Introduction
A career in nursing seems fulfilling, but nurses encounter challenging situations every day. Regardless of their roles, nurses face ethical dilemmas that may affect them and the patient. Importantly, there is no right or wrong solution to a particular ethical dilemma. However, nurses rely on the legal papers related to nursing standard of health care practice according to legal aspects of nursing. This paper involves the standard and legal relation between nurses and their patient. Even with the nursing standard of health care practice literature, ethical dilemmas still occur in healthcare institutions. The aim of this paper is to examine all the aspects of ethical dilemmas in nursing. It will focus on tort, crime, a felony, misdemeanor, neglected, malpractice, liability, assault, battery, consent, informed consent, autonomy, and beneficence. Also, it will highlight the legal papers related to ethics of nursing standard of health care practice.
Aspects of ethical dilemmas in nursing
At times people commit civil offenses against others either intentionally or due to negligence. Such crimes are classified as torts and are punishable. Nurses commit such crimes when they hurt their patients due to malpractice. Torts may results in suffering or injury and patient may decide to take a civil act against the physician. This ethical dilemma is processed using the Tort Law which classifies torts as either intentional, negligence or strict liability. Since a tort is a civil act which involves private parties such as doctor and patient, severe punishments such as fines or incarceration do not apply. The settlement of torts involves restoring the patient monetarily.
Felony is another ethical dilemma that nursing students may encounter when applying for a practice license. Essentially, a felony is a serious crime that is punishable by death or incarceration (Miller, Rossi, and Simpson, 1991). Some of the crimes listed as a felony include murder, burglary, manslaughter and tax evasion. When a person commits a felony, they are not allowed to apply for a nursing license. Importantly, the board of nursing scrutinizes an applicant’s profile to determine if he/she qualifies for a nursing license. In some states, a person is allowed to apply for a nursing license after five years from the time they committed the offense. It is unethical for a person to appeal for a nursing license if they have committed an offense.
Also, crimes are ethical dilemmas in nursing. A crime may be an action that harms individuals as well as the society (Martin, 2013). Any action by a nurse that impacts their patient negatively is a crime. Some offenses in nursing include prescribing wrong drugs, releasing contagious factors to the environment and immunizing people with a dangerous vaccine. Other offenses in nursing include raping patients or prescribing a medication that causes death. An ethical dilemma happens when the doctor is involved in a sexual relationship with a patient without consent. Since this action is prohibited, a nurse may be prosecuted in the court of law.
Further, misdemeanors affect nursing students and nurses who wish to renew their licenses. Although a misdemeanor is considered less severe than other crimes, it is punishable. In some states, misdemeanors are also known as summary offenses. Some misdemeanors include prostitution, small theft, and trespassing. Various nursing institutions handle these crimes differently. According to Dean (2011), nursing schools in the UK discontinue students who have a misdemeanor record. Also, some healthcare organizations do not allow students with criminal history background to practice. The nursing board also checks the criminal background of the nurses who wish to renew their licenses. The nursing board may require a person to produce a permit indicating that they have faced federal punishment for any action that they might have committed in other states.
Nurses may also face ethical situations of negligence. Neglect happens when nurses fail to offer standard care. Medical professionals in nursing homes may fail to provide proper basic care or abuse aged people due to negligence. In nursing homes, issues of negligence include physical or emotional abuse. Even though, various individuals in the society face neglect from the medical staff, some fail to report (Negligence, n. d.). Neglect in nursing homes can result in serve diseases, injury, or even death. Issues of malnutrition may also arise when an individual who is residing in a nursing home face negligence. Also, neglect may occur when a doctor is treating a patient. For instance, a surgeon may leave a surgical blade in a patient’s organ when performing an operation.
Medical malpractice may also happen when a physician offers a treatment that is below the legal standards (Mello, Studdert, and Kachalia, 2014). The medical malpractice leads to injury, suffering or may even result in death. In most cases, medical malpractice issues are handled as civil torts since they are wrongdoings against private parties. However, a case of medical malpractice may be subjected to criminal procedures if it results in death. Medical errors due to negligence or intentional actions by nurses are malpractices. Medical professionals, patients, and insurance groups hold that malpractice litigation is costly, ineffective and adversarial.
The nurse liability laws hold that a nurse can at times be liable for suffering or injury he/she has caused triggered to a patient. In such as case, the situation is processed under negligence laws. However, depending on the situation, the healthcare institution and the nurse can be liable for the suffering or injury. For instance, if a nurse prescribes a wrong medicine knowingly, they may be held accountable (LaMance, 2014). Also, if a nurse breaches his/her duty of care, they may be liable for the resulting injuries. Nurses may consider having a liability insurance cover to cater for any liabilities that may occur when handling patients.
