For example, a nurse has been caring for an elderly gentleman for several months as he has been receiving treatment for cancer. While a nurse might not agree with a patient’s decision, they must support it. As nurses, we must support and advocate for our patients’ rights, including their right to make decisions. Sometimes it can be difficult to see a patient make a decision about their health that the nurse does not personally agree with or that the nurse does not feel is the best decision for that patient’s individual circumstances. This principle is described as an agreement to respect another’s right to self-determine a course of action and to support another’s independent decision making (ANA, 2015). Many of these same standards apply for nurses who are involved in clinical research as they are a way to ensure that people’s rights are protected as guided by specific moral principles. These resources should assist the nurse with their expected behaviors and role within the professional discipline of nursing.Īutonomy, beneficence, nonmaleficence, and justice are four of the basic ethical principles used to guide nurses and clinicians in the care and decision making of patients. Additionally, nurses should refer to the Code of Ethics for Nurses with Interpretive Statements (ANA, 2015). This can be found in the Standards of Professional Nursing Practice from the American Nurse Association (ANA, 2010). Nurses need to possess a basic understanding about the scope of practice and standards of care. The goal of this chapter is to provide a basic understanding about ethical principles and to explore issues surrounding the issues that can arise during end of life decisions in patients who are nearing the end of life. After several evaluations, the child was determined to be medically brain dead, and therefore continuation of medical treatments was considered to be futile. In this case, the family wanted to continue to keep their young daughter on life support which conflicted with what the health care facility wanted. This was evident in the recent national news story about 13-year old Jahi McMath (Fox News, 2013). Other times, the insurance or health care system has specific criteria that may come in conflict with the goals and values of the patient or family. Sometimes, there can be conflicts between what the clinicians believe to be best for the patient and what the patient and family want to have done. In the clinical setting, it is not uncommon to witness conflicts between the patient’s wishes and those of their family. Some of these are related to what kinds of medical treatments they would want to have if they were no longer able to make their own decisions. Often as patients near the end of life, many difficult decisions will have to be made. These are the goals the patient wishes for in terms of their illness. These goals are based on the patient’s moral principles and values. By having an understanding about some of the issues that can arise during end of life decisions, the nursing student or novice nurse can be better prepared for what to expect and how best to handle ethical issues.Īs discussed in Chapter 5, patients’ goals of care are what patients place highest value on and would hope to achieve in regard to their illness. As nurses, sometimes our morals and values are in conflict with those that our patients have, and this can cause some distress for the nurse. There are often ethical issues that can arise in the context of end-of-life care, particularly when patients and families make decisions regarding the care they will accept or not accept.
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