Every profession has its own code of ethics which is put to a test in order to determine whether its embodying moral principles are effective or not. Faced with an ethical dilemma, a professional or practitioner is beset and beleaguered to decide or choose between what is legally or morally appropriate and acceptable. When a problem challenges his or her standards, a practitioner is bound to do what is right in accordance with what the profession calls for, what the society dictates and what interests the public is clamoring. The nursing profession is one area in the medical field which is susceptible to being faced with an ethical conflict.
A nurse practitioner or NP is exposed to a number of personal and professional struggles, which in the end, he or she has to settle or solve. In doing so, a nurse practitioner needs to consider all the essential components of coming up with an appropriate resolution. These elements of ethical dilemma in the nursing profession include the main problem itself, pieces of supporting evidence, the need for compliance or adherence to nursing principles or theories and most importantly, both the protection and promotion of the rights of the patient and nurse practitioner as well.
Ethical dilemma in the nursing profession is manifested in various manners. One morally-related conflict which has long confronted nurse practitioners is the controversy over a patient’s right to die with dignity. The complexity of the issue is presented in a way that a patient, who is suffering from terminal condition, opts or wishes to end his or her pain by preventing the natural course of death and allowing an assisted-killing or suicide to take place.
Under the belief of dying with dignity, a patient or the family is likely to observe such practice which, in turn, challenges the ethical standards of medical professionals including nurse practitioners. However, it is apparent that upholding a dying patient’s last wish to die with dignity is an open book in the medical field and this even includes the participation of a nurse practitioner. The practice has long existed and falls under several terminologies such as mercy killing and Euthanasia.
In fact, a provision in the Code of Ethics for Nurses has manifested the involvement of NPs in such practice. This is because they are perceived or expected to be leaders and cautious supporters for the conveyance of a dignified and humane patient care (American Nurses Association, 2001). While the said practice has long been deliberated, medical professionals such as NPs are bounded by their responsibility to alleviate patient’s suffering even up to the extent of withholding and removing life-sustaining treatment.
Providing a terminally ill patient to die with dignity as he or she wishes, in essence, should be the main ethical consideration and justification of NP in order not to allow for a guilty conscience to hamper the performance of the profession. Ethical Dilemma A nurse practitioner’s ethical dilemma of allowing a dying patient to die with dignity was tackled by Bednarz (2000). She wrote that a wish of a terminally ill patient or the family to withdraw life-sustaining treatment burdens medical professionals with apprehension and guilt that they are likely to be doing an unacceptable action of assisted-killing or suicide.
In doing so, medical professionals including NPs are disturbed about the possible violation of certain standards. In particular, the ethical conflict brought about by the issue of patient’s right to die with dignity compromises or challenges the ethical codes or standards of beneficence and nonmaleficence which they sworn to under the Hippocratic Oath. Medical professionals such as NPs are also wary that the practice harms the medicine honor which is regarded as a healing art (Bednarz, 2000).
Bednarz added that aside from the said ethical principles, the more at stake are the moral issues of patient’s autonomy and the concept of quality of life as desired and viewed by the patient which, she said are two vital elements that the relationship between the patient and medical professional such as NP should possess (Bednarz, 2000). A concrete supporting evidence for the patient’s right to die with dignity is provided in the provisions of A Patient’s Bill of Rights.
The said measure specifically identified the various rights and privileges of a patient and most importantly presented the perspective that the patient always has the final say or decision as far as his or her medical condition and the manner how medical professionals such as nurses will respond to his or her medical concerns. With regard to the right to die with dignity, the Bill generally presented the idea that a patient’s health care requirement will always and ultimately depend on what a patient asks for.
Hence, in the case of a dying patient, foregoing life-support treatments or equipments may be done if it is desired and asked by the patient or the family and it should not results to ethical struggle among medical professional such as NPs (American Hospital Association, 1998). Bandman and Bandman (2002) corroborated the above discussion when they wrote that the function of the NP in the care and supervision of dying patients is to assist them to die well.
In doing so, the NP should not be morally disputed because in helping a terminally ill patient to die in a good way is to maintain the patient’s sense of self-esteem, dignity and option until his or her last breath. The authors added that the practice necessitates the ability and kindness of the NP in order to lessen possible problems and ultimately grant the wish of the patient (Bandmand & Bandman, 2002, p 281). While a patient’s choice or right to die with dignity leads to conflicts, the fundamental desire of a dying patient should be the foremost consideration.
