Please pay attention to the documents I attached. I attached the Bloom Taxonomy that you need to apply, the sample that the instructor sent us as an excellent pa…and the two docume

Anticipatory Guidance for the Bioethical Issues Paper

Acceptable Issues for the Bioethical Issues Paper: Be sure to review the description and rubric for this assignment, especially the following section from the syllabus:

Nursing Ethics Paper

Please refer to Bloom’s cognitive domain for guidance on graduate level expectations. At the graduate level there is an expectation of tight organization, rigor, strong analysis, incisive argument, and scrupulous citation.

Students will select an ethical issue to examine, and write a scholarly paper on the issue’s importance to nursing. The issues should be a large professional issue that affects nursing (e.g., nurse migration, racism in nursing education, just pay for nurses, NINR and underfunding of nursing research…) or a large health-related issue (e.g. poverty, climate justice, unequal healthcare, child poverty/hunger, homelessness…). The paper will examine the issue, including its antecedents, dimensions, ethical analysis, cultural dynamics, the position of the nursing profession on the issue (nursing code of ethics). National, state, and/or healthcare organizations’ policies or stance surrounding this issue should be reviewed, and evaluated, with recommendations or suggestions for enhancement. Succinct examples and illustrations will be an important part of this paper as they are in any ethical discussion.

Do not write on a medical issue, for example, treatment cessation, futility, consent for surgery, abortion, genetic manipulation, placebos, etc.

The reference list should include a variety of sources and demonstrate the student’s research of the topic. This is a scholarly paper and the research must include academic substance, not merely opinions or propaganda (i.e., media reports without verifiable facts).

All papers are to be in standard academic APA (7th ed. or current) format, and be free of spelling, grammatical, and typographical errors. Headings should be utilized in all papers of this length to guide your reader. For this paper you must use the headings from the rubic. Body of the paper should be 10-12 pages (3,000 words). This does not include the title page, reference list, or appendix.

Graduate papers: ALL academic, graduate, papers are formal papers, similar to journal articles in academic style. Do not use colloquialisms, do not use first person (I/me), do not write about your personal opinion, do not self-reference: avoid all personalization. Graduate papers are arguments, not opinions or assertions. All claims must be substantiated with proper citations from the academic literature. Use of popular literature is generally unacceptable.

Citations: At the graduate level, failure to provide proper and accurate citations in your work is considered an act of academic dishonesty and can result in immediate failure of the course and dismissal from the program. The importance of proper citations cannot be over-stressed. Failure to cite your sources is the most serious of offenses in the academic world; it is tantamount to the theft of the work of others. At the graduate level it cannot be argued that one did not know how to cite one’s work. If you have any haziness, any at all, about the use of citations you must, contact the writing center for guidance forthwith.

Paper Length:–to repeat—paper “length” is based on assumed adequate content, not actual paper pages, and “paper length” are an estimate of how much space is needed to accomplish the task of the assignment. A page of text is approximately 260 words. The corpus (body) of a paper 12 pages in length would be roughly 3,100 words. Packing in white space reduces the paper content to about 2,000 words – it is about quality of the content, not pages. Stretching a paper with white space, large font, oversized margins, pages with one paragraph, etc., to reach “page length” will essentially guarantee that the paper will fall far short of expected content quality depth, breadth, and rigor. It is a bit more accurate to use word count but, as to word count, where the assignment is analysis and synthesis, adding non-analytical content such as biographical and historical information to meet a word count will still fail to accomplish the specified task.

Sources: Paper length and sources share the same issues. It is not about the absolute number of sources and citations, it is about the quality, rigor, breadth, complexity, and depth of the sources. At the graduate level it is expected that the student will focus on primary sources, written by the authors themselves, not secondary sources (reflections by others on what the primary author says). It is also expected that the student will use a wide range of sources, some of which may conflict with others, i.e., take differing views. It is also expected that the sources will be exclusively academic and not popular works.

Mechanics: Graduate papers need to be error free. Proofread. Look up the rules for the use of quotation marks, block quotes, colons, semicolons, commas, etc. Going forward, points will be deducted for errors in spelling, grammar, punctuation, diction. A list within narrative text does NOT use numbers, it uses letters. Look up the rules.

Inclusive language: It is expected that all papers will be written using inclusive language. Man/mankind are exclusive and unacceptable. Avoid using female pronouns for nurses. If you write about nurses (plural) you can say “they” and can avoid the awkward construct of “she or he.”

English Dictionary: the definitive dictionary of the English language is the Oxford English Dictionary (OED). No other dictionary carries the same authority. The OED is available online through the APU library and any public library.

