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Individuals are free to use their autonomy and make decisions based on informed consent. A foremost theorist in value development, Lawrence Kohlberg, addressed the maturity element of informed consent. He suggested that individuals reach the post-conventional level when they are years of age and older. Upon reaching this level, Kohlberg believed that individuals were able to reason and make autonomous decisions.

Ethical dilemmas become more pronounced when the practitioner and patient are from different cultures.

Nursing Ethics - Ethical Dilemmas Faced By Nurses Everyday

As the difference between the cultures increases, so does the risk of inappropriate care. There should be respect for cultural particularism. Practitioners must be willing to include the cultural and spiritual values and requests of the patient in the treatment program. This understanding assists the nurse in providing appropriate patient care.


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In cases where a patient refuses care, the staff must determine if the care is considered ordinary care or extraordinary care. On the other hand, extraordinary care was considered to include treatment that did not offer a hope of benefit and that caused excessive pain. Should the patient be allowed to refuse extraordinary care? One such court case was that of Elizabeth Bouvia. Bouvia was a young adult quadriplegic who also suffered from cerebral palsy. She endured numerous hospitalizations and experienced uncontrollable pain.

Because of her intense suffering, she requested that she be allowed to withhold nutrition and starve herself to death. The hospital refused. She took her plea to the court and eventually received a ruling that allowed her to choose informed non-consent of treatment. Bouvia followed through on her desire to withhold nutrition and eventually died because of her action. Practitioners take an oath that obligates them to help the patient. The responsibility accepted by taking this oath is not taken lightly.

The willingness of a practitioner to follow their oath, results in patient confidence that the practitioner will work diligently on their behalf. In practice, the lines between beneficence and virtue ethics may become blurred. By considering what a good nurse would do, the nurse characteristically avoids evil as beneficence requires.

Additionally, the nurse has received formal education and accumulated practical experience. This gives them a strong understanding of the medical problem and the potential impact for the patient. This approach to medicine is known as paternalism. The fiduciary relationship gives the patient confidence in knowing that the practitioner will do everything they can to benefit the patient.

In other words, as long the practitioner does their duty, they are acting ethically The patient always maintains their personal autonomy, but the practitioner must also be allowed to follow the autonomy of the profession. Practitioner autonomy is supported by Callahan This is true even if the program contradicts the cultural values of the patient. The practitioner should respect the universality of his actions.

The conflicting autonomy of the patient and practitioner is best described by the contractarian theory.

Essay on Ethics and Beneficence

In order to receive services, a person must be willing to surrender some of their autonomy Opponents of Mr. It was noted that because of their profession, practitioners were recognized as being beneficent and virtuous people. By itself, beneficence is a good principle to follow, but when coupled with virtue ethics it leads to paternalism. In the case of Mr. K, as well as, subjugated Mr. Additionally, it was noted that the paternalism led to a strong fiduciary relationship. In most circumstances a fiduciary relationship benefits the patient.

The practitioner focused solely on a desired positive outcome and discounted the pain and suffering experienced by Mr. In regard to Mr. Supporters of Mr. K presented the maturity level and experience required to provide informed consent. K was well aware that the level of care necessary to tend to his needs was extraordinary as evidenced by the unintentional pain that was experienced each time his wounds and physical needs were addressed.

Previous court decisions upheld the right of a patient to choose informed non-consent especially when faced with unmanageable pain. Additionally, Mr. This means that it is the responsibility of the healthcare professionals to protect their patients. This goes along with the ethical theory of utilitarianism which believes in the actions that provide the greatest good for the greatest number of people.

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In healthcare ethics, utilitarianism supports the idea of maximum benefits and minimized costs and risks Mack, The two principles of beneficence and non- maleficence often go simultaneously hand in hand. However, they may override each other at times. In the given situation where the nurse is asked to keep away the news of poor prognosis, the decision to do so may be in favor of the patient and the intention of the family members to do so may be to protect the psychological wellbeing of the patient through beneficence.

This act according to Edwards outweighs the respect for autonomy in regard to obligations of non- maleficence. However, in doing so, the nurse may lose the trustworthy relationship built with the patient. In addition to the therapeutic relationship, if the diagnosis is accidentally revealed to the patient, she might end up to more serious complications like suicidal attempt or acts of self harm. Moreover, hiding the news may end up in mental and psychological trauma to the patient which could be more fatal than the disease itself. In this way, the principle of beneficence holds true but the probability of non-maleficence is high.

Medical Ethics 2 - The Four Principles - Prima Facie Autonomy, Beneficence, NonMaleficence & Justice

The principal of autonomy often comes into conflict with the principle of beneficence. In this situation, intentionally or unintentionally, healthcare professionals use paternalistic approach while caring for their patients as they consider that approach as useful for their patient. Though the intervention seems useful for the patient, yet it breaches the autonomy of the patient by disrespecting the right of her decision in the treatment. It is important to note that while situations like these require healthcare professionals to critically analyze the risks and benefits associated with the choices that they make, in the process of choosing the best option, the entire situation along with its consequences should be taken into account, well discussed and planned so that the decision made should promote maximum beneficence and minimum or no harm with respect to autonomy.


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The literal meaning of justice is equality and fairness. In healthcare industry, justice refers to equitable distribution of resources. Conn, Gillam and Conway mentions about different forms of justice such as distributive justice and the rights based justice. The rights based justice deals with respect to people's rights rather than the law.

It is believed that and especially in healthcare industry that all individuals have equal rights in terms of seeking healthcare and to participate in their plan of care. Moreover, another ethical dilemma is that since there is no mention about any personal limitations or incapability because of which she would not be able to process the information then the act of not disclosing the information or truth to her is incorrect.

In contrast to this statement, the nurse in this situation clearly violates the right of the patient to know about the poor prognosis. The situation described here has no perfect answer. In this situation we cannot come to a perfect conclusion, rather we can analyze the situation and use the ethical decision making process and apply the best possible principle. It is difficult to come to a conclusion due to certain reasons. Firstly, the description of the situation is very brief. One cannot analyze or evaluate all the aspects of the situation with this brief explanation.

Thus making a judgment as to which ethical principle applies best in the given situation would be difficult. The Nurse could wait, assess the patient for the degree of acceptance and let the physician involve or take over. It is equally important to access the family condition and ties.

Moreover the competency and threshold of the patient needs to be accessed before comming to a conclusion. However analyzing the situation with all its intrinsic and extrinsic factors, a decision can be made considering the best possible outcome in favor of the direct recipient of care patient. Along with all these factors, Edwards believes that "all actions by healthcare professionals have a moral dimension to them" p.

To sum up, There seems no perfect answer to an ethical dilemma. The paper has discussed the application of the ethical principles in the given situation. It is hard to justify the use of one principle over another. Yet the ethical decision making process provides a guide to take a step ahead and apply the best possible principle. However, it may not be the perfect choice but it may result in maximum beneficence and minimum harm which could be avoided. The framework that guides nursing practice for example the America Nurses Association code of ethics and the patient bill of rights should also be taken into consideration while deciding for the best choice in situations which give rise to an ethical dilemma.

Nevertheless, in any such situation, pros and cons and risks and benefits should be weighed against to get to the get best possible solution which would be in favor of the patient.