Ethical Issues In Professional Nursing Practice Chapter 14 R

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Identify and discuss the key ethical issues faced by nurses in professional practice, including nurse–physician, nurse–patient–family, and nurse–nurse relationships. Explore the concepts of trust, boundaries, dignity, patient advocacy, and the importance of professional boundaries, emphasizing the significance of maintaining ethical standards. Address moral rights and autonomy, such as informed consent, the Patient Self-Determination Act, and advance directives. Delve into social justice considerations, including fair resource allocation, healthcare rationing, and ethical concerns surrounding organ transplantation. Analyze the approaches for nursing care related to end-of-life decisions, euthanasia, rational suicide, and palliative care, explaining the principles behind these practices. Discuss the use of the rule of double effect and the ethical implications of withholding and withdrawing treatment, including key legal cases. Examine the moral conflicts nurses encounter at the end of life, such as communication challenges, managing pain, and maintaining moral integrity amid complex decision-making.

Paper For Above instruction

Introduction

Nursing practice is intrinsically rooted in ethical principles that uphold the dignity, rights, and well-being of patients. As frontline health professionals, nurses regularly confront complex ethical dilemmas that require careful consideration of relationships, moral rights, social justice, and end-of-life care. This paper explores critical ethical issues in professional nursing, emphasizing the importance of maintaining boundaries, promoting patient autonomy, and ensuring fairness in resource distribution. It also scrutinizes controversial topics such as organ transplantation, euthanasia, and palliative care, illustrating how nurses navigate moral conflicts while upholding their moral integrity.

Professional Relationships and Ethical Boundaries

Nurses function within a web of relationships that impact patient outcomes and professional integrity. The nurse–physician relationship requires mutual respect and clear communication, fostering collaborative decision-making based on ethical principles. Nurse–patient and family relationships are founded on trust, respect, dignity, and advocacy, where boundary-setting is vital to prevent dual relationships that could compromise care (American Nurses Association, 2015). Maintaining professional boundaries prevents exploitation and promotes therapeutic relationships centered on the patient’s best interests. Nurse–nurse relationships contribute to a positive work environment and ethical practice, requiring mutual support and respect (International Council of Nurses [ICN], 2012).

Moral Rights and Autonomy

Moral rights, such as the right to privacy, informed consent, and self-determination, form the foundation of ethical nursing practice. The concept of autonomy empowers patients to make informed decisions regarding their care, respecting their values and beliefs. The Patient Self-Determination Act (1990) institutionalizes the right to formulate advance directives, including living wills and durable powers of attorney, reinforcing patient autonomy (Jonsen, Siegler, & Winslade, 2015). Respecting these rights is essential to patient-centered care and involves balancing informed consent with compassion for patients’ moral and cultural preferences.

Social Justice and Healthcare Resource Allocation

Social justice concerns prohibit discrimination and advocate for equitable access to healthcare resources. Ethical dilemmas often involve resource allocation, especially in scenarios of scarcity. The debate over healthcare rationing involves questions about whether all individuals have a right to care, and how to distribute limited resources fairly (Danis et al., 2012). Ethical frameworks like Rawls’ veil of ignorance and Nozick’s entitlement theory provide different perspectives on justice. Nurses advocate for policies that minimize disparities and promote fairness, engaging in advocacy and ethics committees to influence resource decisions (Goold & Lipkin, 2018).

Ethical Issues in Organ Transplantation

Organ transplantation poses numerous ethical challenges related to procurement, allocation, and justice. The moral acceptability of organ use depends on consent, euthanasia policies, and fairness in allocation. Ethical principles, including justice and medical utility, guide organ distribution—prioritizing sickest patients or those most likely to benefit (Delmonico, 2014). Nurses support transparent processes, advocate for equitable policies, and educate patients about transplantation procedures. The balanced approach emphasizes caring for patients’ physical needs while respecting societal ethical standards.