Graduate level work: All graduate papers are looking toward analysis and synthesis, not description.

Notes on writing a “Classical Essay” meaning a generic essay.

A classical essay has 6 components:

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11

Effects of Healthcare Practices on Environmental and Human Health

Anonymous Student Quality Nursing Ethics Paper

GNRS 504: Bioethics and Healthcare Policy

Marsha D. Fowler, PhD, MDiv, MS, RN, FAAN, RSA., Brent A. Wood, PhD.

November 30, 2020

Effects of Healthcare Practices on Environmental and Human Health

Healthcare services seek to maintain and improve health and are essential in our society. In their mission to promote health, these services do not come without harmful effects on other aspects of society, specifically the health of the natural environment. Through intensive energy use, production of excessive waste, and the use of toxic chemicals, the healthcare sector creates a variety of air, water and soil pollutants that directly harm the health of the environment (Lenzen et al., 2020., Schenk et al., 2015). These environmental destructions and changes cause secondary health risks to humans as we depend on and are sustained by the environment in which we live (Lenzen et al., 2020., Valentine-Maher et al., 2018., Schenk et al., 2015).

In their attempt to treat illnesses, improve health and advance practices, the healthcare sector contributes to environmental changes that impact patient health, thus increasing the need for further healthcare interventions, which in turn creates additional environmental changes. This sequence maintains and in fact fuels what is referred to as the “healthcare-environment cycle” (Clark, 2019, The problem: An environmental crisis section, para. 4). The aim of this paper is to bring awareness to the healthcare-environment cycle, analyze the ethical components of the issue, discuss the cultural dynamics of the issue, and address the nursing profession’s position and responsibility in the matter. Environmental stewardship must be practiced widely within healthcare to manifest change towards a healthcare system that can continue to maintain and improve health but in a way that diminishes the future harm to environmental health and human health as a biproduct. Nurses, the nursing profession, and nursing organizations play a vital role in leading this pursuit.

Issue & Dimensions

Environmental Impacts

Like all industries and people, the healthcare industry has an ecological footprint. The ecological footprint measures how fast we, in this case the healthcare industry, consume resources and generate waste compared to how fast nature can absorb these wastes and generate new resources (Global Footprint Network, 2020). In other words, it measures the demand and supply of nature. Healthcare practices in the United States contribute to a large portion of the nation’s resource consumption and waste generation, accounting for the annual production of over 2.5 million tons of complex waste and 10% of the nation’s greenhouse gases (Clark, 2019).

A conservative estimate of the average amount of waste produced per patient per day in the United States is 29 pounds (Schenk, 2020). In their study, Denny et al., estimate 30 to 33 pounds of waste per patient per day equating to 12 billion pounds of waste annually (2019). The rise in the use of plastics, disposables, and single-use items are some of the ways by which waste production has been exacerbated (Denny et al., 2019).

Greenhouse gases (GHGs) are the leading contributors to climate change, which has vast and alarming effects on the environment such as, but not limited to, extreme heat and weather events, rising sea levels, increased food insecurity, soil and water contamination, reduced air quality, natural disasters, drought, and insect outbreaks (NASA, 2020., Travers et al., 2019., WHO, 2018a). Increasing GHGs and the increasing frequency of these environmental changes has resulted in what Dr. Elizabeth Schnek, a nurse scientist and board member of the Alliance of Nurses for Healthy Environments, refers to as an “environmental crisis” (Clark, 2019, The problem: An environmental crisis section, para.1).

In addition to the GHG-related emissions from healthcare, there are also non-GHG-related emissions from healthcare with negative environmental health consequences (Eckelman & Sherman, 2016). Furthermore, indirect emissions that occur as a result of industrial production of the electricity and materials that healthcare facilities use are also substantial contributors to environmental pollution and changes (Eckelman & Sherman, 2016). The healthcare industry has been relatively limited in their recognition of the problem and its massive scope and has additionally been slow in addressing the problem (Nicholas & Breakey, 2019). While there are numerous contributors to the current environmental crisis, the healthcare sector, both nationally and globally, is a major contributor and therefore should assume a major role in finding and implementing solutions (Gallagher & Dix, 2020). In particular, the nursing profession plays an important and integral role in addressing these issues, as will be discussed later in this paper.

