69.
doi: http://dx.doi.org.ezproxy.library.kapiolani.hawaii.edu:8080/10.4037/ccn2011550

Mitchell, M. (2012). An analysis of common arguments against advanced directives. Nursing


Ethics, 19(12), 245-251. Retrieved from
http://web.ebscohost.com.ezproxy.library.kapiolani.hawaii.edu:8080/ehost/detail?vid=2&
sid=82aebd1f-764f-4727-81ce0c7768d61700@sessionmgr14&hid=27&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZ
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