End-of-Life Care and Decision-Making

End-of-life care involves complex ethical and legal considerations, such as withholding or withdrawing treatment. Landmark cases like Quinlan, Cruzan, and Schiavo highlight dilemmas about patient autonomy and the state’s role in life-sustaining decisions (Fried, 2019). Nurses must navigate communication challenges and moral conflicts—balancing truthful disclosure with hope preservation, and pain management with concerns about hastening death. Approaches like palliative care focus on comfort, dignity, and quality of life, often employing the rule of double effect to ethically justify the use of high-dose analgesics that may unintentionally hasten death (Cherny & Siegler, 2017).

Euthanasia, Rational Suicide, and Ethical Controversies

Euthanasia encompasses active and passive, voluntary and nonvoluntary forms, raising profound moral questions about causing death to relieve suffering (Like & Breitbart, 2016). Rational suicide involves patients making reasoned choices to end their lives when faced with incurable conditions, challenging traditional notions of moral acceptability. Physician-assisted suicide laws, such as Oregon’s Death with Dignity Act, exemplify the legal and ethical tensions surrounding autonomy and beneficence. Nurses supporting patients in these decisions must adhere to legal guidelines, maintain confidentiality, and uphold their moral integrity while respecting patient autonomy (Hale, 2017).

Palliative Care and the Rule of Double Effect

Palliative care emphasizes alleviating suffering and enhancing quality of life for terminal patients. The rule of double effect permits administering high doses of pain medication intended to relieve pain, even if it may hasten death, provided the intent is pain relief, not death (Cherny & Siegler, 2017). Ethical decision-making in palliative care requires assessing proportionality, intentions, and the patient’s wishes. Nurses play a crucial role in managing symptoms compassionately while navigating moral conflicts about hastening death.

Surrogate Decision-Making and Moral Conflicts

When patients lack decision-making capacity, surrogates or proxies are authorized to make decisions on their behalf. The substituted judgment, best interest, and autonomy standards guide these decisions, but conflicts often arise when surrogates’ choices differ from healthcare providers’ recommendations or patients’ prior wishes (Caplan & McGuire, 2011). Ethical dilemmas at this stage include withholding or withdrawing treatment, especially in cases like Quinlan, Cruzan, and Schiavo, where determining the appropriate course of action involves balancing respect for autonomy, beneficence, and nonmaleficence.

Conclusion

The multifaceted nature of ethical issues in nursing underscores the importance of moral sensitivity, professionalism, and adherence to ethical principles. Nurses must constantly evaluate their relationships, respect moral rights, promote justice, and navigate end-of-life decisions with compassion and integrity. Ongoing education, ethical reflection, and advocacy are vital to uphold ethical standards in an increasingly complex healthcare environment. Ensuring that patient dignity and autonomy remain central to care is paramount for ethical nursing practice.

References

• American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. ANA.
• Caplan, A. L., & McGuire, A. (2011). The ethics of surrogate decision-making. The New England Journal of Medicine, 365(5), 387-389.
• Delmonico, F. (2014). Ethical principles in organ transplantation. Clinical Transplantation, 28(4), 366-370.
• Fried, T. R. (2019). The importance of ethics in end-of-life care. Journal of Palliative Medicine, 22(1), 4-6.
• Goold, S. D., & Lipkin, M. (2018). The ethical importance of resource allocation in healthcare. The Hastings Center Report, 48(2), 22-29.
• Hale, C. (2017). Physician-assisted death and nursing practice. Nursing Ethics, 24(2), 177-185.
• International Council of Nurses. (2012). ICN Code of Ethics for Nurses. ICN.
• Jonsen, A. R., Siegler, M., & Winslade, W. J. (2015). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. McGraw-Hill Education.
• Like, R. C., & Breitbart, W. (2016). Ethical issues in end-of-life care. Journal of Pain and Symptom Management, 52(2), 207-214.
• Patient Self-Determination Act. (1990). Public Law 101-508. U.S. Congress.