Human Health Impacts

Anything that affects the environment will also consequently impact systems that depend on the environment and its resources for survival. The environmental crisis has a wide-ranging impact on vast ecosystems within our planet; this paper addresses its impact as it relates to human health globally. Due to its depth and scope of destruction and impact, climate change has been identified as the greatest threat to global health in the 21st century (WHO, 2020., Lopez-Medina et al., 2019). Human health effects related to air pollution include increased risk of asthma and other respiratory diseases, heart attack, stroke, and cancer (Nicholas & Breakey, 2019). Extreme weather events such as hurricanes, droughts, wildfires and mudslides damage public health infrastructures, increase occupational health hazards, promote social and mental health stress, and predispose humans to illnesses associated with insufficient shelter and population displacement; they are also the direct cause of injuries and death (Nicholas & Breakey, 2019., Travers et al., 2019). An increase in contaminated food and water results in more frequent pathogen-associated disease outbreaks and increased exposure to contaminants (United States Climate Resilience Toolkit, 2016). Insect outbreaks, such as that of mosquitos, due to global climate change, increase the number of mosquito-vectored diseases such as malaria, dengue, and zika virus (Kraemer et al., 2019., Nicholas & Breakey, 2019., Lenzen et al., 2020). Disruption of agricultural production magnifies food insecurity, malnutrition and undernutrition (Travers et al., 2019). Mentioned here are some of the numerous human health impacts of environmental pollution and climate change.

While all populations are affected by environmental pollution and climate change, some populations are disproportionally impacted, including people of low socioeconomic status, communities of color, immigrant groups, indigenous people, children, pregnant women, the elderly, people with disabilities, and those living with pre-existing or chronic medical conditions (WHO, 2018a., Valentine-Maher et al., 2018, Crimmins et al., 2016., Fowler & ANA, 2015).

The Healthcare-Environment Cycle

In its efforts to improve health and advance practices, health care consumes massive amounts of resources and produces significant quantities of wastes that contribute to environmental degradation and changes that threaten human health. This in turn increases the need for further healthcare interventions which enables the healthcare-environment cycle to continue (Clark, 2019). While a polluted environment can cause many physical ailments, human health is also impacted in other ways. Therefore, the human health impact referred to in this argument goes beyond that of physical and mental health, or the absence of disease or illness, but also incorporates other dimensions of health and well-being including social, spiritual, emotional, intellectual, vocational, and financial health. Healthcare professionals must become better environmental stewards in order to fully meet their duty of improving human health. Without environmental stewardship, the cycle continues.

Ethical Theory & Principles

The principles foundational to biomedical ethics, as established by Beauchamp & Childress, include moral principles of respect for autonomy, nonmaleficence, beneficence and justice. The issues mentioned surrounding and enabling the healthcare-environment cycle can be analyzed through the lens of these ethical principles, in particular those of nonmaleficence, beneficence, and justice. It is important to clarify these principles first and foremost. Nonmaleficence is the obligation to intentionally avoid actions that cause harm as well as not to impose risks of harm to the individual patient (Beauchamp & Childress, 2013). Beneficence is the obligation to provide benefits to others, and secondarily to balance these benefits against any associated risks (Beauchamp, 2003., Beauchamp & Childress, 2013). The principle of justice involves obligations of fairness in the distribution of these benefits (Beauchamp, 2003., Beauchamp & Childress, 2013).

In its attempts to solve immediate health needs, healthcare creates future health problems for its patients and communities, both locally and globally, through environmentally negligent practices. Healthcare focuses on reducing harm in numerous ways including implementing fall and seizure precautions, engaging in checklists or “timeouts” to prevent surgical errors, implementing standards of care to prevent nosocomial infections and medication errors, as well as implementing contact, airborne and droplet precautions to prevent the spread of infectious diseases. When it comes to pollution, of major harm to environmental and human health, healthcare is not held adequately accountable. While some hospitals measure and report their pollution, most hospitals do not, as they are not required to do so (Schenk, 2020). While this requirement is not that of a legal one, it is arguably that of a moral one. In their book, The Principles of Biomedical Ethics, Beauchamp & Childress discuss the standard of due care as taking appropriate action to avoid causing harm, as the circumstances demand. Additionally, the standard of due care requires that the goals pursued justify the risks that must be imposed to achieve those goals (2013). In the current circumstances, that is with climate change identified as the greatest threat to global health in the 21st century and our certain understanding that it disproportionally impacts populations (therefore fueling injustices), healthcare is engaging in unjustifiable and inadvertently negligent practices (WHO, 2020., Lopez-Medina et al., 2019., WHO, 2018a., Crimmins et al., 2016). Healthcare does not seek to cause harm through its practices, but its decision to continue to engage in practices that impose risks of harm to the environment and thus to human health, thereby depriving others of the goods of life, is an ethical oversight. A duty to the public has been breached, and substantial harm to health is its result. This is a violation of the ethical principle of nonmaleficence.

