Paternalism To Tell Or Not To Tell Nursing Essay

Paternalism To check Or Not To Tell Nursing EssayMr. white is a 70 year erstwhile(a) male tolerant who has been pretty wellnessy finished fall to the fore his whole life story besides some bring ons with pneumonia in the past few years. He was cause along the road last Monday where he hit a composition of black ice, swerved wrap up the road, and crashed into a tree. He lost consciousness and suffered modest abrasions to his arms, legs, and face. When he regained consciousness, he stated he felt very cold, numb, and wearied as several paramedics hovered over him placing a collar around his fill in and a spinal board underneath him. He was very overturned and was told to non move as they oriented him to soulfulness, commit, and time. He was taken to the requirement room where he was placed him on oxygen via face masquerade and D5 normal saline 100ml/hr. He was transferred to the ICU after lung complications and a tracheotomy was inserted to open his airway and sol elyow for oxygen exchange. Each day his family has been at the hospital supporting him and praying he volition recover from this severe accident.The bind c commensurate caring for him was reviewing his medical records and saw that he is a do not resuscitate patient and that he does not extremity to receive every life sustaining treatments that will prolong his life. The patient has been awake, alert, and oriented and fixed adequate two days past, which enables him to chafe lasts for himself. His daughter, Mrs. Black, told the imbibe that she doesnt roll in the hay what she would do with surface her dadaism because he is the rock that holds their family to addher. The rest of the family replied that these atomic number 18 his wishes and we will urinate to remove what he has requested, even though it saddens us to think we whitethorn pretermit him soon.During a r tabuine test a few days ago the medical student noticed that his labs were not within normal limit and en join stat tests to determine the problem. The chest x-ray ordered confirmed he had pneumonia, further to a fault revealed he was suffering from metastatic lung malignant neoplastic disease. The physician conscious the book of the malignant neoplastic disease and stated that Mr. sinlessness is still very weak and trash for his life. We will inform him and his family when he is more stable and able to be strong enough to take the news. strike the ProblemThe curb is certain of the confirmation that the patient indeed is suffering from fuelcer secondary to his car accident and pneumonia. Does she advocate for the patients indemnify to liberty in delivering the news to him and his family or does she follow the doctors orders and withhold the news since the physician believes that notification him will whole worsen his condition and result in a loss of think for moreover involved? The bind believes that withholding tax instruction is liberation against the patients indem nify wings to make his own decisions. The retain wants to do what is turn outperform for the patient and believes that keeping this culture from the patient is being dishonest and is not what any(prenominal) pr take onical nanny-goat would do in this situation. However, she is unsure of the scoop up approach in addressing the rejoinder. receive relevant F moldsA give way doctor-patient kind is an internal component when consorting out decisions base on a patients flush for treatment. Studies have shown a coefficient of correlation between the caliber (communication) of physician-patient relationship and better (health accusation) outcomes (Stewart, 1995). The doctor and the patient lack to have a strong relationship with the patient that includes sound communication, fidelity, fellowship based learning, beneficence, and Nonmaleficence.There are four different styles to a doctor-patient relationship which include consumeristic, default, paternalistic, and mutuality relationships. The mutualistic approach is considered the optimal relationship to have when twain the patient and the doctor bring both of their ideas and resources to the table and make a commitment to act upon with one another to solve disagreements in a respectful way. Paternalism involves physician focused disquiet because the decision is based on what the physician believes is exceed for the patient and not necessarily what the patient wants. In the scenario, the physician believed that it would be in Mr. Whites better interest to hold off telling him the news of his cancer until he was healthier and stronger, but this power not have been what Mr. White would have decided (Roter and Hall, 2006).At the offset printing of the 1960s, medical procedures were beginning to address the honorable issues with paternalism by a patients right to autonomy and apprised consent. Issues with paternalism began to arise due to an increment in consumerism, the womens movement, and laws passed that allowed for the rights of patients in their health care. The patients wanted to be more involved in their care in feeling about their health, quality of life, survival, and mortality rates of their condition. As a result, a physicians violation in duty to the patient caused an increase in lawsuits. Healthcare induceers began to be faced with a difficult decision in determining what pertinent development the patient learned to be about their condition (Wear, 1993 Charles, Whelan, Gafni, 1999).Legal and more paternalism were in conflict from the use used with Mr. White. Legal paternalism base decisions around following laws and regulations created by federal, state, or local level while virtuous paternalism base decisions using ethical principles. The physician was going against legal paternalism because truth-telling is now considered a legal discipline and the competent patient is to be informed of all matters link to their health, unless if the patient is deem ed incompetent. The physician was trying to practice moral paternalism because he believed that withholding the culture from the Mr. White was beneficial in a sense that he would not be strong enough to handle the news of his cancer and cause his condition to worsen or not improve (McCarthy and Schafermeyer, 2004).The postulate today about paternalism is whether it is acceptable for doctors to make choices about patients treatments in their health care when they may believe that the patient may possibly hold up the decision if they were correctly informed. Is it justifiable for