Ethical Delima

This geek presents an honorable predicament, a detail which arises when one moldiness choose between mutually exclusive alternatives (Beauchamp& Walters, 2003). Decisions may generate results that are desirable in almost respects and undesirable in opposites. In Juanas case, her decision to refuse the blood blood transfusion had the desired essence of allowing her to remain true to her spiritual beliefs. However, her choice also resulted in her death. If she had followed the recommendation of the physicians and the team, the desirable outcome would have been possible survival but would have had the undesired effect of violating her apparitional principles.The major honourable dilemma was that by honoring the tolerants indecorum and religious beliefs, the physicians and interdisciplinary team were faced with compromising their virtuous responsibility to make do professional care in accordance with established standards (Chua & Tham, 2006). A brief review of the lit of Nu rsing Collection II Lippincott Nursing Journals (from Ovid) and CINAHL databases for the past 5 years found no consequence to support beat out practice for a Jehovahs Witness who is pregnant and has experienced blunt trauma.Healthcare providers faced with this situation have sometimes attempted to obtain court orders that would overrule the diligent roles decision and result in her submitting to recommended aesculapian give-and-take. For example, the Illinois Supreme Court (Illinois v. Brown, 1996) upheld a mothers decision to refuse blood transfusions even though they were vital for both the mothers and fetus survival. The Patients Bill of Rights states that the health care providers responsibility is to give patients accurate information and that patients must consent to treatment (New York rural area Department of Health, 2008).This is consistent with the Federal governments recommendations to create guidelines that assure health care quality and to reaffirm the critical a ffair consumers play in safeguarding their own health, (United States Department of Health and Human Services, 1999). Nursing practice is governed by the patients refine to autonomy rather than her religious beliefs (Levy, 1999). The first item in the Ameri disregard Nurses Association (ANA) Code for Nurses with interpretive Statements (2001) mentiones respect for human dignityTruth telling and the process of reaching informed choice underlie the exercise of self-determination, which is basic to respect for person Clients have the moral right to determine what will be done with their own person to be given accurate information, and all the information necessary for fashioning informed judgments to be assisted with weighing the benefits and burdens of options in their treatment to accept, refuse, or terminate treatment without obsession and to be given necessary emotional support (p. 1).However, it is difficult to witness death based on a persons decision to forgo care when medi cal options to sustain life are available. Treating this type of patient becomes peculiarly challenging when it involves two lives. Virtue ethical motive To analyze this ethical dilemma, the principles of Western medicine and the religious beliefs of Jehovahs Witnesses were examined. The questions that surfaced were (a) how would the application of virtue ethics provide insight into Juanas situation, (b) what were the ethical principles in conflict, and (c) why was it an issue to administer a blood transfusion to Juana in an emergency situation.Volbrechts framework for ethical depth psychology was utilized to address the clinical dilemma and the questions listed above. Virtue ethics was the primary hypothesis employed prior to the 17th century. This theory centers on shared familial and cultural histories and religious traditions and acknowledges the communitys ability to identify, interpret, prioritize, and adjust to moral considerations within a particular context (Volbrecht, 20 02). The following is an exposition of this case according to virtue ethics. Virtue ethics focuses on what is morally correct from the patients view mention and centers on the patients autonomy.Actions and character are intertwined, and the ability to act morally is item on ones moral character and integrity. Virtue ethics focuses on the context of the situation (Volbrecht, 2002). Ethical analysis of virtue ethics entails (a) identifying the problem, (b) analyzing context, (c) exploring options, (d) applying the decision process, and (e) implementing the plan and evaluating results (Volbrecht, 2002). Identifying the problem Juana, a 20-year-old Hispanic muliebrity, 32 weeks pregnant, was involved in a car accident. Internal bleeding to the thoracic or abdominal cavity was suspected.The stakeholders were the woman, her husband, the fetus, and the interdisciplinary healthcare team. The team thought the best method of treatment for this patient was to administer a blood transfusion a nd perform an emergency cesarean section. Both the patient and her husband refused this option because of their religious beliefs and provided written support indicating that the patient would not accept blood or blood products. The value issues were the physical survival of the woman and her fetus versus the womans religious integrity. Analyzing contextTo understand the decision- do process in this case, one must consider the ethical principles of autonomy, beneficence, nonmaleficence, justice, compassion, and respect. The patients religious beliefs and how they influenced her decision must also be taken into consideration. Gardiner (2003) confirms that the ethical principles mentioned above influence ones choices. In Juanas case, the healthcare team suspected she was experiencing internal bleeding and that she and the fetus were in physiological distress. Juanas decision to reject the proposed treatment was based on her stated religious beliefs.The contextual factors of this case centered on the patients religious beliefs. The patient stated she would rather be embraced in the hollow bosom of Jehovah than to be condemned for all eternity, if she should arrive a blood transfusion. Nurses