Nursing Practice: Concepts And Perspectives - A Discussion Of The Four Ethical Principles

Respect for Autonomy

Discuss About The Nursing Practice Concepts And Perspectives.

The healthcare practice experienced challenges in seeking the voice of the patient where practitioners made decisions on behalf of patients involving their care as long as they observed it as necessary and demanding. Beauchamp and Childress four ethical principles provide legal and ethical considerations important to the medical fraternity in their day-to-day operations. The four principles involved in their reflection include the respect for autonomy, nonmaleficence, beneficence, and justice. The paper uses the case scenario to examine the application of the four principles in the discussion given in the video concerning patient decision making.    

The principle surrounds the understanding that that persons are responsible for what they do and the ultimate action taken amounts to a product of own choice. The principle informs the basic freedom at the heart of humanity that guides the respect for autonomy and thus guaranteeing an individual to be informed of any action and thus seek permission from one before carrying out an action. In healthcare, it is important for a patient’s voice to be considered whenever a given operation is to be done or in worse cases involve immediate persons to the patient in decision making in cases where one cannot talk or be able to give consent (Nieswiadomy & Bailey, 2017).

According to the principle, any notion of moral decision-making considers the involvement of the parties involved in making voluntary and informed decision on a given matter. The case involves the informed consent aspect based on the choice to convene a meeting between the medical representative and the husband to the patients as well as the daughter who at the time remain representatives of the patient (Blais, Hayes, Kozier, & Erb, 2015). The event involves a case where the patient is on a high-dependency machine and needed that rendered her unable to make the prime decision concerning her healthcare situation.

 As such, the involvement of the immediate party in the decision that supports comfort and best experience of the patient was presented before the family members. Therefore, the choice to involve the persons responsible for the patient protected the right to informed consent in patient healthcare delivery. In previous circumstances before the coming of the principle doctors used to do whatever they deemed good for the patient involving ending lives through stopping of the life support machines for patient’s comfort through end of suffering (Gillon, 2015). However, the case presents the reform that includes seeking patient’s voice in decision making aspects concerning one’s healthcare.

Beneficence

The responses given by the daughter represent the wishes of the mother who preferred not to be supported by machines in the wake of pain but rather opt for end of life which is highly disputed by the husband. Despite the indecisive and sharp reaction from the husband on the matter suggesting end of suffering and pain on the patient, the respect for autonomy is observed and evident in the practitioners step in seeking consent from the persons responsible since the patient was not in a position to offer the consent given the nature of condition presented.    

Beneficence refers to acting in best interest of the other parties in a given condition. In reflection to the healthcare system, individuals are advised to act responsibly considering the interests of the other party in question concerning good health and expenditures involved therein. According to Beauchamp (2016), healthcare providers have a duty to remain of benefit to the patients and take positive moves towards preventing and removing harm in the way of a patient. A patient seeks medical services and thus trusts the doctor to provide the best service that would leave one feeling better and hence becomes a part of the process that needs serious consideration.

The case scenario justifies the application of the principle as observed in the action of the practitioner seeking to divulge information to the immediate family on the need to change treatment to subject the patient to a more sound care pattern. In the information, the individual cites the present condition of the patient as dire considering the pain involved and suggests the end of life choice that would cease the pain of the patient as opposed to maintaining the present state that would continue to be painful on the side of the patient. In the present case, the state of the patient according to the practitioner continues to worsen and registers no improvement and the more one remains on the support machine the more the costs incurred rise. Therefore, it is evident that the practitioner acts in the best interest of the patient and the immediate family.

On the other hand, the patient comfort is considered given the indication on setting the best act towards maintaining a comfortable experience on the side of the patient. The doctor acknowledges that they are doing their best to keep the patient out of pain as well as preserve the life of the party involved. Moreover, the practitioner suggests the involvement of another doctor that has not had experience on the patient to offer a consultancy on a different treatment procedure that might save the patient from the pain. The consideration acknowledges the good will of the individual in driving benefits to the patient in terms of healthcare to offer a better feeling. Despite the reaction and non-decisive nature of their engagement, the option seems viable in tackling the fears of the husband and avoiding the end of life procedure that seems unethical and non-legal to the husband.     

The Principle of Nonmaleficence

According to Ebbesen (2016), acting in the best interest of the patient remains a serious principle in healthcare. Individuals entrust health providers to take care of their medical condition and deliver the best result within the shortest time and in the best means possible. The recovery of patients depends on the efforts placed by health providers and the willing nature bound by professional ethics to deliver benefits to persons involved.  The physicians’ intervention in providing the option for another consultant in the case of the patient provides a willing spirit towards providing benefit to the patient as opposed to the monetary value that the facility can get from the prolonged stay. As such, the considerations remain evident in the case thus proving the application of the same towards an improved experience. 

