Bioethical Issues in Nursing Practice

Ethics is a discipline in philosophy pertaining right and wrong, good and bad- of the all life in a community; and bioethics is application of these ethics in the field of healthcare and medicine. Bioethics is a multi-disciplinary that blends history, philosophy theology, health policy, nursing, medical humanities and medicine law. It is concerned with life questions, on basic human values like; rights to health and life, wrongness or rightness of health developments, health professions, and medicine and life technology. It is comprised of difficulty ethical questions for everyone; hospitals, families, civilization and government. One of the bioethics that has always been controversial is abortion, where the religion, society, government and medics argue on it, some against it while others favoring it (“‘Complementary & Alternative Medicine’ (CAM): Ethical and Policy Issues,” 2014).

According to Barry, Vincent, (2014), abortion is termination of pregnancy either accidentally (miscarriage) or intentionally; abortion caused by incest, health concern to baby or mother and rape consist 7% the rest are caused by personal and social issues. Non-maleficence requires a health profession not to do anything that is harmful, and in the context of abortion it may mean; a health care provider should not be involved in an act to cause death to the foetus. Conversely, failure to provide the patient with care may cause harm to the patient. The issue is solved depending with the health profession view on the foetus; some view it not as a person while others as a person and the one who view it as a person be torn on who to kill. There are so many facts on abortion; it is a hard decision for a woman to make, 50% of women performing abortion are below 25 year and 60%of these abortions are done on single women.

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There are arguments in favour of abortion; unplanned pregnancy maybe wanted later, it presents death and life threatening complications and a woman may suffer from psychological impairment. Those in favour of abortion argue that; the mother can decide on what to do, baby’s life depend with the mother’s health and restricting abortions leads to elevated of illegal abortions. Both arguments add up to the dilemma on what to do in the ethical issue. As a nurse, one should be independent on decision making and action and accept consequences of his or her actions. The nurse should be truthful in accepting and recognizing the true patient situation and communicating it accurately to the patient (Ito & Natsume, 2015).

The law limits a woman’s right to perform an abortion, but many states advocate for counselling before an abortion. The nurse should be aware of the waiting period before performing any abortion and the gestational period. For women under age (18years) there should be parental involvement where the consent of one parent or both is required. Partial birth-ending pregnancy by partially delivering an intact foetus- is banned by the federal government. New laws are continuing to emerge where patients are allowed to listen to the foetal heart rate before an abortion (Lippincott Williams & Wilkins, 2009).

In the case study, an 89year old man with a shot wound whose wife had recently died is brought to ER. The man had written a note indicating his pain after losing his wife and had no strength to go on and wanted to die. The neurosurgeon discusses the condition and potential outcome of the man stating the surgery not being a good idea. The family which accompanied him insists the surgery procedure to be completed. The ethical issue is the old man willing to loss his life, the neurosurgeon profession view on the surgery and the family insisting on the procedure.

Assisted dying is illegal and is carried out by health professions in two ways; assisted suicide and euthanasia. Euthanasia is taking away life on request by the patient or family through administration of drugs competent request and personal voluntary (Lippincott Williams & Wilkins, 2009). Assisted suicide, the doctor provides drugs to a patient who takes his or her life voluntarily. The American Nurses Association (ANA) prohibits nurses in participating in euthanasia and assisted suicide as the act is against the nurses Code of Ethics for Nurses with Interpretive Statements (ANA, 2001; herein referred to as The Code), the ethical goal and tradition for professions (Cowen & Moorhead, 2011). 

The distinction between terminally ill and not terminally ill has pulled the decision of euthanasia down and led to many countries making it illegal. The matter of life and death is laid to supernatural powers and it should always be the last option or not an option as many term it as murder. This is controversial to Do Not Resuscitate (DNR) order many which patients sign in nursing homes during old age. The ethical issue here thus calls for the surgery as requested by the family irrespective of the surgeon’s opinion.

The neurosurgeon opinion is that the surgery may fail, but the family right has to be considered on the man’s life. As a nurse practitioner, it is an obligation to provide comprehensive, compassionate and humane care that respect the patient’s right and upholds profession standards in the presence of debilitating, chronic illness and at the end of life (Cowen & Moorhead, 2011). Through the understanding as a nurse everything should be done to save the man’s life. Although the surgeon opinion is still valid and highly possible, the family should be given the chance. Its contrasting as the old man wish was to die soon and would be given the chance as he was willing and the his health state is bad.

The dilemma is complicated with the call from a nursing home of a DNR (Do Not Resuscitate) form the man had filled. Nurses participate actively in assuring and assessing appropriate and responsible intervention to minimise unwanted and unwarranted treatment and patient suffering (Sundar, Do, & O’Cathail, 2015). The condition was not an old age or chronic illness but an accidental one. The law protects the patient right and he had a right not to undergo surgery as it was more suffering and pain to the man. The man had the right not to be in supportive and resuscitation machine, a discussion with the family on the order was conducted and that family insisted on the surgery. The choice from a competent patient should be given high priority even when it is against the will and wish of family and health team.

As an OR nurse, the patient might have signed the order in distress due to the loss of his wife. The DNR order protects him legally but the ethical issue starts from his competency, everything was enhanced by psychological stress. Through this, the man is not competent as he did not engage his family and was mentally disturbed. I would honour the family wish, judging by no history of chronic illness, as it was accidental incidence and due to the fact of his previous letter which was immediately after the death of the wife. Before the death of the wife, the man wished to live long but the incident broke his heart and he had no more reason of being life. 

References

Barry, Vincent. (2014). Applying ethics: A text with readings.

Cowen, P. S., & Moorhead, S. (2011). Current issues in nursing. St. Louis, MO: Mosby Elsevier. 

Ito, C., & Natsume, M. (2015). Ethical dilemmas facing chief nurses in Japan: A Pilot study. Nursing Ethics. doi:10.1177/0969733015574923

Lippincott Williams & Wilkins. (2009). Evidence-based nursing guide to legal & professional issues. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 

Sundar, S., Do, J., & O’Cathail, M. (2015). Misconceptions about ‘do-not-resuscitate (DNR)’ orders in the era of social media. Resuscitation, 86, e3. doi:10.1016/j.resuscitation.2014.10.014

‘Complementary & Alternative Medicine’ (CAM): Ethical and Policy Issues. (2014). Bioethics, 28(9), iii-iii. doi:10.1111/bioe.12135

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