Values Clarification and Ethical Legal Case Analysis
Values Clarification
Values dictate the way people function both personally and professionally. In nursing practice, having clear values is essential in achieving moral competence (Jormsri et al., 2005). In completing the value clarification exercise, forty-two items were answered. Of these forty-two items, 15 responses were “mostly agree” and another 15 responses were “mostly disagree.” Six responses were “somewhat disagree”, three responses were “somewhat agree”, and the final three responses were “neutral.”
In a cluster that relates to issues raised by advanced technology, I had some agreements and disagreements. Giving extraordinary medical treatments to patients is essential, particularly when the patient is in a critical condition and demands to have innovative and advanced medical treatment to prolong his life. The use of medical technology has also made possible the improvement of a quality of life among patients. The medical technology of today is more forward-thinking, more operational, and in various circumstances, more expensive (Tan & Ong, 2002). While this notion is true, I also believe that advancements in medical technology have some loopholes. For instance, among women, one of the most prevalent cases of illness is breast cancer. Despite the advancement in medical technology, still, some women with breast cancer condition are detected late. Hence, instead of receiving the immediate remedy, often, the treatment comes late and is no longer an effective mechanism to combat the disease. Regarding discontinuance of life support systems, I strongly disagreed. In a clinical debate between Crippen and Hawryluck concerning life support, Crippen emphasized the “potential for unexpected recovery” (Crippen & Hawryluck, 2004) as a basis of his argument, and to this, I completely agree. The term ‘unexpected recovery’ is associated with futility and families of patients tend to use such reason to keep the patient on life support while they search for a cure (Crippen & Hawryluck, 2004). In the aspects of kidney failure and transplantation, the decision to undergo such invasive treatment relies on the patient.
Nursing Profession
Nurses are educators and advocates. They strive hard to learn about the newest medications and technology. Nurses are also experts in dealing with patients, ensuring their comfort, and facilitating their full recovery. However, nurses’ roles have limitations. For instance, in resuscitating patients, no matter how badly they want to save the patient’s life when there is a ‘do-not-resuscitate’ order, nurses have to comply.
Death
Nurses are often placed in a position where they need to be with the dying patient until the latter’s last breath. This frequently makes nurses more uneasy and anxious (Peters et al., 2013). I believe that professional nurses have the responsibility to preserve their patient’s dignity until the last days. But I also believe that life support system should only be rendered when the patient asks for it. Patients also have the right to create their living will and everything written thereafter must be honored and strictly followed.
Children
Whether to kill a disabled individual or not is a question of morality and has been one of the most well-debated topics in the society. Having a family member with disabilities can be very challenging. For those people who opt to care for their members with special needs, they often see amazing rewards and valuable insights from the experience (Schurman-Kauflin, 2012). In human experimentation, children must not be used or even asked to participate, particularly when the outcome of the experimentation would not render them any benefit. However, there are special cases such as conducting an experiment to determine their classroom performance and other research investigations that would later benefit them. Children are minors and must not be institutionalized. They have no capacity to make decisions yet.
Human Experimentation
Society’s Rights
The topic of what is more important between individual rights and societal rights boils down to the issue of serving the common good. In 1901, a smallpox epidemic engulfed Massachusetts, thus, putting all infected individuals in quarantine (Bayer, 2007). Harsh measures were placed on them to ensure the public’s health protection. I believe that the common good of the society at large must be given more priority than the good of one person alone. While morality speaks against discrimination, this need not be the case in the health industry. Health specialists must conduct their responsibility by giving protection to the people under their care.
Allocation of Resources
There is scarcity regarding the number of health professionals in rural areas. There is also scarcity concerning the mode of equipment used to render quality care. I believe that it is the government’s obligation, along with the duties of the health sectors, to ensure that people in all levels of society receive the same and equal treatment.
Perceptions of Obligations
Nurses function to prevent illness and spread of diseases, promote health, and aid patients in coping with their physiological condition. They offer direct care to patients and work with physicians collaboratively in conducting examinations as well as treatments. Nurses must value responsibility and as such, they must be proactive and take part in the decision-making, especially with matters concerning bioethics and professional ethics.
Ethical Legal Case Analysis
This section of the paper presents the case of a surgeon, Dr. Joseph Ndiyob, who was comatose and his relatives were struggling in the fight against taking off his life support system.
Medical Indications
Dr. Ndiyob had a history of the heart attack back in 1988. Last December 29, he had another major heart attack. His heart stopped beating intermittently for five times. This led his brain to have the insufficient amount of oxygen thus resulting to comatose. To keep his heart functioning, his doctor gave dopamine. Dr. Ndiyob also had multiple organ failures including the digestive organs, kidneys, and lungs. To keep his lungs working, he was given a breathing machine. To inject food into his stomach, he was given a nasogastric tube. To substitute the functions of his kidneys, he underwent dialysis. Dr. Ndiyob’s condition is a very critical and irreversible one. The doctors and the hospital lawyer ordered to take Dr. Ndiyob off his life support system. If this so happened, Dr. Ndiyob would have died within a day to a week.
