Legal / Ethical Issue Focused On Advocacy and the Role of the Advanced Practice Nurse (Coursework Sample)

Legal/Ethical Issue Focused On Advocacy and the Role of the Advanced Practice Nurse
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Ethical issues in nursing practice underscore the importance of the nursing profession to express their commitment to provide high quality healthcare as well as maintain and improve community health. From a clinical perspective, nursing ethics encompasses the moral behavior of nurses towards patients that aims at improving health outcomes. Professional ethics define the legitimate norms that govern the professional behavior of both nurses and patients (Dehghani, Mosalanejad & Dehghan-Nayeri, 2015). In the recent past, healthcare systems and settings have rapidly changed due to the changing, diverse, and unique health needs of the modern patient. Consequently, the nursing practice continues to be confronted with complex ethical concerns. Using a case study presented in the article “When Doctors and Daughters Disagree,” this paper explores and examines the background of the ethical issue of autonomy, its implications in practice, and the role of the advanced practice nursing in observing ethical concerns such when faced with a similar dilemma.
Background of the Issues Identified
Autonomy is a major ethical aspect in nursing practice. It guides the nurses in acknowledging and understanding the patients’ rights when making critical healthcare decisions. Although patients have the right to be given an informed consent on the kind of healthcare to receive, they can opt to take part in any treatment (ANA, 2012). It is often challenging for nurses to observe autonomy for incapacitated patients who can no longer request or reject potentially life-sustaining treatment. Thus, a formal attempt to protect individuals’ right to autonomy when they are no longer autonomous is enhanced through an advanced directive. Based on this point of view, the assumption is that previously expressed wishes are immutable and precise. Many families make decisions together, but individuals may negotiate, compromise, and adjust their genuine preferences at times when new threats arise (Abadir, Finucane & McNabney, 2011).
Case Study
The case study presented in the article involves two daughters who overruled a patient’s genuine reason to refuse a life-sustaining treatment, resulting in burdensome illness prior to her death. Mrs. GF was an 83-year old woman diagnosed with diabetes mellitus, hypertension, heart failure, coronary artery disease, stroke, amputation, renal insufficiency, cholecystostomy, chronic bronchitis, and biliary drain. Having been enrolled in a program of All-Inclusive Care for the Elderly Day Health Center for several years, she regularly expressed her wishes to decline intubation, but attempted and completed cardiopulmonary resuscitation, where she reconfirmed the relevant documents including the legal advance directives. She designated her elder daughter as her health agent, but requested that the discussion remain private without the knowledge of her daughter.
Mrs. GF was returned to her primary care clinic with acute illness. She was immediately taken to the emergency department (ED) with her advance directives (Abadir, Finucane & McNabney, 2011). Since she appeared septic, the ED personnel requested for the consent from her two daughters to perform intubation, which they agreed despite being aware of the patient’s initially expressed wishes. Mrs. GF appeared agitated after learning that her daughter and the ED physician were planning for intubation. Despite her efforts to reject the treatment procedure, she was intubated and admitted to the intensive care unit. For 22 days, the primary care physicians, hospital, ethics committee, and ICU staff met with Ms. GF’s family regularly. They insisted on continued ventilator support and resuscitation if cardiac arrest occurred. In addition, the family did not refuse hemodialysis when it became medically necessary. Even after 22 days of highly burdensome treatment, the patient clearly expressed her desire to be removed from the respirator, which led to her death within an hour (Abadir, Finucane & McNabney, 2011).
Significance of the Issue
According to the case study, Mrs. GF understood her daughters’ needs and showed her willingness to have those needs met, at least in retrospect. Over years, Mrs. GF expressed her wishes not to be extended medical treatment or be put on a ventilator machine due to the painful experiences encountered by her sister. She also requested that her preferences should not be shared with her daughters. Based on these directives, Mrs. GF clearly understood the implications of her decisions since her wishes were authentic, convincing, thoroughly justified, and consistent over years. Her daughters, on the other hand, did not understand her directives including their implications; hence they thought it was their loving duty to interpret the decisions in the context and on behalf of their mother (Abadir, Finucane & McNabney, 2011).
For several years the primary care team had accomplished their important role to protect Mrs. GF from receiving any treatment against her wishes. The ED physician and her daughters, however, did not respect and acknowledge her wishes to forgo intubation. The decisions made by the ED physician against her preference are a subject of discussion with regards to the ethical issues of advance directive in respect to patient autonomy. While the preferences of family members are likely to be important , it is necessary to acknowledge the possibility of coercion to when incorporating the essence of advance directives during critical and palliative (Abadir, Finucane & McNabney, 2011).
Ethical Theoretical Framework
In Mrs. GF’s case, a major ethical issue is the manner in which a life-sustaining treatment was administered to her against her genuine and immutable wishes. The decision by her primary care team to change their approach towards her life-sustaining treatment, including advance directives, is an issue of ethical concern as far as advanced practice nursing is concerned. Mrs. GF’s initially expressed wishes could have imposed psychological suffering to her daughters because they could have witnessed her death without life-sustaining treatment. The fact that her daughters still approved the administration life-sustaining treatment for Mrs. GF contests her right to autonomy by refusing life-sustaining treatment. It is quite a challenge to determine the extent to which the decisions of her daughters contravene the ethical framework of portray the advance directives by patients suffering from terminal illness.
The case of Mrs. GF and her daughters show how disagreement can arise between two sides of the family. Mrs. GF preferences were protected and excluded from her daughters’ knowledge, which shows her desire to avoid confrontation and conflict. Lack of family involvement in planning for the patients’ advance directives may lead to misunderstanding and non-adherence to the patient wishes on life-sustaining treatment (Nursing World, 2015). Therefore, the decision changes and approach by the primary care team during Mrs. GF’s end-of-life discussions reveals a greater emphasis and influence of family members in the implementation of patient’s advance directives. In particular, the several confrontations by her daughters during her terminal hospitalization could have compelled the primary care team to consider their decisions based on the family consensus, recommendations from other professionals, quality of life, and the patient’s initially expressed wishes.
Implications on Nursing Practice
Mrs. GF case offers a critical insight about ethical issues of advance directives that can have significant implications towards the nursing practice. First, the primary care physicians (PCP’s) consistently protected Mrs. GF’s advanced directives from unwanted treatment over years without involving her daughters. Although the PCP’s protected Mrs. GF’s right to privacy, it was ethically wrong by failing to make efforts t encourage and inform her on the benefits of involving her family members into her routine discussions of advance directives. This may have helped to avoid misunderstanding between Mrs. GF and her daughters, as well as mitigate any non-adherence treatment against her wishes (Nursing World, 2015).
During planning and implementation of patient’s advance directives, a patient-centered collaborative decision making is necessary. It helps to substitute the decision-making with the knowledge of the patients while maintaining the authenticity and autonomy of the patient’s values and interests. Mrs. GF’s case was unethically handled during her end-of-life discussions. When immediate high-stakes decisions were needed, the available information was limited. Therefore, the substitute decisions seemed to have acted prior careful philosophical analysis of whether the daughters’ devotion intubation was the right thing or not. If the daughters had been involved in planning, a collaborative decision-making would have been developed to avoid unethical interference of the patients. Interference occurs when nursing care procedures are too intrusive to the extent that they affect the patient’s privacy (LaSala & Bjarnason, 2010).
Advance care planning is meant to prepare patients and surrogates to participate with clinicians in the making the best possible ongoing medical decisions. However, the physi...