NHS FPX 4000 Assessment 1 Applying Ethical Principles

NHS FPX 4000 Assessment 1  Applying Ethical Principles

Applying ethical principles to an ethical dilemma

Summary of a suicidal patient case study 

Health care professionals face ethical dilemmas during practice due to many reasons. Some of the reasons are medical errors leading to blame culture, assisted suicide, patient information privacy, life support decision based on decision-making authority, negligence, and other ethical dilemmas (Park et al., 2015). The purpose of this paper is to analyze a patient suicide case study ethical dilemma to apply an ethical decision-making model to mitigate the issue. 

The case is of a patient, Mr. Green who has suicide tendencies after admitting to the health care facility. Mr. Green is an old gentleman who is 57 years old. The patient was admitted to the oncology unit of the health care facility in Brisbane, Australia. Seven years ago, he was diagnosed with prostate cancer but did not take surgical and medical treatment. The patient chose alternative therapy and treatment but has failed to follow up on his condition with the assigned urologist since then. Now, he has contracted hypoproteinemia and anemia. A series of diagnostics tests were conducted and it was found that cancer has metastasized to the bones (Jie, 2015). 

Further, the spread has reached lymph nodes, the tumor has invaded the bladder and affected the functioning of the left kidney. It was estimated that he will live for six to twelve months, but the latest diagnosis after the cystoscopy indicated that tumor growth was fast and he will live for four to six weeks. Further, it was determined that medical or surgical interventions are not possible at this time. The health care professionals suggested palliative care. However, the patient informed the nurse that he had enough and want to end his life, but urged the nurse to disclose this information and intentions to anyone (Jie, 2015). This constitutes an ethical dilemma as keeping communication with the patient, honoring their wishes, and promoting health by fulfilling nurse responsibilities collide with each other (Suhonen et al., 2018). 

Ethical dilemma in the case study

It is the nurse’s duty to discuss different options with the patient to make a decision that is based on the patient’s choice and wish (Awenat et al., 2017). For example, a patient on life support can give decision-making rights to his family member to take the right decision when he is not capable of decision-making (Campo-Engelstein et al., 2015). However, in this case, the decision to end the life is against the core responsibilities of a nurse. Further, health care professional should keep their conversation with the patients confidential. However, the issue leads to legal, philosophical, moral, and professional dilemmas as ending a life and keeping the information private is against the professional practice code of nursing (Goligher et al., 2017). For example, a nurse can persuade a patient with terminally ill cancer not to drink or smoke to extend the possibility of life. Another example is midwives can highlight the complexities of normal birth in a particular case to suggest a caesarian (Diema Konlan et al., 2019). Another aspect is even if the nurse honors the wish of the patient, the intervention to end the life should be well-thought and based on clinical outcomes. Suicide attempts leading to more complex problems and patient not dying reflects poor decision-making even though patient’s autonomy was considered (Goligher et al., 2017). For example, health care assisted suicide poses less risk compared to individual suicide attempts without precautions (Goligher et al., 2017). 

Individual ethical decision-making consists of understanding moral awareness of the case based on individual, organizational, and cultural values and morals then make the judgment based on communication, issue analysis, and exploring options, and finally acting based on different aspects to make the right decision to the case (Snyder Sulmasy & Mueller, 2017). Thus, the most important ethical dilemma faced by the nurse in this situation is whether to inform other health professionals and violate patient’s consent and autonomy or keep the secret and subject self against moral and professional responsibility as a nurse and as a human (Jie, 2015). This constitutes the moral awareness aspect of ethical decision-making. 

NHS FPX 4000 Assessment 1 Applying Ethical Principles

Analysis of the case

It is important to identify the relationship between an ethical dilemma and ethical principle. The first aspect is the patient’s autonomy (Jie, 2015). Even though the decision to end life is the patient’s autonomy, but it is taken after knowing that he will live for four to six weeks. He is not cognitively sound and facing emotional distress. This clouds judgment. Thus, the nurse should first establish communication to remove suicidal thoughts as it is her duty to suggest the best possible option to the patient. Snyder Sulmasy & Mueller (2017) argued that even when the patient has complete autonomy, but it is the responsibility of the nurse to implement clinical judgment by limiting cognitive biases. Goligher et al. (2017) supported physician-assisted suicide when a patient is in a vegetative state, but not when a patient can function properly and can live his remaining life. Jie (2015) recommended the nurse take a life-prolonging decision and persuade the patient to communicate with other professionals before making the decision as the ethical clash between beneficence, non-maleficence, and the principle of autonomy should result to benefit the patient.  

The core responsibility of the nurse is to protect the life of Mr. Green as it leads to the beneficence aspect of moral decision-making. The nurse should take positive actions even if at the time it is against the patient’s autonomy. Large et al. (2017) in their study concluded that nurses should identify the patients at risk to commit suicide to prevent it. Discussions with nursing staff and other health care staff help in assessing the situation based on individual and organizational values, policies, morals, and laws (Campo-Engelstein et al., 2015). Further, Awenat et al. (2017) reported that nurses go through psychological issues after assisting suicide, withholding suicide information, or witnessing their patients commit suicide. This indicates negative induced effects on nurses. 

Another aspect is non-maleficence. This ethical principle deals with an obligation to not to harm the patients knowingly or unknowingly. The nurse should take a decision that should harm the patient. For example, suicide attempts might not be successful and it might lead to other complications. The study by Shand et al. (2017) showed that the suicide survivors felt that the decision was instinctive and any outside help would have prevented them from committing the act. Barnfield et al. (2018) also highlighted the need to prevent suicide attempts to reduce potential self-harm. Therefore, violating the patient’s autonomy and informing others to take the right decision is the right choice in this case. However, it is important to explain the benefits and harms of different actions to Mr. Green so that understanding his perspective aid in mitigating the issue (Large et al., 2017). Ignoring the values of beneficence and non-maleficence over autonomy is cannot be justified in this case as even under euthanasia, patients do not have a right to end their life when they want and however they want (Jie, 2015). As a result, the nurse should inform others and persuade the patient not to commit suicide through communication, advocacy, and different therapies. 