Assaults are common actions in some healthcare institutions. An assult is an intentional act of threatening to harm a person. Ideally, threatening is alone an assault even without causing injury. Verbal threats by medical professionals are also assaults (Black, 199). Some attacks in nursing include inducing fear and sexual abuse to patients. Even when there is consent, a sexual action between a doctor and patient is considered as an assault. The assault may also be processed on the third-party basis when a physician engages in a sexual act with the victim’s relatives. Various states define assault differently, and there are also different punishments that apply to these actions. In most cases, criminal procedures apply to attacks. Nevertheless, restorative justice may be used in other cases.
Even though the battery is not prevalent in the medical profession, it may occur when a nurse feels irritated or when they are in a bad mood. A battery is an action that causes physical harm to a person. As opposed to assault, a battery does not involve threats or causing fear (Black, 1991). A battery can mean hurting a person using an object or bare handed. Some forms of the battery include pushing, slapping and punching. An array is handled using criminal laws, and punishments are severe including incarceration. Battery induced by a nurse to a patient is considered as an ethical dilemma when it happens in the hospital only.
In nursing, consent is a case whereby the patient agrees to undertake a particular procedure proposed by the physician. Consent is essential in virtually every medical procedure including physical examinations, organ transplant or prescription. Consent can either be voluntary or informed, and it is made verbally or through writing. Importantly, the patient agreeing to a particular procedure must be in a stable condition (Beauchamp and Childress, 1994). At times, consent is offered by the next of kin if the impacted person is not in the position to make a sound decision. Ethical issues arise when nurses decide to initiate a particular medical procedure without seeking permission from the patient. For instance, do not resuscitate notice on patients with Down’s syndrome is an ethical dilemma.
Informed consent holds that a medical physician should disclose the treatment to a patient before commencing. The doctor should advise the patient by sharing information on benefits, shortcomings and side effects of a certain procedure. The provisions of informed consent insist that the patient should have the capacity to comprehend the information (Beauchamp and Childress, 1994). The doctor should use simple language to ensure their patient understands. Finally, the patient should sign an informed consent form to prove they understand and agree to the specific treatment.
Autonomy is also an ethical issue in nursing. It is the capacity to act in accordance to a person’s proficiency and discernment, offering nursing care as prescribed by professional, regulative and institutional policies (Weston, 2008). Autonomy provides the patient an opportunity to make a decision regarding their treatment. A nurse should respect and adhere to the patient wishes. Nevertheless, an ethical dilemma may occur in a case of euthanasia, abortion or treatment that may endanger the life of the patient.
Lastly, beneficence is the most prevalent ethical dilemma in modern nursing. It holds that a medical practitioner should ensure the welfare of the patient during any clinical procedure. According to Ross (1998), under beneficences, a physician should not perform any action that may harm the patient. Even though the concept of beneficence seems obvious to patients and doctors, ethical dilemmas do occur. Sometimes a medical professional might conduct a cost-benefit evaluation to determine if a particular action is appropriate. For instance, inducing death to a terminally ill person is an ethical dilemma.
References
Beauchamp, T. L., & Childress, J. F. (1994). Principles of biomedical ethics (4th ed.). New York: Oxford University Press.
Black, M. H. C. (1991). Black’s law dictionary: Definitions of the terms and phrases of American and English jurisprudence, ancient and modern (6th ed.). United States: West Publishing Co.
Dean, E. (2011). NMC to keep student records in bid to ensure fitness to practise. Nursing standard, 25(36), 5-6.
LaMance, K. (2014). LegalMatch law library. Retrieved July 30, 2016, from http://www.legalmatch.com/law-library/article/nurse-liability-laws.html
Martin, E. A. (2003). Oxford Dictionary of Law (7th ed.). Oxford: Oxford University Press.
Mello, M. M., Studdert, D. M., & Kachalia, A. (2014). The medical liability climate and prospects for reform. JAMA, 312(20), 2146-2155.
Miller, J. L., Rossi, P. H., & Simpson, J. E. (1991). Felony punishments: A factorial survey of perceived justice in criminal sentencing. The Journal of Criminal Law and Criminology, 82(2), 396-422.
Negligence in nursing home patients. (n. d.). Retrieved July 30, 2016, from http://www.nursinghomeabuseguide.org/neglect/
Ross, W. D. (1988). The right and the good. Indianapolis: Hackett Publishing Co.
Weston, M. J. (2008). Defining control over nursing practice and autonomy. JONA: The Journal of Nursing Administration, 38(9), 404–408
