Ethical Delima

This fountain presents an ethical dilemma, a situation which arises when one essential choose mingled with mutually exclusive alternatives (Beauchamp& Walters, 2003). Decisions may direct results that argon desirable in some respects and undesirable in opposites. In Juanas gaucherie, her decision to fend the filiation transfusion had the desired outcome of allowing her to remain true to her ghostly beliefs. However, her excerption in addition resulted in her death. If she had followed the recommendation of the physicians and the team, the desirable outcome would have been practicable survival but would have had the undesired effect of violating her sacred principles.The major ethical dilemma was that by take noteing the uncomplainings self-sufficiency and spiritual beliefs, the physicians and interdisciplinary team were approach with compromising their incorrupt duty to conduct professional c atomic number 18 in accordance with established standards (Chua & Tham , 2006). A apprize review of the literature of Nursing Collection II Lippincott Nursing Journals (from Ovid) and CINAHL databases for the then(prenominal) 5 years found no evidence to support outgo consecrate for a Jehovahs Witness who is pregnant and has experienced blunt trauma.Healthcare providers faced with this situation have sometimes attempted to obtain court orders that would upset the patients decision and result in her submitting to recommended medical treatment. For example, the Illinois Supreme Court (Illinois v. Brown, 1996) upheld a mothers decision to refuse blood transfusions even though they were vital for both the mothers and foetus survival. The Patients Bill of Rights states that the health care providers certificate of indebtedness is to give patients accurate information and that patients must consent to treatment (New York State Department of Health, 2008).This is consistent with the Federal governments recommendations to name guidelines that assure he althcare quality and to reaffirm the slender role consumers comprise in safeguarding their own health, (United States Department of Health and Human Services, 1999). Nursing pr work outice is governed by the patients right to autonomy rather than her religious beliefs (Levy, 1999). The first head in the American Nurses Association (ANA) Code for Nurses with Interpretative Statements (2001) addresses respect for military man dignityTruth telling and the do work of reaching informed choice underlie the exercise of self-determination, which is basic to respect for somebody Clients have the moral right to determine what will be done with their own person to be given accurate information, and all the information necessary for qualification informed judgments to be assisted with weighing the benefits and burdens of resources in their treatment to accept, refuse, or terminate treatment without coercion and to be given necessary activated support (p. 1).However, it is difficult to witness death based on a persons decision to forgo care when medical options to sustain life are available. Treating this type of patient becomes particularly challenging when it involves two lives. fair play ethical motive To analyze this ethical dilemma, the principles of Western medicine and the religious beliefs of Jehovahs Witnesses were examined. The questions that surfaced were (a) how would the application of chastity morality provide insight into Juanas situation, (b) what were the ethical principles in conflict, and (c) why was it an secrete to administer a blood transfusion to Juana in an sine qua non situation.Volbrechts modeling for ethical analysis was utilized to address the clinical dilemma and the questions listed above. Virtue ethics was the primary possibility employed prior to the 17th century. This theory centers on shared familial and ethnic histories and religious traditions and acknowledges the communitys ability to identify, interpret, prioritize, an d counterbalance to moral subscribe toations within a particular context (Volbrecht, 2002). The following is an interpretation of this eluding according to lawfulness ethics. Virtue ethics focuses on what is morally correct from the patients viewpoint and centers on the patients autonomy.Actions and character are intertwined, and the ability to act morally is contingent on ones moral character and integrity. Virtue ethics focuses on the context of the situation (Volbrecht, 2002). Ethical analysis of virtue ethics entails (a) identifying the problem, (b) analyzing context, (c) exploring options, (d) applying the decision butt against, and (e) implementing the plan and evaluating results (Volbrecht, 2002). Identifying the problem Juana, a 20-year-old Hispanic woman, 32 weeks pregnant, was confused in a car accident. Internal bleeding to the thoracic or abdominal cavity was pretend.The stakeholders were the woman, her husband, the fetus, and the interdisciplinary healthcare te am. The team thought the dress hat method of treatment for this patient was to administer a blood transfusion and perform an emergency cesarean section. Both the patient and her husband refused this option because of their religious beliefs and provided written documentation indicating that the patient would not accept blood or blood products. The value issues were the physical survival of the woman and her fetus versus the womans religious integrity. Analyzing contextTo visualize the decision-making mental process in this case, one must consider the ethical principles of autonomy, beneficence, nonmaleficence, justice, compassion, and respect. The patients religious beliefs and how they influenced her decision must likewise be interpreted into consideration. Gardiner (2003) confirms that the ethical principles mentioned above influence ones choices. In Juanas case, the healthcare team suspected she was experiencing internal bleeding and that she and the fetus were in physiologic al distress. Juanas decision to balk the proposed treatment was based on her stated religious beliefs.The contextual factors of this case centered on the patients religious beliefs. The patient stated she would rather be embraced in the hollow bosom of Jehovah than to be condemned for all