Ethics has become part of the nurses’ life when it comes to decision making and taking actions in the face of adversity or opportunity. Husted and Husted (2008, p.9) states that the patients has lost their power to take actions on their medical conditions due to the lack of knowledge in the health care settings. Hence, the healthcare providers are there to impart their skills and knowledge to treat the patient with the best care. This assignment would discuss how the medical decisions for A B who has undergone radical mastectomy are made using the model for ethical decision-making.
A B’s husband suspects that there might be a spread of the tumors and informed the nurse in the out patient clinic not to mention to her if she had a spread of the tumor. A has the right to refuse to speak to the counselor and not to know in depth of her disease process. The ethical dilemma is in this case study is, whether the nurse should refrain herself from reveBng A’s progress on her condition.
The second ethical dilemma is should A continue to restrain herself from speaking to her counselor.
Yarbro, Frogge and Goodman (2005) states that the prognoses of patients with non invasive tumors will benefit from the mastectomy, however for patients who have invasive tumors are at probability for relapse. After the mastectomy operation the patients are at risk of wound infection, flap necrosis and seroma formation. Yabro et al. (2005) also mentioned that although breast cancer in young women is a rare condition, the disease is more aggressive biologically and has unfavorable prognosis as compared to older women.
In most of the conditions, radiation therapy or chemotherapy is given to reduce the chances of relapses and to increase the chance of survival.
This shows that there is high chance for A to have a relapse and that she is also highly at risk for depression due to her medial condition, and the altered body image. Mastectomy causes emotional distress and that is advisable to seek a counselor or a social worker to express the feelings which aids in recovery (Mills, 2006, p.561). In a research done on emotions of patients after mastectomy found that patients who have undergone mastectomy experienced is similar feelings to those of bereavement. Anxiety, denial and tension leading to stress are commonly found after post operation of mastectomy patients .The research further elaborates that the role of the patient in social, sexual and interpersonal is altered thus affecting the individual physically and mentally (Farooqi, 2005, p.270).
Having so many mental and physical conflicts, A should seek help from the counselors and allow herself to express her thoughts so that she is able to cope with the situation. By doing so, she will be able to see things positively and have the courage to move on. Keeping in mind that she has two children, A will also need to make the necessary arrangements for the children in terms of financial, social and physical needs. National University Hospital (n.d) states that patients have the right to know information about their treatment and care plan and to participate in decision-making about their treatment care and their discharge. A has the right to know her treatment plan. She will not be able to see the broader picture of her condition and will remain in depression thinking that it is the end of the world if she remains unaware. When help is provided, she will be highly motivated to move on.
Respect for autonomy is the fundamental rule of clinical ethics. It is defined as an individual right to make a decision without having interferences by others and personal limitations. Healthcare providers should educate and guide the patients so that they can understand the medical condition and will be able to make decisions. Patients have the right to seek consent for their medical treatment and to disclose information about their medical condition to them (Pantilat, 2008).
Therefore, the nurse should inform A regarding the spread of the cancer, if there is, so that she will be able to make a rightful decision on her treatment. This is supported by AustrBan Nursing and Midwifery Council (AMNC) (2006), Code of Professional Conduct, Conduct Statement 7; nurses are required to inform the patient of the nature and purpose of recommended nursing care to assist the patient to make informed decisions. However, the husband had mentioned not to inform A about the spread to prevent their marriage from getting worst. By listening to the husband’s point of views, there are chances of saving their marriage and it benefits A and her family. Beneficence
Beneficence is explained has an action done to promote good for others. An obligatory act to assist patients based on their importance and legitimate interests (Beauchamp & Childress, as cited in Parker & Dickenson, 2010, p.195). In the case study, it is said that A is very stressful and that she does not want to talk about her disease to the counselors. If the nurse listens to the husbands instruction, A’s stress level will not be added on and thus doing good for her. On the other hand, if A is not told about the disease and how much the counselors wanted to help her. The more she will pull herself back and may decide not to have any further treatment. These will deteriorate her condition. SNB Code of Ethics and Professional Conduct Value Statement 7 states that clients’ best interests must be taken care of (SNB, 2006 p. 8). Non-maleficence is a principal that requires not inflicting harm to the patients.
Before being ethically reasonable in trying to help the genuine interest, the nurse must be very certain of doing no harm. Aiken (2004), non-maleficence demands that health care providers defend from harm to those who cannot protect themselves. SNB Code of Ethics and Professional Conduct Value Statement 5.1 and AustrBan Nursing & Midwifery Council (ANMC) Code of Ethics for Nurses in AustrBa Value Statement 1 both supports that nurses should safeguard the health and safety of their clients against incompetent, unethical or illegal practices. In A’s case, there is no evident that she is in a state of unsound mind or there that she wants her husband to decide for her.