While rules of nonmaleficence are negative prohibitions of action (refraining from actions that cause harm), the rules of beneficence are positive requirements of action (engaging in actions that are beneficial) (Beauchamp & Childress, 2013). Just as for nonmaleficence, beneficence incorporates prima facie rules of obligation. These include, preventing harm, removing harmful conditions, and promoting healthy actions and the general good (Beauchamp & Childress, 2013). In discussing these aspects of beneficence in relation to the issues surrounding the healthcare-environment cycle, a few questions arise. Can harm be prevented? Can harmful conditions be removed? Can benefits be provided for one another? While harm cannot be completely eliminated, some harm can be prevented and removed. We have the means, technology and resources to alter healthcare practices to reduce the amount of harm (and risks for harm) inflicted upon environmental and thus human health. For instance, cutting down on electricity and water use to only that which is necessary, using more re-useable materials vs single-use disposables, implementing proper waste and recycling practices, divesting from fossil fuels and non-renewable resources of energy are examples of ways in which harm can be prevented or removed while these benefits are provided. Healthcare is already highly recognized and respected as an industry that prevents harm, removes harmful conditions and promotes good for others, however, this analysis argues that more can be done.

The bioethical principle of justice involves obligations of fairness in the access to and distribution of resources (Beauchamp & Childress, 2013). Its relevance in the issues surrounding the healthcare-environment cycle is unquestionable, however, due to its magnitude and scope this analysis only briefly touches upon the involvement of this bioethical principle. Those who experience the greatest burden of environmental pollution and climate change are the ones most vulnerable to begin with. This includes those mentioned before: people with less immediate access to financial and social power, the poor, immigrants, people of color, indigenous people, children, women, the elderly, people with disabilities, and those living with pre-existing or chronic medical conditions (WHO, 2018a., Valentine-Maher et al., 2018, Crimmins et al., 2016., Fowler & ANA, 2015). Alongside being the most vulnerable, it is suggested that these populations are also the least equipped to respond to and least likely to contribute to the harmful environmental changes (Travers et al., 2019., CDC, 2015., Leyva et al., 2017., Nicholas & Breakey, 2017). This phenomenon widens societal gaps and deepens social injustices. Environmental injustice, social injustice, and climate injustice are interdependent realities involved in the healthcare-environment cycle.

Cultural Dynamics

Through energy use, resource depletion, waste production, and the use of toxic chemicals, the best of healthcare systems still pollute the environment and thus negatively impact human health globally. As previously mentioned, populations are affected disproportionately by environmental harm and pollution. In particular, populations already burdened by social inequities are the most impacted, thusly causing further injustice. The following are cultural examples of populations who live with environmental health inequalities.

Indigenous people are among the most affected by environmental pollution (Crimmins et al., 2016., WHO, 2018a., Fernández-Llamazares et al., 2020). Fernández-Llamazares et al., attribute this vulnerability to indigenous peoples high and direct dependency on local natural resources, limited access to healthcare, and relatively low levels of governmental support (2020). In a comprehensive review of literature (686 studies), Fernández-Llamazares et al., reveal the impacts of pollution on the environment, health and culture of indigenous peoples globally (2020). The pathological impacts of environmental pollution on indigenous people include diabetes, hypertension, childhood leukemia, neurologic disease, anemia, cancer, autism, cardiovascular disease as well as changes in the age of initial menstruation, contaminants in breastmilk, anxiety, and depression (Fernández-Llamazares et al., 2020). Spiritual, social and cultural health is also harmed by environmental pollution, as many traditional practices and spiritual ceremonies rely only on access to local plants, animals and watersheds. With these resources being polluted, using them poses additional health risks. In the absence of traditional practices, indigenous culture, spirituality and social relationships are threatened (Fernández-Llamazares et al., 2020).

The large disposal of wastes from healthcare facilities pose a threat to environmental and human health globally (Asante et al., 2014). This is mainly due to the flow of chemicals and other wastes and pollutants through air, water, and eventually soil. A few of the recognized waste-related human health concerns are cancer, reproductive health, respiratory infections, asthma, neuropathies, and death (WHO, 2015., Njoku et al., 2019). People living in closer proximity to and with higher exposure of hazardous wastes suffer greater health impacts than those living further away and with less exposure to these waste site pollutants (WHO, 2015., Bullard et al., 2007., Mohai & Saha, 2015). Hazardous waste facilities are more often than not located in neighborhoods where poorer people and people of color live, thereby creating further disadvantages and injustices for already marginalized groups of people (Bullard et al., 2007., Mohai & Saha, 2015

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