Introduction to nursing arts and science

Competency 725.1.8: Introduction to Bioethics – The graduate applies the basic ethical
theories in bioethics and engages in basic analysis key bioethics issues surrounding the
beginning of life, the end of life, procreative decisions, and informed consent; applies
ethical principles to selected bioethical case studies; and recognizes the difference between
ethical and bioethical dilemmas and between ethical and legal issues.
Introduction:
Nurses are confronted with ethical decisions every day, ranging from decisions about
routine vaccination to issues of death and dying. It is important, therefore, that nurses
know how to analyze a bioethical issue based on nursing ethical values, principles, and
facts in order not only to make ethical decisions about their practice, but also to help
support patients and families as they struggle with ethical decisions.
You will use the following scenario to complete this task:
Matt, a 20-year-old white male, was brought into the emergency department unconscious
with a needle protruding from a vein in his left forearm. It was determined from his lab
work that he had been taking opiates, and a heroin overdose was suspected. After Matt was
intubated and placed on mechanical ventilation, he was stabilized and transferred to the
intensive care unit. Matt’s family was notified, and they rushed to his bedside within a half
hour. After speaking with the physician, the family told the healthcare team that they
wanted to do everything possible to save their son’s life.
An hour later, Matt’s heart stopped, and after a full code, Matt was stabilized but was still
not breathing on his own. Matt’s heart stopped two more times over a span of three hours.
Dark blood was becoming visible in the suctioning canister, but Matt remained in a full
code status, and the family refused to assign him a “Do Not Resuscitate” (DNR) status after
five codes.
Currently, the physician does not want the patient to have any further resuscitation. EEG
shows no brain activity. The nurse is torn between supporting the family and following
through with the physician’s desires. The nurse manager informs the nurse that she should
do as the physician says. The nurse also dislikes caring for drug abuse patients. The patient
did not have a DNR order on file. If he had a DNR, there would have been an agency policy
to follow it. The hospital also has an ethics committee.
Task:
A. Analyze (suggested length of 1-2 pages) the moral aspects/issues found within the
scenario.

  1. Provide relevant facts that relate to the aspects/issues.
  2. Discuss the ownership of the situation.
  3. Discuss how the five essential nursing values might play into the scenario.

INTRODUCTION TO NURSING ARTS & SCIENCES        2
B. Analyze (suggested length of 1-2 pages) two bioethical issues in the given scenario in
terms of a specific ethical theory of your choice.

  1. Discuss the theory.
  2. Explain how the chosen theory relates to the given scenario.
  3. Discuss an applicable law or agency policy.
    C. Discuss (suggested length of 1-2 pages) how alternative actions might affect the patient
    outcome.
  4. Apply the ANA Nursing Code of Ethics to guide these actions.
    D. If you use sources, include all in-text citations and references in APA format.

Introduction to Nursing Arts & Sciences

Introduction
In the daily operation, nurses face different ethical decisions situations that range from
routine vaccination to issues relating to dying and death. It is essential that these nurses have
knowledge on how to analyze these bioethical issues based on nursing ethical values, facts,
principles to be able to make ethical decisions about their duties and responsibilities. This will
also help support their patients and families as they struggle with understanding application of
ethical decisions.

PART A

Moral aspects/issues in the scenario
The scenario has various moral issues that require to be addressed. One of the moral issue
concerns the decision whether to save the life of Matt or not. The family members are of the
view that, their son can be saved from death while the physician has given up on the same. Matt
is in a very critical state, as his brain has stopped working, his dark blood is visible in the
suctioning canister. This indicates that indeed he is at risk of dying. However, amidst all these,

INTRODUCTION TO NURSING ARTS & SCIENCES        3
he is unable to express his will. Despite this, family members are optimistic that he can survive
and therefore there is no need for the physicians to end his life and therefore have refused to
assign him a “do not resuscitate’. Furthermore, the physician refusal to abide by the directive of
the family members to ensure that the patient life is not terminated is a moral issue, as the
physician does not want the patient to have any further resuscitation. It is also a moral question
for the nurse to state that she dislikes taking care for drug abuse patients and yet that is her duty
to enhance the health of patients.
In this case, the ownership of the situation was the family members. This is captured in the
case, “the family told the healthcare team that they wanted to do everything possible to save their
son’s life”. This indicates that the family had the last decision of the end of life decision. Even
though Matt was in a critical condition, they were the only people to give directive on the next
decision to be taken and there decision was to ensure that all assistance was provided to ensure
that their son was saved. Furthermore, the family members refused to assign “Do not
resuscitate” status after being approached. Therefore, this is a clear indication that the family
members owned the situation and was supposed to make the last decision.
The five essential nursing values that suit this scenario include; altruism, autonomy,
human dignity, integrity and social justice. Altruism means that the nurses should aspire to do
well and be concerned with other people issues (Andre, 2002). Therefore, the nurses should put
in their best in restoring Matt life. They should also have autonomy in the sense that they should
put on a spirited heart to save the life of Matt. They should also has human dignity by respecting
the uniqueness of the patient, should have integrity by being honest and acting in accordance to
the code of ethics and standards and practice. Lastly, the nurses should have a sense of social
justice by working to ensure that there is equal treatment and equal accessibility to quality

INTRODUCTION TO NURSING ARTS & SCIENCES        4
healthcare. The scenario in which the nurse expression her dislike to attend to drug patients
should not have arisen. The nurse has the moral duty to use her professional qualifications to
serve all patients without discrimination. Therefore, these five values are of importance in
ensuring that appropriate services are provided that adheres to ethical standards.