Therefore A should be informed of a disease process and allow herself to speak to the counselors. If A is not told the truth, the nurse is indirectly inflicting harm for the patient as she owes a duty of care. Yeo, Moorhouse, Khan and Rodney (2010, p.293) mentioned that justice is the wider sense of fairness, whereby everyone should be treated fairly and equally based on the individual or groups entitlements. Every patient would want know how much their condition has improved or deteriorated. In A case, she deserves to be treated and to know her prognosis as this allows her to have time to make arrangements in her social life. She may not want to talk about her disease to the counselor but there might be someone whom she feels comfortable in opening up. As her care providers, the team of healthcare professionals should find out the details and provide her with the best care possible.
There is no evidence that A is in a state of unsound mind and that she has given her rights to her husband to make decisions on behalf of her. Therefore it is Madam Aminiah’s right to know her condition and to discuss her treatment plan. Although by breaking the news A would be distressed but it is the responsibility of the practitioners to give her an opportunity to participate in the decision making even if it has to involve a third party with A’s approval. After making discussions with A, she decides that her husband will be the only decision maker, he will be the surrogate decision maker (University of Illinois at Chicago College of Medicine, n.d) and we should respect her decision. Butts and Rich (2013) mentioned that a better ethical approach to patient care is by providing truthful information at the same time keeping the patient composed and educating her successful ways to manage her condition. Although by not telling A the truth may save her marriage life and benefit her family.
The rights of the patients should not be violated. When patient right are being violated, the nurse is at risk of causing harm. SNB Code of Ethics and Professional Conduct Value Statement 2 emphasize the mandate of respect and support clients’ autonomy. Value Statement 7 requires nurses to defend those clients who may be vulnerable and incapable of protecting their own interests and to be an advocate in the best interest of their clients. Everyone is considered innocent until proven guilty. The approved investigators must collect enough evidences to visibly convince Nursing commission members that a violation had occurred. Under the Patients’ Right (Scotland) Act 2011, section 3, states that patient has the right to know about their condition and to make decision relating to the patient’s health and well being. As nurses, we should not refrain ourselves from telling the patient the truth unless stated.
This is vastly supported by SNB Code of Ethics and Professional Conduct, value statement 2 Respect and promotes client’s autonomy. Therefore the nurse could be liable for professional misconduct under the Nurses and Midwives Act 2012, Chapter 209. Although A is in a stressful situation, there is no evident that her stress is allowing her to loose her rights in making decision for her disease. A is still in a state of sound mind and therefore her rights should not be violated unless she has agreed for her husband to decide for her or she showed signs and symptoms of unsound mind. This case is indeed an ethical challenge faced by the health care professionals. The author’s decision is to inform the patient on her current condition. If A is to have a spread, it’s her right to know so that she could make the right decision. This decision is supported by AustrBan Nursing and Midwifery Council, (AMNC, 2008) conduct statement 7; Nurses support the health, wellbeing and informed decision making of people requiring or receiving care.
However, the physician will be the best person to break the news. Sullivan (2011) mentioned that health information is compulsory for the patient and it is the ethical and legal obligation of the physician to communicate that information so that patients can make decisions. The patient has the right to a diagnosis and, if consented to, the physician has a duty to treat. Therefore the author will update the team doctors. When A had decided to allow her husband to be her decision maker, than her rights will be respected. In A’s case, a family conference would help to resolve not only her medical issue but also her social issue.
The team doctors will have to document the decision in the treatment and progress notes Medical records are legal documentations that are extremely essential and serve as a means of communication in the health care industry. When there is systemic documentation of patient’s medical history and the treatment provided are recorded, it may benefit when used as an evident in the court (Judson & Harrison, 2013, p. 196).
ANMC National Competency Standards for Registered Nurse, statement 6.3 and 8 both highlight that documentation of care plan must bring about towards achieving expected outcome based on continuity of assessment and to be transparent (ANMC, 2006, p. 5 & 6). A’s decision should be clearly documented on the progress notes highlighting the issues of her decision maker and the treatment recommended to her. Situations that offer ethical dilemmas are common in the healthcare industry. In such situations, it is critical to consider not only the standard regulations, but also the professional code of ethics within the profession. To avoid any legal implication, the medial and nursing team should be mindful of their care provided without violating patient’s interest.
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