ISSUES AND TREND (Essay Sample)

Issues and Trends Name Course Institution Professor Date Issues and Trends Introduction In healthcare, ethical issues arise when the needs of the patients, their families, or the caregivers of the patients are to be met. This paper explores ethical dilemmas in the case of an older woman named Mrs. Nguyen, who has advanced dementia and myocardial infarction and was successfully resuscitated by paramedics. The first ethical conflict is about honoring Mrs. Nguyen's wishes that were outlined in her do not-resuscitate order by denying her daughter any form of aggressive treatment that may save her life. This case raises several important ethical issues involving patient self-determination, family pressure, and the medical team. This paper reflects on ethical principles, nursing values, statutes, and an ethical decision-making framework to mitigate the situation. Main Ethical Issue One of the main ethical dilemmas in the case of Mrs. Nguyen is autonomy versus coercion in her decision-making process regarding end-of-life treatment. Her two sons have decisions to withhold and withdraw life-sustaining treatment, and they have a do-not-resuscitate (DNR) order in Mrs. Nguyen's medical record. Nevertheless, when Mrs. Nguyen falls into critical status, her daughter emphatically asks for her admission to the Intensive Care Unit and the application of all the available life-prolonging measures. This situation presents an ethical dilemma because it involves choosing between two morally acceptable but conflicting options: respecting the patient's right to self-determination and the patient's stated preference and addressing the daughter's preference for aggressive treatment. The healthcare staff must work within the conflict and evaluate ethical aims and principles, including autonomy, beneficence, non-maleficence, legal aspects, and emotions of the family members. Ethical Principles Involved Autonomy This means patients have the legal right to decide on health care matters. In this case, Mrs Nguyen's autonomy is highlighted by her advance care directive, which indicates her preference for do-not-resuscitate orders. This directive is arrived at due to a decision she made when she was in a position to do so. When she can no longer speak for herself, it means recognizing her earlier decisions and preferences (Keatings & Smith, 2009). The omission of this principle would violate her right to self-determination since the directive has been ignored. Beneficence Beneficence entails doing good things for the patient or preventing something bad from happening to him or her. The two sons and the healthcare team also think that moving Mrs. Nguyen to palliative care fulfills the concept of beneficence as it seeks to reduce her suffering and focus on her quality of life in the last days of her life (Keatings & Smith, 2009). This approach takes into account her declining health and severe dementia, meaning that aggressive interventions would only result in her suffering and reduce her quality of life without any benefits. Ethical Theory: Principle-Based Ethics The principle-based ethics theory is the most useful theory for understanding these concerns. This theory consists of the principles of beneficence, non-maleficence, the principle of justice, and the principle of autonomy. The healthcare team should aim to incorporate the following principles into the decision-making process and choose the course of action that will most accurately respect Mrs. Nguyen's autonomy, provide her with the highest levels of benefit, minimize risk, and be fair in its considerations for and treatment of her (Keatings & Smith, 2009). This becomes balanced when handling her case to exhibit high ethical standards. CNO Values and Commitments Client Well-Being: The provision of client care is basic to the practice of professional nursing. It forms an index through which clients' health, comfort, and dignity are maintained and enhanced. According to the well-being principle, the healthcare team working with Mrs. Nguyen should strive to reduce her suffering and increase her comfort as much as possible, given that she is elderly, has dementia, and is in a fast deteriorating health condition (CNO, 2023). The emphasis placed on the provision of palliative care also supports this value, given that it focuses on managing pain and other complications in order to enhance her quality of life in the last few weeks of her life. The CNO standards show that a nurse has to support interventions that would be in the patient's best interest, such as the advance directive for no life-sustaining treatments. Another aspect of ethical nursing practice is respect for a client's right to choose. It entails accepting and respecting the patient's choices relating to their treatment. Mrs. Nguyen does not want to be resuscitated or receive other life-prolonging interventions, as expressed in her advance directive. In this regard, the healthcare team complies with the ethical tenet of autonomy, considering her prior stated preferences as the guide to treatment. As mentioned by the CNO, the nurses must promote the client's self-determination and assist them in making effective decisions concerning their health care (CNO, 2023. Otherwise, in the present case, where the patient cannot make decisions immediately, as Mrs. Nguyen's dementia may suggest, prior advance directives must be followed. CNA Values Providing Safe, Compassionate, and Ethical Care: This value emphasizes the importance of providing care that is not only safe and evidence-based but also person-centered and compassionate while being mindful of the patient's preferences and best interests (CNO, 2023). In Mrs Nguyen's situation, adhering to advance directives constitutes ethical health care and adheres to the client's wishes, hence avoiding any suffering. Preserving Dignity: Respecting Mrs. Nguyen’s right to die with dignity is important in nursing practice because it entails the preservation of her dignity as she succumbs to her illness. Relating to her by abiding by her advance directive is critical in preserving her dignity during this delicate phase of life. Relevant Legislation Ontario's Substitute Decisions Act of 1992 outlines the decision-making process for medical treatment and procedures for those who cannot consent. This legislation also encourages the honoring of advance directives, whereby if the patient was once able to make decisions, his or her decisions must be followed (MAG, 2021). In the case of Mrs. Nguyen, regarding care-making, the Act requires substitute decision-makers (her children) to act by advance care directives that involve DNR and no life-sustaining treatment. The Act gives a legal base to protect patient rights, fulfilling the wishes previously stated, thus actively contributing to the ethical principle of autonomy (MAG, 2021). Although it is stated that the daughter wants her mother to receive intensive care, based on the legislation, the advance directive is the primary document to be considered in decision-making. Decision-Making Framework Using the Nursing Framework: Assessment: Obtain details about Mrs. Nguyen's health state, the advance directive, and her children's thoughts and preferences. Diagnosis: Explain the ethical dilemma and the necessity of a palliative care plan over aggressive care (CNO, 2024). Planning: The plan should consider Mrs. Nguyen...