PART B

Analysis of two bio-ethical issues in the scenario in relation to ethical theory
One of the ethical issues in the scenario is the wish of the family members and that of the
physician. The family refused to assign DNR despite the physician’s advice and the physician’s
decision to make Matt a DNR over the objections of the family. The second bio-ethical issue
concerns the nurse. The nurse is torn apart whether to support the family on DNR or the
physician who has contrary thought otherwise. To address these issues in depth the theory of
Deontology by Kantianism will act as guidance. The theory provides direction on determining
what is rational and what is not. The will and reason should also come into play in making
decisions. An individual is also required to do that which is required by being consistent and
avoiding self-contradictory policies since people are evaluated on what they do. This theory also
seeks to differentiate between what is good and bad. Doing good is brought by doing the right
action. Therefore, right is a basic notion and people need to have a positive attitude towards
doing or acting according to ones moral duty (Curtis, 2011). Therefore, this theory relates to this
situation especially when it comes to making the right decision of end of life care. Physicians in
the case had an obligation to choose from what was good and right from what was not right. The
physician had the duty and moral obligation to act in ethical manner by coming up with the right

INTRODUCTION TO NURSING ARTS & SCIENCES        5
decision that would be in tandem with the wish of the patient. He therefore, chose to stop to give
further resuscitation after learning that their family members had failed to assign DNR. The
physician therefore failed to adhere to ethics by refusing to abide by the wishes of the family
members. Refusing to provide resuscitation was against the law. In the second case of the nurse,
there was also lapse in adherence to ethics. It is the moral duty of the nurse to make appropriate
decisions concerning end of life decisions. Therefore, the nurse would have supported the family
members, as this was the right way to go because she could have acted in moral way. Abiding by
the directive of the manager and physicians indicates that she failed to act in a moral way. The
physicians also breached ethical standards by failing to adhere to the wishes of the family who
were the owners of the situation.
One of the applicable law that would have enabled this case to be handled well is if
uniform rights of the terminally II Act law was adhered to (Saunders 2010). This law was
formulated in 1985 and revised in 1989. United States of America recommends it as a Uniform
Act. The law gives authority to an individual to declare a living will, which clearly states that in
circumstance that he or she does not wish to remain alive in case of a coma, terminal ill or
through support life, and then the physicians can take away the patient’s life. Therefore, had
Matt declared this living will then the end of life decision would have gone on smoothly.
Furthermore, the law allows a patient to obtain a health care known as power of attorney, which
allows appointment of an agent that is required to make medical decisions for the patient incase
the patient becomes incompetent. Hence, if Matt had obtained the power of attorney then this
problems of end of life decisions would not have surfaced as the uniform rights of the terminally
II Act law could have been used.

PART C

INTRODUCTION TO NURSING ARTS & SCIENCES        6
Discussion of how alternative actions might have affected the patient outcome
The patient outcome could have been affected through Cardiopulmonary resuscitation
(CPR) interventions. This is because there were no written physician orders that deterred
performance of CPR (Bishop, Brothers, Perry & Ahmad, 2010). CPR interventions could have
helped to extend the life of the patient. Further alternative action in this scenario would be to use
the agency laws and policies. For instance, the agencies policies that concerns mechanisms for
safer transfer of care by agency or providers should have been adopted. In such a case DNR
decisions has ethical conflicts and the best way is to transfer the patient (Matt) to another nurse
or physician that is competent to take care of the patient (Matt). This alternative action could
have provided hope of recovery as another physician could have used his skills and experience to
safe his life as the level of skills and knowledge among physicians varies. An ethics committee is
yet another appropriate alternative action that suits this case. The committee will come up with
deliberations after investigating on the breaches of adherence to ethical standards by physicians
and nurses in their conduct and therefore they will have to come up with alternative solutions
such as looking for another physician to provide treatment to the patient. Such alternative course
of actions would have provided hope for resuscitation because of the different levels of skills of
physicians. The family members would also been in peace and in harmony with the decision
hence disputes between them and the physicians would not have ensued anymore.
American Nurses Association codes of ethics (ANA) are helpful in understanding how
these alternatives could have impacted on the patient’s outcomes. American Nurses Association
code of ethics is composed of provisions that guide the behavior and the way nurses need to
behave during their service delivery. The nurses at all the time are required to appear
professional in their service delivery and relationships with patients. Therefore, they have a duty

INTRODUCTION TO NURSING ARTS & SCIENCES        7
to always save the lives of their patients; they are also required to be always committed to their
patient’s, community and groups to ensure that they improve their health status (Michael, 2010).
They also need to have integrity when carrying out their roles. Furthermore, they need to
collaborate with other nurses and patients to ensure that they provide the best services.
Therefore, in case of a situation that requires an appropriate decision they need to help
physicians with ideas on the ways of solving problems (American Nurses Association 2011).
Hence, as stipulated in the American Nurses Association, nurses have the responsibility of
impacting positively on the end of life care by being professional and upholding to high level of
integrity among other important values.

INTRODUCTION TO NURSING ARTS & SCIENCES        8

References

Andre, J. (2002), Bioethics as Practice, Chapel Hill and London: University of North Carolina
Press,
American Nurses Association (ANA). (2011). Codes of ethics.
Bishop, J., Brothers, K., Perry, J., & Ahmad, A. (2010). Reviving the conversation around
CPR/DNR. American Journal of Bioethics, 10(1), 61–67.
Curtis, B. (2011). Ethical Theories Compared. Retrievd form: Ethical Theories Compared
Hayry, M. et al (Eds.) (2010). Arguments and Analysis in Bioethics. Amsterdam/New York:
Rodopi
Michael, D. (2010). The role of the American nurses association code of ethical decision making.

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