Effectiveness of communication approaches

Eliciting and then responding to the suicidal thoughts can help the patient to understand the impact of a recent adverse event on the patient. This can be achieved by establishing paraprofessional or professional-patient interaction to gain trust and understand patient’s perspectives. Further, highlighting the possible adverse outcome of suicide and possibilities of prolonged life by giving examples of previous patients aid in relaxing the suicidal thoughts (McCabe et al., 2016). Instead of group discussion, it is better to establish one-to-one communication first and then discuss the issue with others including family. It is also recommended to interact within the institutional setting or within the community to make the patient feel trusted (Shand et al., 2017). Instead of concentrating on conditions, it is better to focus on suicidal ideations. It is better not to highlight the possibility of health care complexities. Also, it is better to avoid discussing negative family or personal issues (McCabe et al., 2016). 

Ramberg et al. (2016) in their case study highlighted that nurses used education as a means to educate the patients to understand the complications of their actions. The process included establishing a nurse-patient relationship to gain trust and provide emotional support. It is advised to have a positive attitude and implement a persuasive communication strategy. Further, incorporating psychiatric nurses with sufficient training aid in preventing suicide thoughts (Ramberg et al., 2016). 

Ethical principles

Establishing communication, educating patient, building trust, discussing with other health care staff, providing support, and having an attitude to prevent suicide and promote the well-being of the patient to prolong the life is under the ethical principle of beneficence, non-maleficence, professional, and moral obligation (Ramberg et al., 2016). As explained in the ethical analysis section, the action plan is to promote health and benefit the patient by understanding his perspectives. As a result, the proposed solution is based on the ethical principles of beneficence, non-maleficence, and moral and professional obligation (Jie, 2015). 

References

Awenat, Y., Peters, S., Shaw-Nunez, E., Gooding, P., Pratt, D., & Haddock, G. (2017). Staff experiences and perceptions of working with in-patients who are suicidal: qualitative analysis. British Journal Of Psychiatry211(2), 103-108. https://doi.org/10.1192/bjp.bp.116.191817

Barnfield, J., Cross, W., & McCauley, K. (2018). Therapeutic optimism and attitudes among medical and surgical nurses towards attempted suicide. International Journal Of Mental Health Nursing27(6), 1826-1833. https://doi.org/10.1111/inm.12490

Campo-Engelstein, L., Jankowski, J., & Mullen, M. (2015). should health care providers uphold the dnr of a terminally ill patient who attempts suicide?. HEC Forum28(2), 169-174. https://doi.org/10.1007/s10730-015-9289-1

Diema Konlan, K., Baku, E., Japiong, M., Dodam Konlan, K., & Amoah, R. (2019). Reasons for women’s choice of elective caesarian section in Duayaw Nkwanta hospital. Journal Of Pregnancy2019, 1-7. https://doi.org/10.1155/2019/2320743

Goligher, E., Ely, E., Sulmasy, D., Bakker, J., Raphael, J., & Volandes, A. et al. (2017). Physician-assisted suicide and euthanasia in the ICU. Critical Care Medicine45(2), 149-155. https://doi.org/10.1097/ccm.0000000000001818

Jie, L. (2015). The patient suicide attempt – An ethical dilemma case study. International Journal Of Nursing Sciences2(4), 408-413. https://doi.org/10.1016/j.ijnss.2015.01.013

Large, M., Chung, D., Davidson, M., Weiser, M., & Ryan, C. (2017). In-patient suicide: Selection of people at risk, failure of protection and the possibility of causation. Bjpsych Open3(3), 102-105. https://doi.org/10.1192/bjpo.bp.116.004309

McCabe, R., Garside, R., Backhouse, A., & Xanthopoulou, P. (2016). Effective communication in eliciting and responding to suicidal thoughts: a systematic review protocol. Systematic Reviews5(1). https://doi.org/10.1186/s13643-016-0211-y

Park, M., Jeon, S., Hong, H., & Cho, S. (2015). A comparison of ethical issues in nursing practice across nursing units. Nursing Ethics21(5), 594-607. https://doi.org/10.1177/0969733013513212

Ramberg, I., Di Lucca, M., & Hadlaczky, G. (2016). The impact of knowledge of suicide prevention and work experience among clinical staff on attitudes towards working with suicidal patients and suicide prevention. International Journal Of Environmental Research And Public Health13(2), 195. https://doi.org/10.3390/ijerph13020195

Shand, F., Batterham, P., Chan, J., Pirkis, J., Spittal, M., Woodward, A., & Christensen, H. (2017). Experience of health care services after a suicide attempt: results from an online survey. Suicide And Life-Threatening Behavior48(6), 779-787. https://doi.org/10.1111/sltb.12399

Snyder Sulmasy, L., & Mueller, P. (2017). Ethics and the legalization of physician-assisted suicide: an american college of physician’s position paper. Annals Of Internal Medicine167(8), 576. https://doi.org/10.7326/m17-0938

Suhonen, R., Stolt, M., Habermann, M., Hjaltadottir, I., Vryonides, S., & Tonnessen, S. et al. (2018). Ethical elements in priority setting in nursing care: A scoping review. International Journal Of Nursing Studies88, 25-42. https://doi.org/10.1016/j.ijnurstu.2018.08.006

NHS FPX 4000 Assessment 1 Applying Ethical Principles