doctors to go about the treatment since they feeling the long term benefits to the patient would be provided and at some stopover the patient would concur that the actions of the doctor were suitable? Certain situations makes it challenging to know exactly what is best for the patient, and it is hard to know when a physician is carrying out an intervention that is in the patients best interest or their o wn interest. mill is a strong believer of autonomy and fights for patients rights. He believes that each several(prenominal) has the ability to identify what makes them happy and that independent exercise of aspirations is a larger-than-life part of their happiness. Kant also supports patients rights and believes that every human has a responsibility to go across their autonomy. (McKinstry, 1992).The Patient tiptops of Rights of 1973 included the physicians responsibility to inform the patient on all matters related to their condition enabling the patient to make decisions based on this knowledge. The Bill was carried out to decrease the occurrence of malpractice by reducing the dissatisfaction of patients that wreak the criteria for more liability from their providers (Faden and Beauchamp, 1986). The law entails that medical information presented to the patient be in plain language that can be voluntarily understand and adequate in quantity. A doctor who is unsuccessful in at taining informed consent may suffer criminal offense charges.In 1998, the Consumer Bill of Rights and Responsibility Act was carried out by President Clinton to uphold consumers feature involved in their own health care by increase consumer confidence in the health care system, to give support in identifying the reasoning for a sound healthcare provider and a sound provider-patient relationship, and to servicing the consumer realize the important role they carry related to their rights and responsibilities of their heath care and recovery. The guidelines included several rights of the patient to create the best quality health outcome. (Shalala,1999).Patients are competent to give informed consent unless examined and evaluated to have mental deficits and incapacity. Informed consent must follow several steps in order to be valid which includes ratting the patient on the diagnosis, the suggested intervention, major benefits, risks, the consequences or prognosis if an intervention is not carried out, and any real options along with their risks and benefits. Informed consent will need to hold uncoiled and be carried out in all cases except when the patient is predisposed to serious stultification or death if the intervention is not carried out immediately, the patient voluntarily gives up their right, and if disclosure would cause serious natural or psychological harm to the patient or another person (Wear, 1993). At UPMC hospitals such as Magee and Presbyterian hospitals patients have certain rights and responsibilities that they are given over such as the right to respected and quality care from staff, the right for information in medical records to be kept confidential, the right to bruise verify and management, the right to know diagnosis, prevention, and treatment options and choices given in frank language, the right to informed consent before any procedures, the right to disclaim any medications, treatments, procedures, and several more . Thi s allows the patient to decide what information they would want to know and to carry out care based on their wishes (UPMC, 2010). station Methods of Ethical JustificationA person who practices consequentialism believes that a morally right act is one that produces a good outcome. The doctor was practicing a consequentialitic approach in that he believed that not telling the patient that he had cancer until he was stronger would cause a better outcome for the patient in the long run. He believed that Mr. White would give up all fancy and stop fighting to survive if he was informed of the news. In deontological theory, an act is right or wrong based on fulfilling a moral duty and cannot be justified by their effects. Even though the physician was trying to do the right thing by not telling the patient that he had cancer because he believed that this would help save his life, the act was against the rules and duty of the physician to inform the patient on information related to his he alth (Gert et al., 1997).Several principles come into play in the scenario such as beneficence, nonmaleficence, fidelity, and autonomy. The nursemaid will have to advocate for the patient that keeping this information from him and is family is not doing good. It may in fact cause more harm to the patient since he is unaware of his cancer. The patient may be able to determine treatments that could delay the spread of cancer, which could allow him more time to drop off with his family. The competent patient has the right to autonomy in deciding what information he would want to know about his health and the doctor should not be the one to make this decision. The physician is keeping essential information from Mr. White that may result in a break in their commitment and destroy the patients trust in his healthcare provider (Cassells and Gaul, 1998). shed light on Relevant Values, Rights, Duties, of Patient, Self, and Significant PersonsThe patient has the right to informed consent if he is seen as competent to make decisions based on his healthcare. It is the physicians duty as well as the nurse to respect the patient and inform him of all matters concerning his healthcare and making sure the patient demonstrates understanding. If Mr. White was deemed incompetent he may have appointed a family member as a substituted surrogate decision maker to make decisions in his health care based on the patients values, beliefs, and wishes. If Mr. White did not appoint someone to be a surrogate then the best interest principle would come to play and decisions on the patients healthcare would be determined by what is the best interest for any reasonable patient in this situation. The family will need explanations on the patients status and what the future will look like for him. The family may be the ones taking care of him and they will need sound direction on how to care for the patient.Identify If There Is an Ethical DilemmaThe nurse faces an ethical dilemma because the a lternatives are between two equally short solutions which display incompatible testimonies. Does the nurse take out the patients right to autonomy in keeping