The principle requires individuals to avoid intentional affliction of pain or harm to the patients in their actions or events involved in the treatment of patients. An act is considered neglect if one was in a position to prevent a situation from occurring that may render a patient in dire pain or negative experience in line with getting better (Ebbesen & Sundby, 2015). Thus, the provision of a proper standard of care is needed in minimizing the risk of such occurrences. The principle affirms the need for medical personnel to remain competent and focused to their call to service delivery through prevention of harm and increasing better experience for patients.

The case presents a situation where a patient is in pain despite the efforts employed by the practitioners in keeping her away from the pain. Consequently, acting in the best interest of the patient, the individuals seeks the decision of the immediate family in determining the next course of action which involve the removal from the life supporting machine to completely end the pain. However, the decision means end of life for the patient which is highly disputable by the husband. In remaining responsible and acting in favour of the patient, who in the present condition seems not to improve and in pain, the option of removal from the support machine seems viable and in the best interest of the patient. The decision to keep the patient in the support given the pain endured would amount to a continuation of life but then increase the cost of medical facilitation as well as the painful experience on the patient with no further hope towards recovery.

The daughter to the patient notes of the wishes of the mother to have a painless experience and opts for end of life in a situation where little hope exists in further medical procedures. The narrations offers the feelings of the mother and the wishes that would be expressed by one were the patient in good condition to offer consent on her case. In goodwill and support of lesser pain subjected to the patient, the doctor recommends a change of professional handling the patient by exploring the services of an independent practitioner to trace the history and try to recommend a treatment that might end or lessen the pain experienced by the patient (Gillon, 2015). The act of seeking consent as well as that of exploring the option of an independent doctor to examine the case presents the application of the principle of nonmaleficence in the case scenario provided. The doctor would not be acting in the best interest of the patient by continuing with the treatment which continues to subject the patient into pain and thus had to intervene to avoid subjecting the patient into more pain.          

The principle of justice is applicable in the healthcare system where each patient needs to be treated fairly in increasing their experience. Healthcare operates with limited resources thus limiting the ability and capability of practitioners to fully dispense their service towards delivery of improved healthcare (Walter, 2017). It is common to note insufficient number of doctors, beds, nurses, and medication in a given facility. The principle of justice determines the priority and right to accord each a specialized care given the nature of care a patient requires (Matwick & Woodgate, 2017). In line with the considerations by Beauchamp and Childress, an observation on the resource distribution and affording care to patients in a just nature is essential.

The case scenario presents a patient whose care and medical support yields no hope for further recovery and total healing of the patient from the medical condition. As such, the principle of justice applies in subjecting or seeking further patient support towards bettering the condition. In this case, the patient is to be accorded specialized care in the same or different facility in trying to find the perfect match and experience that would positively alter the condition of the patient. The options explored in such a case ought to lead towards best care and experience of the patient as well as cumulative expenses on the side of the family members.

The justice principle is applicable and evident in the case represented by the practitioner’s suggestion to seek the services of an independent specialist in re-examining the situation of the patient as well as the history in the process of finding the best care for the patient. In consideration of the fact that the facility might be lacking the necessary personnel, the suggestion pointed towards a better professional experience that would change the case of the patient. The suggestion is offered in light of providing the best care and reducing the pain experienced while limiting the options of ending the life. The option comes after the sharp criticism by the husband to the patient who perceived end of life suggestion as a deliberate option to separate him from the wife regardless of the pain. The husband opted to have the wife kept alive through all other options possible. As such, the suggestion once adopted would offer justice to the patient with the hopes that a specialized care or an independent observation might lead to a change in the condition.       

Conclusion

Beauchamp and Childress principles act in good faith to the medical fraternity which previously remained out of consideration. Doctors used their experience and intuition while ignoring the desire and voice of the patient in medical care. The four principles lead to better experience as observed in their practicability and evident nature in the case. Respect for autonomy has been justified through the seeking consent from the family members, nonmaleficence observed through seeking specialized care and option for end of life procedure, beneficence achieved through specialized care option by an independent professional, and justice by according the patient access and possibility of referral to specialized unit where better resources can manage the case.    

References

Beauchamp, T. L. (2016). Principlism in Bioethics. In Bioethical Decision Making and Argumentation (pp. 1-16). Springer, Cham.

Blais, K., Hayes, J. S., Kozier, B., & Erb, G. L. (2015). Professional nursing practice: Concepts and perspectives (p. 530). NJ: Prentice Hall.

Ebbesen, M. (2016). Clinical Research & Bioethics.

Ebbesen, M., & Sundby, A. (2015). A Philosophical Analysis of Informed Consent for Whole Genome Sequencing in Biobank Research by use of Beauchamp and Childress’ Four Principles of Biomedical Ethics.

Gillon, R. (2015). Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics. Journal of medical ethics, 41(1), 111-116.

Matwick, A. L., & Woodgate, R. L. (2017). Social justice: A concept analysis. Public Health Nursing, 34(2), 176-184.

Nieswiadomy, R. M., & Bailey, C. (2017). Foundations of nursing research. Pearson.

Walter, R. R. (2017). Emancipatory nursing praxis: A theory of social justice in nursing. Advances in Nursing Science, 40(3), 225-243.