This is because in the medical profession, the nursing practice in particular, the concerned people are obligated to nobody else but the patient. This may even require alleviating his condition through assisted- killing such as removal of life-support treatments. In essence, this position is confirmed by several papers such as those by Aiken (2006); the McCain-Edwards-Kennedy Patients’ Bill of Rights; by Peterson and Potter (2004); and by Wildfire, Stebbing and Gazzard (2007).
The McCain-Edwards-Kennedy Patients’ Bill of Rights detailed the various rights of the patients as regard their health care requirements which also includes patients’ protection and even their option to end their lives with dignity. The said measure also serves as a safety net for medical professionals including NPs because they are redeemed from any manifestation of guilt or ethical dispute as the patient decided for his or her personal concern (“Summary of the McCain-Edwards-Kennedy Patients’ Bill of Rights,” n. d. ).
Additionally, keeping communication confidentiality is another ethical issue or duty which follows when a patient was eventually allowed to die with dignity. This basic right serves as an application of rights theory where it is unethical to speak ill of dead people (Wildfire, Stebbing & Gazzard, 2007). Aiken stated that while legal, ethical and political issues surround the nursing profession, it is primarily the responsibility of the NP to carry out his or her profession even to the extent of allowing a patient to die with dignity but defying the natural manner of death (Aiken, 2006).
Peterson and Potter, meanwhile, supported the idea when they said that the function of the NP is definitely distinct because of its ethical challenges or requirements. Since they consider that the widened profession of the NPs imparts ethical issues which may have not been covered by Nurses’ Code of Ethics, the two have proposed that efforts should be made in order for the NPs’ functions to be broadened and that they may exercise flexibility while in the performance of their profession.
In doing so, supporting a patient’s desire to die with dignity will not burden their career because of the ethical concerns associated with it (Peterson & Potter, 2004). Ethical Decision Ethical conflicts are important components of the reality and implications of the nursing profession. An established set of principles direct the NP in deciding difficult morally-related conflicts or problems. In resolving or making a decision about the issue of a dying patient’s wish and right to die with dignity, the ethical standards of beneficence goes against the respect for a patient’s autonomy.
Dunbar (2003) said that when the wish of a patient or the family to discontinue life-support treatments is granted, medical professionals such as the NPs exercise and support the principle of beneficence. Not adhering to the standard of beneficence violates a patient’s autonomy where self-rule is observed in order for the continued suffering and pain to cease (Dunbar, 2003). Hence, applying the principle of beneficence in deciding an ethical dilemma such as patient’s right to die with dignity is tantamount to using the Utilitarian Theory.
This is because the said standard, which refers to utmost happiness, is the innate foundation of morals where any action is correct according to their support to happiness and incorrect when it results to otherwise. However risky or demanding, it can be construed that the right to die with dignity is indeed ethical because the action itself is right and eventually leads to the ultimate beneficial implications rather than continued harm to the patient. The duty of medical professionals such as the NPs to maximize advantage and limit damaging effects is, in essence, justifies the act foregoing life-support treatments. Conclusion
The complexity of the ethical issue of permitting patient’s right to die with dignity may be simplified by an objective of medical professionals such as the NPs to act in accordance with what is called for. It may also be moral to consider that in doing so, the act of assisted-killing or withdrawal of life-support treatments is more aimed at providing benefits rather harm to the patient and family. Additionally, it is worthy to note that a dying or terminally-ill patient has long suffered and that invoking the right to die with dignity is like upholding a patient’s autonomous view of which he or she has a right to do.
Under this perspective will the medical professionals, NPs in particular, are relieved of their guilt feeling or view of ethical violation because such decision is the most ethical thing to do even if it may hinders with their Hippocratic vow.
References
Aiken, T. A. (2006). Legal, Ethical, and Political Issues in Nursing. Philadelphia: F. A. Davis Company. American Hospital Association. (1998). A Patient’s Bill of Rights. Retrieved October 2, 2008 from http://www. injuredworker. org/Library/Patient_Bill_of_Rights. htm American Nurses Association.
(2001). Code of ethics for nurses with interpretive statements. Washington, D. C. : American Nurses Publishing. Bandman, E. & Bandman, B. (2002). Nursing ethics through the life span (4th ed. ). Upper Saddle River, NJ: Pearson Education, Inc. Bednarz, A. A. (2000). Death with Dignity Withdrawal of Life Support – medical advances bring with them ethical dilemmas. Humanist. Retrieved October 2, 2008 from http://findarticles. com/p/articles/mi_m1374/is_3_60/ai_62111880 Dunbar, T. (2003). Autonomy versus beneficence: An ethical dilemma.
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