Quality of Life
The patient had been comatose, and health experts found Dr. Ndiyob’s condition to be irreversible. His brain and internal organs had stopped functioning, and the chance for the patient to be able to return to his normal life is very thin. Because of this, it was decided that the life support system is taken off from Dr. Ndiyob. However, the relatives refused. Using the moral and spiritual laws, they cited that only God can take a man’s life (Murphy, 2001). On the contrary, the hospital lawyer said that they could no longer extend the stay of Dr. Ndiyob and that the family had to seek another medical facility that would be willing to accept Ndiyob’s case. The lawyer supported his statement by emphasizing the fact that the space occupied by Ndiyob in the facility is a very serious resource.
Patient References
There is nothing to say in this aspect because the patient was comatose and only the family negotiated with the lawyers and the ethics committee.
Contextual Features
This case presents several direct and indirect factors that may have influenced the decisions of different parties. The first factor relates to cultural and religious. Dr. Ndiyob’s family is a Catholic. As Catholics, they believe that God gave us life; hence, it is only God who can take back a human being’s life (Murphy, 2011). Further, the family claimed that there was a purpose for why God created the life support system, and that is to extend a person’s life. On the other hand, the physicians and nurses that make up the ethics committee pattern their reasoning to the constitutional law of 1999 allowing the health experts “to override a family’s decisions” (Murphy, 2011), especially when the condition is irreversible. Nonetheless, there were other factors that might have triggered to the decision to take off the life support system. These factors include the lack of health insurance of Dr. Ndiyob, the increasing amount of hospital bill, and the scarce allocation of resources, for instance, the use of the bed in the cardiovascular unit. The hospital facility had the very limited cardiovascular unit. Given the fact that Dr. Ndiyob has no health insurance, the hospital might have thought of letting the unit used by someone who has a greater chance of survival and someone who has a secured health insurance. But if the case were to be based on legalities, it would be unlawful to extend the life of a patient with an irreversible condition. Under the Tex. Health & Safety Code §166.046: “the physician and the health care facility are not obligated to provide life-sustaining treatment after the 10th day after the written decision” ("Texas Health and Safety Code," 2016).
Evaluation of the Clinical Ethics Model
If I were the APN on a medical ethics committee, I would consider the Clinical Ethics Model of Jonson very viable, easy to follow, and detailed. The Clinical Ethics Model has four sections – medical indications, patient preferences, quality of life, and contextual features (Jonsen et al., 1982). The clinical ethics model offers a well-thought-out method to making decisions. This model also aids health professionals and those under their care to recognize, examine, and respond to ethical issues. The utilization of this or a comparable clinical ethics model is intended to help the clinician working with relatives and other social insurance experts in thinking about the different layers in a particular moral issue (McCabe, 2001). Since moral issues focus on contending commodities, there are times when specific issue is left undetermined despite the fact that a state of agreement may be reached (McCabe, 2001). After examining a challenging situation in this approach, clinicians are typically able to contemplate undoubtedly concerning what the issue is and to recognize the best option accessible to them.
References
Bayer, R. (2007). The continuing tensions between individual rights and public health. EMBO reports, 8(12), 1099-1103.
Crippen, D., & Hawryluck, L. (2004). Pro/con clinical debate: Life support should have a special status among therapies, and patients or their families should have a right to insist on this treatment even if it will not improve outcome. Critical Care, 8(4), 1.
Jonsen, A. R., Siegler, M., & Winslade, W. J. (1982). Clinical ethics a practical approach to ethical decisions in clinical medicine.
Jormsri, P., Kunaviktikul, W., Ketefian, S., & Chaowalit, A. (2005). Moral competence in nursing practice. Nursing Ethics, 12(6), 582-594.
McCabe, M. (2001). Understanding Ethical Issues: The Clinical Ethics Model. Nathaniel.org.nz. Retrieved 26 July 2016, from http://www.nathaniel.org.nz/component/content/article/13-bioethical-issues/what-is-bioethics/63-understanding-ethical-issues-the-clinical-ethics-model
Murphy, B. (2001). Cleric's help asked in life-support case. Houston Chronicle. Retrieved 26 July 2016, from http://www.chron.com/news/houston-texas/article/Cleric-s-help-asked-in-life-support-case-2008210.php
Murphy, B. (2001). Life-and-death matter goes to court. Houston Chronicle. Retrieved 26 July 2016, from http://www.chron.com/news/houston-texas/article/Life-and-death-matter-goes-to-court-2001120.php
Peters, L., Cant, R., Payne, S., O’Connor, M., McDermott, F., Hood, K., & Shimoinaba, K. (2013). How death anxiety impacts nurses’ caring for patients at the end of life: a review of literature. The open nursing journal,7(1).
Schurman-Kauflin, D. (2012). Killing the Disabled. Psychology Today. Retrieved 26 July 2016, from https://www.psychologytoday.com/blog/disturbed/201206/killing-the-disabled
Shapiro, H. T., & Meslin, E. M. (2001). Ethical issues in the design and conduct of clinical trials in developing countries. New England Journal of Medicine, 345(2), 139-142.
Tan, L., & Ong, K. L. (2002). The impact of medical technology on healthcare today. Hong Kong Journal of Emergency Medicine, 9(4), 231-236.
Texas Health and Safety Code. (2016). Findlaw. Retrieved 26 July 2016, from http://codes.findlaw.com/tx/health-and-safety-code/health-safety-sect-166-046.html
