Kevin Jones is a farmer in his mid seventies. He is married to Dawn and has two children, Bronwyn and Daryl. Dawn has experienced a massive stroke three weeks ago and is now unconscious. Her condition continues to deteriorate and the nurse has initiated a family conference to discuss the next stage in her care plan. Kevin, Bronwyn and the nurse have a heated discussion about their ideas around Not for doing CPR. We have an obligation to respect the autonomy of dawn, Bronwyn and there father Kevin Jones which is to respect the decisions made by other people concerning their own lives. This is also called the principle of human dignity. It gives us a negative duty not to interfere with the decisions of competent adults, and a positive duty to empower others for whom we’re responsible. All we can do is listen to what each person have to say and what there worries and concerns are and help to explain when needed. Later in the essay we will be talking about the 4 principals of law and ethics and they are Autonomy – respect for the patient’s right to self-determination
1. Beneficence – the duty to ‘do good’
2. Non-Maleficence – the duty to ‘not do bad’
3. Justice – to treat all people equally and equitably
The principle of autonomy is the individuals have to be permitted personal liberty to determine their own actions to. This means to respect an individual as self-controlled chooser. With in health care respecting people’s autonomy requires us to consult people and obtain their agreement before we do medical procedures on them as in the case with Dawn, hence the obligation to obtain informed consent from patients before we do any medical procedures to help them. Across the common law world there has long been recognised “a competent adult’s right of autonomy or self-determination: the right to control his or her own body.” in accordance with that right: A competent adult is generally entitled to reject a specific treatment or all treatment, or to select an alternate form of treatment, even if the decision may entail risks as serious as death and may appear mistaken in the eyes of the medical profession or of the community … it is the patient who has the final say on whether to undergo the treatment. This common law right has been recognised as an aspect of a number of fundamental human rights, including the right to privacy, security, and protection from cruel, inhuman or degrading treatment.
Beneficence and Non-maleficence
If the scenario is analysed, and the family’s decision consideration, a question arises about the intentions of the family. However, if the intensions are good then this act takes us towards the ethical principles of beneficence and non- malificence. The ethical principle of beneficence requires healthcare professionals to treat their patient in the same way as they would with others to maximise that patient and the principle of non-malificence assures the duty staff to avoid causing any harm to the patient. The principle of non-maleficence in doing no harm to Dawn. This means that it is the responsibility of the healthcare professionals to protect their patients. This goes along with the ethical theory of utilitarianism which believes in the actions that provide the greatest good for the greatest number of people. In healthcare ethics, utilitarianism supports the idea of maximum benefits and minimized costs and risks. The two principles of beneficence and non- maleficence often go simultaneously hand in hand. However, they may override each other at times.
The principal of autonomy often comes into conflict with the principle of beneficence. In this situation, intentionally or unintentionally, healthcare professionals use paternalistic approach while caring for their patients as they consider that approach as useful for their patient. Though the intervention seems useful for the patient, yet it breaches the autonomy of the patient by disrespecting the right of her decision in the treatment. It is important to note that while situations like these require healthcare professionals to critically analyze the risks and benefits associated with the choices that they make, in the process of choosing the best option, the entire situation along with its consequences should be taken into account, well discussed and planned so that the decision made should promote maximum beneficence and minimum or no harm with respect to autonomy.
Conclusion To sum up, There seems no perfect answer to an ethical dilemma. The paper has discussed the application of the ethical principles in the given situation. It is hard to justify the use of one principle over another. Yet the ethical decision making process provides a guide to take a step ahead and apply the best possible principle. However, it may not be the perfect choice but it may result in maximum beneficence and minimum harm which could be avoided. The framework that guides nursing practice for Nurses Association code of ethics and the patient bill of rights should also be taken into consideration while deciding for the best choice in situations which give rise to an ethical dilemma. Nevertheless, in any such situation, pros and cons and risks and benefits should be weighed against to get to the get best possible solution which would be in favor of the patient.
The fourth ethical principle, justice, means giving each person or group what he/she or they are due. It can be “measured” in terms of fairness, equality, need or any other criterion that is material to the justice decision. In nursing, justice often focuses on equitable access to care and on equitable scarce resource allocation. So with the family they will need to all be treated the same and each have the right to say what they need to say. Nurse can offer the same support to dawn’s husband and kids.
When life support first came out, it was perceived as something good, special and a real life-saving procedure. These days, people are divided between different ethical issues, especially with the number of landmark cases that fuelled debates to be carried on until today. Some of the concerns being raised include:
– Quality vs. the quantity of life: It may be true that life support can prolong the life of Dawn, but are they really living without the discomfort or indignity? Are Kevin and his children’s really thinking about the welfare of their mum/wife or simply holding on to the hope of a full recovery?
Giving doctors autonomy: If family members answer yes to a doctor’s question of “do you want us to do everything”, they are highly likely to be setting themselves up for unethical practices. Although doctors are bound by their ethical and legal obligations to provide treatments in the context that can best help the Dawn and their families, some make decisions without consulting surrogates, while others don’t even provide a clear and comprehensive explanation as to what is really involved in the process.
Withholding and withdrawal of life support: When is enough? The principle behind withholding and withdrawal of life support states that treatment may not be initiated if the patient or surrogate refuses. There have been cases, however, when physicians suggest for treatments to be withdrawn, but family have strongly disagreed. Care of the unconscious patient Dawn highlights many ethical dilemmas that face modern society. Most unconscious patients either die or recover mental function within a few days, and this rapid resolution avoids appreciable ethical problems. Many, however, linger for months or years in the vegetative state in which the eyes usually open but the Dawn remains unaware of her environment; this vegetative state, together with prolonged coma and other related conditions, has recently been designated permanent unconsciousness. Still other patients regain consciousness, but with only the rudiments of psychological awareness. All these patients pose particularly troublesome ethical issues: the problem, stated simply, is whether to limit life sustaining treatment for a patient who cannot participate in the decision. In this case Dawn have had a stroke and is in a coma and her condition continues to deteriorate and is unable to speak on her behalves this is where her family comes in and makes a decision on her medical treatment I to continue on or to stop.