Ethical Framework Essay
Consider the “Four Topics Approach” (or Four Box method) to ethical decision making on Table 2.1 in Butts (below). Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.
In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?
Your paper should be 1-2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.
Review the rubric for further information on how your assignment will be graded.
TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases
Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?
Source: Jonsen et al., 2010
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Solution
Ethical Framework Essay
One of the most challenging situations in my nursing career that required me to consider ethical dimensions was when I attended to an 80-year-old woman suffering from stage IV cervical cancer. I needed to consider different ethical dimensions related to the patient’s care when attending to the patient.
Medical Indications: The Principles of Beneficence and Nonmaleficence
- What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
The patient’s medical problem was stage IV cervical cancer which can be classified as a terminal disease. In stage IV, cancer means that cancer will have spread in an individual’s body to other parts of the body and organs of an individual, making it difficult to treat.
- What are the goals of treatment?
The goals of treatment for stage IV cervical cancer include controlling symptoms and improving a patient’s quality of life, and stopping cancer growth in some instances.
- In what circumstances are medical treatments not indicated?
For patients with stage IV cervical cancer, medical treatment is not indicated when cancer has spread extensively to major organs.
- What are the probabilities of success of various treatment options?
For patients with stage IV cervical cancer, the probability of success of various treatment options such as chemotherapy are low because cancer has already metastasized to major organs.
- In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Stage IV cancer patients can benefit significantly from medical and nursing care, especially through receiving counseling services to avoid trauma from the diagnosis and the various treatment procedures such as surgery that may be associated with the diagnosis. The provision of a non-judgmental environment for the patient and consistent therapeutic communication can also help significantly to improve the health outcomes of the patient. On the other hand, harm can be avoided on the eight-year-old stage IV cancer patients by avoidance of unnecessary treatments that can negatively affect the patient’s quality of life while not providing the patient any benefits as a result of the significant advancement of their cancer Guidolin et al., (2021). For instance, chemotherapy may not be preferred for the Stage IV cancer patient due to the significant harm it could cause on the patient while also having less impact on the improvement of symptoms related to the patient.
Patient Preferences: The Principle of Respect for Autonomy
- Has the patient been informed of benefits and risks, understood this information, and given consent?
For the case study involving the 80-year-old female patient suffering from stage IV cancer, they were advised on the risks and benefits of any form of treatment such as chemotherapy. The patients were therefore educated on how chemotherapy would affect them and were given space to decide whether to begin chemotherapy treatment or to forgo treatment and receive less engaging treatments to improve their daily life.
- Is the patient mentally capable and legally competent, and is there evidence of incapacity?
The 80-year-old female with stage IV cancer was legally competent and mentally capable of making informed decisions. This is because the patient did not show any form of mental incapacity or impairment of thoughts.
- If mentally capable, what preferences about treatment is the patient stating?
In the case study, the eight-year-old patient highlighted that she did not want to go through chemotherapy as her cancer had already spread to different organs and that what she needed was a treatment that would improve her quality of life and extend her life. The patient stated that she did not want to go through chemotherapy as such treatment was risky, and she had no chances of controlling cancer which had advanced significantly.
- If incapacitated, has the patient expressed prior preferences?
Because the eight-year-old patient with stage IV cancer was not incapacitated, she had not expressed any prior preferences.
- Who is the appropriate surrogate to make decisions for the incapacitated patient?
Patient’s children
- Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
The eight-year-old patient with stage IV cancer was, therefore, unwilling to cooperate with medical treatment because she did not believe it would make her better in any way but would only cause severe side effects on her.
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
- What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
Considering the condition of the eight-year-old patient with stage IV cancer, the prospects for a return to normal life with or without treatment were significantly low. It will therefore be difficult to try and cure stage IV cancer that had already spread to major organs using chemotherapy, with the management of symptoms being the major priority.
- On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
A third party can judge that the quality of life is undesirable for a patient who cannot express such a judgment in cases of patients who have lost consciousness for a long time (Forte et al., 2018). Patients who have stayed on life support for long periods of time require Third parties such as close family members to assess their quality of life and determine whether it’s desirable.
- Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
Different prejudices can affect providers’ evaluation of patients’ quality of life, such as considering a patient’s diagnosis.
- What ethical issues arise concerning improving or enhancing a patient’s quality of life?
The ethical issues that arise in relation to improving and enhancing the patient’s quality of life are related to beneficence and nonmaleficence.
- Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
Quality of life assessments determines different issues, such as assessing the treatment plan and administering life-changing treatment to patients.
- What are plans and rationale to forgo life-sustaining treatment?
The rationale and plan to forgo life-sustaining treatment would involve instances where patients would have a poor quality of life and would not have any chance of recovery.
- What is the legal and ethical status of suicide?
Physician-assisted suicide is illegal in some states, where it is still illegal in others. On the other hand, the practice is mainly viewed as unethical because the main role of healthcare providers is preserving life and not assisting patients in taking their own life (Gornick & Zikmund-Fisher, 2019).
Contextual Features: The Principles of Justice and Fairness
- Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
There are different interprofessional professional and business interests that might create conflict in the clinical treatment of patients especially related to health insurance and reimbursement. In some instances, health insurance providers may fail to reimburse certain treatments for patients affecting the whole treatment process (van Bruchem-Visser et al., 2020).
- Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
Family members and insurance providers might have an interest in clinical decisions due to various reasons.
- What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
Generally, patient confidentiality is protected from any third parties; however, insurance providers may sometimes access patient information during reimbursement to assess the need for reimbursements of certain treatments.
- Are there financial factors that create conflicts of interest in clinical decisions?
Financial factors can create a conflict of interest in clinical decisions, especially in instances where a patient cannot be able to afford certain recommended treatments.
- Are there problems of allocation of scarce health resources that might affect clinical decisions?
On the other hand, instances of allocation of scarce resources can affect clinical decisions, especially in healthcare facilities that do not have adequate resources and a high number of patients (van Bruchem-Visser et al., 2020).
- Are there religious issues that might influence clinical decisions?
Religious issues such as the prohibition of certain treatment approaches in a given religion can influence clinical decisions significantly.
- What are the legal issues that might affect clinical decisions?
Malpractice laws can significantly affect clinical decisions
- Are there considerations of clinical research and education that might affect clinical decisions?
Considerations of clinical education and research can affect clinical decisions because health care practitioners will favor evidence-based practices compared to those that are not supported by evidence.
- Are there issues of public health and safety that affect clinical decisions?
Different issues of public safety and health care affect clinical decisions, especially in instances where a certain treatment is not approved for general public use and is only experimental.
- Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?
Issues of conflict of interest between organizations can affect clinical decisions, especially in instances where institutions want to be more efficient and save on costs (Gornick & Zikmund-Fisher, 2019).
References
Forte, D. N., Kawai, F., & Cohen, C. (2018). A bioethical framework to guide the decision-
making process in the care of seriously ill patients. BMC medical ethics, 19(1), 78. https://doi.org/10.1186/s12910-018-0317-y.
Guidolin, K., Catton, J., Rubin, B., Bell, J., Marangos, J., Munro-Heesters, A., Stuart-McEwan,
T., & Quereshy, F. (2021). Ethical decision making during a healthcare crisis: a resource allocation framework and tool. Journal of medical ethics, metaethics-2021-107255. Advance online publication. https://doi.org/10.1136/medethics-2021-107255.
Gornick, M., & Zikmund-Fisher, B. (2019). What clinical ethics can learn from decision science. AMA Journal of Ethics, 21(10). https://doi.org/10.1001/amajethics.2019.906.
Van Bruchem-Visser, R. L., van Dijk, G., de Beaufort, I., & Mattace-Raso, F. (2020). Ethical frameworks for complex medical decision making in older patients: A narrative review. Archives of Gerontology and Geriatrics, 90, 104160. https://doi.org/10.1016/j.archger.2020.104160