Ethical Reasoning In Nursing practice Information 2022

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Exploring the Theory and Application of Law and Ethical Reasoning in Nursing Practice.
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Introduction.
Health ethics are based on questions about what is right and wrong and what constitutes
professional conducts while taking justification based on situations, value conflicts or ethical
dilemmas, systematic analysis and the resolution processes of those conflicts(American Nurses
Association, 2016). Health ethics takes a broader perspective including issues faced by health
care providers, health policy-makers, patients and their families and health researchers in various
health-related contexts. Primarily, health ethics are built on complex and empirical realities on
certain and specific health issues. (WHO, 2016) Ethics and laws are highly related since they
both define how individuals ought to act. They are sometimes complementary than a person may
be legally required to do what is ethically required. However, some laws can conflict with ethical
standards. This is because ethics are majorly concerned with wide aspects of behaviors and
relationships than most forms of legal relationships. For instance, abusing elders may be seen
unethical but not against the law(Johnstone, 2016). Health care professionals are obligated to
follow codes of ethics which largely align with legal regulations. Therefore, health care
providers need to follow ethical standards in every clinical decision-making.
Ethical standards are important in order to make sure nurses and other health workers do
what is best for the interest of the patients(Gough, 2014). Such bio-medical ethics seek to defend
and protect patients rights and dignity through the use of specific norms, principles, and values
that regulates ethical conducts(International Council of Nurses, 2012b). Ethics makes all nurses
to be legally and professionally answerable to their actions. In this regard, ethics provides
guidelines and a framework in which health care professional work. Other than that, ethics
protect nurses and patients as they contain all requirements needed during clinical practice. The
code for nurses and midwives provide guidelines for nurses while they are working with people,

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during their practice, in their profession and while working with co-workers(Pitama et al., 2017).
Therefore, ethics and laws equip and govern nurses with knowledge and skills while tackling
ethical and legal issues.
Patient choose to do not resuscitate at the end of life care
Mrs. M, a 60 years old female patient, was admitted in the palliative care unit six months ago
with stage four breast cancer. She is married and has two children, a daughter, and a son. Mrs.
M has a history of diabetes and hypertension which she has been receiving treatment at the
palliative care unit. She is also under pain management for cancer. Mrs. M is a Christian who
strongly believe that it is the will of God when a person dies and therefore nobody should
interfere with Gods Work. Her children often come to visit her with her glad children. She is
often happy and like preaching to other patients requesting them to repent at their final days.
Some of her most consistent symptoms include joint pain and urine incontinence. Sometimes she
refuses to eat saying she had nausea, or she is contented. The doctors and nurses on duty have
been trying to help her day by day to alleviate the symptoms.
When admitted to the palliative care, her medical doctor explained to her that she had
about eighteen months to live and the reason for admission was for monitoring and pain
management only. She said she has made peace with God and when the time of death comes she
will be ready. However, over the past two weeks, her condition has been deteriorating more than
expected. She is currently bedridden, and she barely talks as usual. She frequently complains of
pain in a different part of the body from time to time. Three days ago she called the nurse on
duty and requested her if she has to die the nurse should not resuscitate her. The nurse on duty
tried to explain to she still had more time to live, but she still insisted that she did not require
resuscitation. She said that was the will of God and no one should interfere with it. She then

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asked the nurse on duty not to tell her children and husband since they would refuse to comply
with her request. The nurse on duty was in dilemma and therefore she consulted the doctor and
explained the whole situation. The doctor said the patient has to sign a consent form together
with the family members as the protocols provided.
Discussion.
Do not resuscitate and advance medical directive as applied in ethics
In palliative care, especially cancer patients a do not resuscitate(DNR) decision is
commonly made(Santonocito, Ristagno, Gullo, & Weil, 2013). DNR decision is often made
when patients decline resuscitation if it is considered that the patient may not survive the
cardiopulmonary resuscitation taking into account the quality of life or in a poor prognosis.
Quality of life is commonly defined as the personal subjective perception of how and where they
live, expectations, associated goals and objectives, standards and concerns(Chen et al., 2014). A
DNR order involves refraining from basic CPR and advance CPR that include drugs and
defibrillation(Bailey et al., 2012). If there is no official DNR order, a CPR must be started
immediately as guided by the clinical guidelines in Singapore.
In Singapore, an Advance Medical Directive(AMD) is a legal document usually signed
by the patient as a directive of what nurses and doctors should use whenever there is an
extraordinary life-sustaining intervention to prolong one's life(Lachman, 2010). Nurses and
doctors are obligated to inform patients all form of treatment and in that case-patients can decide
what form of treatment they should receive at the end of life(Sanderson, Zurakowski, & Wolfe,
2013). For instance, any patient over the age of 21 and mentally fit can decide on his or her own
whether to receive CPR or not. In our scenario, the patient had not signed the AMD and thus
there was no legal justification indicating the patient admitted DNR decision. In that case, a