Ethical Frameworks Essay – “Four Topics Approach”
40418*Please see in the attachments which contains also this paper details I just copy and paste, the rubric and the unedited instructions and 4 topics approach.
Week 2 Ethical Frameworks Essay
Consider the “Four Topics Approach” (or Four Box method) to ethical decision making on page 61, Table 2.1 in Butts (below EDITED WITH SHORT ANSWER TO GUIDE YOU WITH WHAT I WANTED TO BE INCLUDED IN THE ANSWER / PDF ATTACHED NOT EDITED). Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.
In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?
Your paper should be 1-2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.
Review the rubric for further information on how your assignment will be graded.
Points: 60
TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases
Describe the situation and the role you played in detail.
ROLE: EMERGENCY DEPARTMENT REGISTERED NURSE ON DUTY
PATIENT MAIN PROBLEM: SEPSIS
SITUATION: SEPSIS IN A 95 Y/O MALE WITH ATRIAL FIBRILLATION HYPERTENSION, DIABETES MELLITUS TYPE 1 AND ON HEMODIALYSIS (END-STAGE RENAL DISEASE)
Begin by describing a challenging ethical situation you faced and the role you played in it, e.g., nurse, patient advocate, coworker, manager, etc.
ETHICAL DILEMMA: WIFE WHO WANTS TO GO AGAINST THE “LIVING WILL” OF THE PATIENT WHICH STATES DNR/DNI AND NO CARDIAC AND LIFE-SAVING EMERGENCY PHARMACOLOGIC TREATMENT WHEN PATIENT GOES INTO ARREST.
BEDSIDE NURSE: RESPONSIBLE IN TAKING CARE OF THE PATIENT
PATIENT ADVOCATE: SUPPORTING AND PROTECTING PATIENT’S PREFERENCE OF CARE
1.) Medical Indications: The Principles of Beneficence and Nonmaleficence
What is the patient’s medical problem? SEPSIS IN A 95 Y/O MALE WITH ATRIAL FIBRILLATION HYPERTENSION, DIABETES MELLITUS TYPE 1 AND STATES DNR/DNI AND NO CARDIAC AND LIFE-SAVING EMERGENCY PHARMACOLOGIC TREATMENT WHEN PATIENT GOES INTO ARREST.
a. Is the problem acute? YES
b. Chronic? NO
c. Critical? YES
d. Reversible? YES
e. Emergent? YES
f. Terminal? NO
2. What are the goals of treatment? CARDIO, PULMO AND RENAL SUPPORT WITH TRIALS OF NORMALIZATION OF LACTATE VIA RAPID ANTIBIOTICS AND FLUIDS INFUSION
3. In what circumstances are medical treatments not indicated? DNR/DNI + NO PHARMACOLOGICAL TREATMENT.
4. What are the probabilities of success of various treatment options? HIGH
5. In sum, how can this patient be benefited by medical and nursing care, – SUPPORT OF CARDIO-PULMO-RENOVASCULAR, STABILIZATION OF HEMODYNAMIC STATUS, STAT DIAGNOSTIC EXAMS (LABORATORIES AND RADIOLOGICAL) AND RAPID ANTIBIOTICS AND FLUIDS INFUSION,
a. and how can harm be avoided? PROPER ASSESSMENT AND RE-ASSESSMENT OF THE PATIENT AND CLOSE MONITORING OF THE NEUROVITAL SIGNS AND THE HEMODYNAMIC STATUS.
2.) Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, YES
a. understood this information, YES
b. and given consent? YES
2. Is the patient mentally capable and legally competent, YES
a. and is there evidence of incapacity? NO
3. If mentally capable, YES
a. what preferences about treatment is the patient stating? PATIENT GENERALLY AGREED ON ALL THE SEPSIS PROTOCOL AS EXPLAINED BY THE PHYSICIAN
4. If incapacitated, NO
a. has the patient expressed prior preferences? NA
5. Who is the appropriate surrogate to make decisions for the incapacitated patient? WIFE
6. Is the patient unwilling or unable to cooperate with medical treatment? NO
If so, why? NA
3.) Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with treatment, = PATIENT WILL BE ABLE TO GET WELL AGAIN
a. for a return to normal life, YES
b. and what physical, NONE
c. mental, and NONE
d. social deficits might the patient experience even if treatment succeeds? NONE
What are the prospects, without treatment, = PATIENT WILL NOT BE ABLE TO SURVIVE
a. for a return to normal life,
b. and what physical,
c. mental, and
d. social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment? LACK OF AUTONOMY
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life? NO
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life? BENEFICENCE, NONMALEFICENCE, AUTONOMY
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment? YES
6. What are plans DNR/DNI
a. and rationale to forgo life-sustaining treatment? PATIENT WISHES NO AGGRESSIVE, LIFE-SAVING MANAGEMENT LIKE INTUBATION
7. What is the legal and ethical status of suicide? = Death with Dignity website (https://www.deathwithdignity.org/learn/healthcare-providers/) provided the five states that enacted Death with Dignity Acts, and these are the following: California (2016), Colorado (2016), Oregon (1998), Vermont (2013), Washington (2008) and Washington, D.C. (2017). Supporters of Death with Dignity Acts justified it ethically using arguments about respect for autonomy, justice, compassion, individual liberty vs. state interest and openness of discussion.
4.) Contextual Features: The Principles of Justice and Fairness
1. Are there professional, NO
a. interprofessional, or NO
b. business interests that might create conflicts of interest in the clinical treatment of patients? NO
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions? YES, THE WIFE (WHO WANTS TO GO AGAINST PATIENT “LIVING WILL”) BUT HAVE NO SAY AS PATIENT HAVE “LIVING WILL”
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
= HIPAA (Public Law 104-191)
Designed to protect the privacy, confidentiality, and security of patient information.
HIPAA standards are applicable to all health information in all of its formats (e.g., electronic, paper, verbal). It applies to both electronically maintained and transmitted information. Pozgar, G.D. (2014) Reference
Pozgar, G. D. (2014). Legal and Ethical Issues for Health Professionals, 4th Edition p. 252 [VitalSource Bookshelf version]. Retrieved from vbk://9781284089530
= Taylor M. J. (2015) The Regulations establish a secure legal basis for a health professional to disclose confidential patient information for the purposes of
a. diagnosing communicable diseases and other risks to public health;
b. recognising trends in such diseases and risks;
c. controlling and preventing the spread of such diseases and risks;
d. monitoring and managing
e. outbreaks of communicable disease;
f. incidents of exposure to communicable disease;
g. the delivery, efficacy, and safety of immunisation programmes;
h. adverse reactions to vaccines and medicines;
i. risks of infection acquired from food or the environment (including water supplies);
j. the giving of information to persons about the diagnosis of communicable disease and risks of acquiring such disease.
REFERENCE
Taylor M. J. (2015). LEGAL BASES FOR DISCLOSING CONFIDENTIAL PATIENT INFORMATION FOR PUBLIC HEALTH: DISTINGUISHING BETWEEN HEALTH PROTECTION AND HEALTH IMPROVEMENT. Medical law review, 23(3), 348-74.
4. Are there financial factors that create conflicts of interest in clinical decisions? NO
5. Are there problems of allocation of scarce health resources that might affect clinical decisions? NONE
6. Are there religious issues that might influence clinical decisions? NO
7. What are the legal issues that might affect clinical decisions? NONE
8. Are there considerations of clinical research and education that might affect clinical decisions? NO
9. Are there issues of public health and safety that affect clinical decisions? NO
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare? NO
Source: Jonsen et al., 2010
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