draw from the code of ethics to reflect upon and understand the persons perspective, and to honor her wishes. The nurse provides function with respect for human dignity and the uniqueness of the client, unrestricted by considerations of social or economic status, personal attributes or the nature of the health problem (ANA, 2001, p.1). To respect the patients decision and honor her dignity, supportive care was provided to the patient in an effort to save her life, while at the same time respecting her wishes. The ANA Code of Ethics supports the point of view that healthcare providers should respect patients wishes and decisions despite their own personal beliefs (ANA, 2001). Applying an ethical decision process looking for through the lens of virtue ethics, the caregivers focused on Juanas autonomy and her right to choose what she perceived best in spite of the possible outcomes.Juana was a competent, pregnant woman who made informed decisions not to adjoin blood transfusions or a caesarean section. Based on virtue ethics, the healthcare providers respected the patients autonomy by reflecting on and honoring the decision of the patient and her husband based on her religious value and beliefs. The healthcare providers also displace on the principle of beneficence, which centers on promoting the well-being of others. In this case, the well-being was not physiological but spiritually oriented.The principle of nonmaleficence was also employed by not intentionally inflicting harm on the patient and honoring her wishes. Violation of a clients deeply held beliefs is a form of doing harm. (Leonard & Plotnikoff, 2000). They also drew from the principles of veracity and respect, which entail being truthful to the patient and allowing her to make an informe d decision (Volbrecht, 2002). The nursing virtues of compassion, moral courage, and self-reliance also contribute to an understanding of this situation. Evaluating resultsAt the time this clinical situation presented itself there were no circumstantial guidelines in the institution for dealing with the dilemma presented by this case. However, there are guidelines for Jehovahs Witnesses specifically geared to beforehand(predicate) identification and management of gynecological patients. For example, in Australasia, there are specific guidelines for treating pregnant women that focus on stabilizing the patient by using traditional and new treatment modalities to meet patient needs, particularly for Jehovahs Witnesses or other patients who decline blood transfusions (Womens Hospitals Australasia, 2005).For antepartum patients, the guidelines focus on early identification of Jehovahs Witnesses during prenatal visits, as well as placing these patients on a high risk protocol, includin g maintenance of high hemoglobin and hematocrit levels, having advance directives completed, and establishing affiliations with other hospitals that are well-equipped and staffed to meet these patients needs (Womens Hospitals Australasia, 2005). The Hartford Hospital in computed tomography has a similar program and also performs bloodless procedures on patients who are Jehovahs Witnesses (Miller, 1996).As a result of Juanas case being reviewed by the ethics committee post-mortem, a risk-management protocol was developed requiring patients who refuse blood transfusions to shorten a waiver that removes the legal responsibility for the decision from the hospital and caregivers. To support this type of protocol, the Society for the advance of Blood Management maintains a database of hospitals that provide blood-conserving services in the United States as well as in Canada, Chile, Korea, and South Africa (Society for the Advancement of Blood Management, 2008).The problem, however, in a n emergency situation is that it may not be possible to get the patient to a participating hospital. The Watchtower Bible and Tract Society (2004) recommends that advance directives and other legal papers be in place should an emergency arise. These documents should be easily accessible so that healthcare providers can honor the patients directives. In so doing, they will be applying the theory of virtue ethics and, therefore, respect the patients wishes (Macklin, 2003).Healthcare providers should practice beneficence and non-maleficence without imposing their beliefs as to the right thing to do. More explicit and familiar guidelines would benefit both patients and providers when faced with similar ethical dilemmas. Conclusion In nursing practice, cases of patients refusing blood transfusions or other interventions are becoming more common. Therefore, content regarding ethical issues, such as Juanas case, needs to be integrated into nursing curricula and the clinical arena.Nursing educators who incorporate bioethics into critical thinking in clinical decision making situations can prepare novice and experienced nurses to handle complex ethical dilemmas, such as draw in this paper. The learning process may be facilitated through integrating lectures with case studies and utilizing patient simulators to nurture enhance the learning process (Larew et al. , 2006).These teaching approaches would provide the opportunity to expose nurses to scenarios of acute patients where they can throw in in a safe environment, which in turn would decrease their anxiety and promote learning. Nurse educators can further facilitate the learning process by providing clinical experiences with diverse patient populations in a variety of settings followed by discussion of actual clinical experiences, ethical issues, and debriefing (Larew et al. , 2006).Nursing faculty have an ethical responsibility to prepare competent nurses and facilitate continuing education that will help nurses recognize ethical dilemmas in practice and apply ethical principles in trying to resolve them. The focus in practice, education, and enquiry must be on providing care that respects patients cultural beliefs and autonomy. Nursing educators should place equal speech pattern on ethics in order to provide the best holistic care possible. To do anything else is a disservice both to the profession and to our patients.