Mr. Whites new diagnoses of lung cancer from the him because the physician believed it was in the his best interest or should the nurse take the issue to higher billet to advocate and make every effort to protect the health, preventative, and rights of the patient (Cassells and Gaul, 1998).Identify Guidelines from Nursing and Professional Codes of EthicsThe American Nurses Association calculate of ethics for nurses was created to help guide nurses behavior when an ethical dilemma would occur. The requirements in the autograph advocate the nurses commitment to their patients autonomy, while still keeping in the safety of the patient (American Nurses Association, 2001). provide 1 states that the nurse needs to practice with mildness and respect each patient regardless of their beliefs, ethnicity, class, age, etc. The pati ent was a 70 year old African American who was a practicing Confederate Baptist and retired bus driver. The Caucasian, Catholic nurse had to make sure she didnt treat Mr. White differently because of his skin color, the religion he practiced, or his age (American Nurses Association, 2001).Provision 2 states that the nurses devotion is to the patient and anyone associated with the patient such as family and friends. The nurse has the ability to advocate for the patient in communicating their wishes to the doctor in carrying out treatment pertaining to his care. The nurse will need to communicate with the patient and determine what information the patient will want specific friends and family to know. The nurse with her high level of skill and knowledge can help evolve his family on his condition and care (American Nurses Association, 2001).Provision 3 states the nurse will need to do all she can to protect the patient from any harm or unsafe events. The nurse would make sure the pa tients requests were followed through while maintaining his safety, health, and prevention from any harm. If she believed that the patient was not well informed of his disease and all treatment plans possible to help delay the feeler of the disease, then she would need to address this issue (American Nurses Association, 2001).Identify and Use Relevant Interdisciplinary ResourcesFirst, the nurse should go to the doctor and see if they can work something out to determine the patients rights. If the doctor doesnt agree with the nurse then the nurse should then reprimand to the nurse supervisor and move up the last mentioned until the highest person is able to confront the issue. If this does not work, the nurse can also get in touch with the people who deal with ethical concerns/ dilemmas. The nurse can also talk to lawyers and get legal matters in place for the patients rights to informed consent to be granted. The nurse can also get a psychiatrist involved who would mouth on beh alf of the patient to confirm that the patient is competent. The nurse may want to get social workers and counselors to help the patient and family finds ways to cope with grief and also determine the best care for the patients prognosis of his such as a skilled facility, base health, or hospice care.Identify and Prioritize Alternative Actions/OptionsThe nurse can speak directly to the patient and his family about the information that has been withheld. This should not be carried out since this is not solving the conflict between the nurse and the physician and it is going behind the physicians back. The nurse can make the decision of not informing the patient or family of the news. She could convince herself that the doctor knows what is best for the patient and bringing up the issue would only cause chaos. This is also going against the code of ethics of a nurse in her lack of being a patient advocate (ANA, 2001).The nurse could talk with the physician about the issue she has wi th the patients right to autonomy and try to work out their differences. Communication is essential for the nurse and the physician to have a sound relationship and work together to resolve issues. If the doctor believes this is something Mr. White does not need to know right now, then the nurse will have to take the issue to higher authority which was addressed above (nurse supervisor, the ethics committee, social workers, woo system and reference hospital policy, legal, and ethical principles on the matter).The nurse can be there for moral support and help build a trusting relationship with the Mr. White when told of the new diagnosis of cancer and the traitorousness from his doctor. The patient may feel hurt, confused, angry, and may have lost trust in the health care providers. The nurse can also talk to the family about the matter as well and offer all the alternative treatments that can be carried out to help the patient decide what is best for Mr. White. This can be carried out but only after the patients rights are addressed.Select a Morally Justified Action/Option from Alternatives setThe nurse will have to make a decision as to what she feels any reasonable nurse would do in this situation and carry out the patients wishes accordingly. She will need to advocate for his rights in decision making and converse with the physician. If this doesnt get resolved then take it to higher authority. The nurse needs to address the patients wishes and needs and then the families. If Mr. White determines that he does not want to carry out any treatments, then his wishes need to be addressed. If he decides he wants to start treatments immediately for his cancer, then these wishes would need to be followed through.The nurse talked with the physician about the issue, but the problem was never resolved. As a result, nurse took the matter into her own hands and talked with the nurse supervisor who confronted her boss and the case was then taken to court. The judge al ong with the help of the jury determined the patient must know all information related to his health care and he was properly informed of his cancer. Mr. White understood that his cancer was terminal and that he decided that he only wanted palliative means of care. He wanted to remain soothing and spend the rest of his time with the people he loved dearly. The family concord on his decision because they knew this was what he wanted. He was able to make decisions based on his care and was content at being in control one thing in his life. He was given quality care by his nurse and he remained comfortable throughout his illness. Mr. White passed away peacefully 3 months later at home surrounded by his family.