eternity, if she should run into a blood transfusion. Nurses draw from the code of ethics to reflect upon and understand the persons perspective, and to honor her wishes. The nurse provides services with respect for human dignity and the singularity of the client, unrestricted by considerations of social or economic status, personal attributes or the nature of the health problem (ANA, 2001, p.1). To respect the patients decision and honor her dignity, validating care was provided to the patient in an effort to save her life, while at the same time respecting her wishes. The ANA Code of Ethics supports the point of view that healthcare providers should respect patients wishes and decisions despi te their own personal beliefs (ANA, 2001). Applying an ethical decision process Looking finished the lens of virtue ethics, the caregivers focused on Juanas autonomy and her right to choose what she perceived best in spite of the possible outcomes.Juana was a competent, pregnant woman who made informed decisions not to watch blood transfusions or a caesarean section. Based on virtue ethics, the healthcare providers respected the patients autonomy by reflecting on and honoring the decision of the patient and her husband based on her religious values and beliefs. The healthcare providers also drew on the principle of beneficence, which centers on promoting the healthy-being of others. In this case, the well-being was not physiological but spiritually oriented.The principle of nonmaleficence was also employed by not intentionally inflicting harm on the patient and honoring her wishes. Violation of a clients deeply held beliefs is a form of doing harm. (Leonard & Plotnikoff, 2000). T hey also drew from the principles of veracity and respect, which entail being truthful to the patient and allowing her to contain an informed decision (Volbrecht, 2002). The nursing virtues of compassion, moral courage, and self-reliance also tolerate to an understanding of this situation. Evaluating resultsAt the time this clinical situation presented itself there were no unique(predicate) guidelines in the institution for dealing with the dilemma presented by this case. However, there are guidelines for Jehovahs Witnesses specifically geared to early identification and management of gynecological patients. For example, in Australasia, there are specific guidelines for treating pregnant women that focus on alter the patient by using traditional and new treatment modalities to agree patient ineluctably, particularly for Jehovahs Witnesses or other patients who decline blood transfusions (Womens Hospitals Australasia, 2005).For prenatal patients, the guidelines focus on early identification of Jehovahs Witnesses during prenatal visits, as well as placing these patients on a superior risk protocol, including maintenance of high hemoglobin and hematocrit levels, having improvement directives completed, and establishing affiliations with other hospitals that are well-equipped and staffed to meet these patients needs (Womens Hospitals Australasia, 2005). The Hartford Hospital in Connecticut has a equivalent architectural plan and also performs bloodless procedures on patients who are Jehovahs Witnesses (Miller, 1996).As a result of Juanas case being reviewed by the ethics committee post-mortem, a risk-management protocol was develop requiring patients who refuse blood transfusions to sign a waiver that removes the legal responsibility for the decision from the hospital and caregivers. To support this type of protocol, the Society for the Advancement of consanguinity Management maintains a database of hospitals that provide blood-conserving services in the United States as well as in Canada, Chile, Korea, and South Africa (Society for the Advancement of Blood Management, 2008).The problem, however, in an emergency situation is that it may not be possible to render the patient to a participating hospital. The Watchtower Bible and Tract Society (2004) recommends that advance directives and other legal papers be in place should an emergency arise. These documents should be easily accessible so that healthcare providers can honor the patients directives. In so doing, they will be applying the theory of virtue ethics and, therefore, respect the patients wishes (Macklin, 2003).Healthcare providers should practise beneficence and non-maleficence without imposing their beliefs as to the right matter to do. More explicit and universal guidelines would benefit both patients and providers when faced with similar ethical dilemmas. Conclusion In nursing practice, cases of patients refusing blood transfusions or other interventions are becom ing more common. Therefore, content regarding ethical issues, such as Juanas case, needs to be integrated into nursing curricula and the clinical arena.Nursing educators who incorporate bioethics into critical thinking in clinical decision making situations can posit novice and experienced nurses to handle complex ethical dilemmas, such as described in this paper. The learning process may be facilitated through integrating lectures with case studies and utilizing patient simulators to further enhance the learning process (Larew et al. , 2006).These teaching approaches would provide the opportunity to expose nurses to scenarios of acute patients where they can substitute in a safe environment, which in turn would decrease their care and promote learning. Nurse educators can further facilitate the learning process by providing clinical experiences with diverse patient populations in a cast of settings followed by discussion of actual clinical experiences, ethical issues, and debri efing (Larew et al. , 2006).Nursing talent have an ethical responsibility to prepare competent nurses and facilitate act education that will help nurses recognize ethical dilemmas in practice and apply ethical principles in trying to resolve them. The focus in practice, education, and research must be on providing care that respects patients cultural beliefs and autonomy. Nursing educators should place equal emphasis on ethics in order to provide the best holistic care possible. To do anything else is a disservice both to the profession and to our patients.