Ethical Dilemmas in Nursing Practice

This assignment delves into the ethical complexities nurses encounter while providing care to terminally ill patients. It centers around a case study of a patient refusing treatment despite potential health benefits, examining the legal and ethical ramifications. The analysis explores concepts like patient autonomy, informed consent, and the nurse's duty to advocate for patient well-being. The document emphasizes the importance of nurses possessing a thorough understanding of professional ethics and legal standards to navigate such challenging situations effectively.

Running head: NURSING
Ethical and legal challenges in a case study
Name of the Student
Name of the University
Author Note

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An experienced nurse is often responsible for assisting patients and their family members
during times of suffering and pain. Assisting patients who are vulnerable to an imminent death
risk is quite complicated and creates burden on the professional performance. In addition, nurses
face various ethical dilemmas each day, regardless of their clinical expertise or practice
(Iacobucci et al., 2013). This essay will explore the case study of a 67 year old lung cancer
patient who considers the treatment to be futile and wants to stop them. It will further illustrate
the ethical and legal issues and will discuss the implications of the scenario in nursing practice.
Legal and ethical issues- All patients have the right to determine his treatment and it is
the fundamental duty of healthcare organizations and practitioners to recognize this right. Nurses
are entitled with the responsibility of respecting patients’ autonomy while taking measures that
would improve patient health outcomes. The case study involves a tension between autonomy
and beneficence. It is of utmost concern that the nurse Mary should respect the decisions taken
by Jerry and should encourage him to participate in the decision making process. Mr. Jerry’s
autonomy provides him the right to take decisions regarding his health condition regardless of
the fact that such a decision can create adverse health effects and can cause imminent death.
Although taking informed consent is generally considered as a legal concept, it is an ethical
imperative that works towards promoting the personal well-being of a patient. The patient’s
autonomy has come into conflict with the beneficence of the nurses and the doctors. Ethical
conflicts will arise between non-maleficence and the power of autonomy (Holt & Convey, 2012).
These can create adverse emotional impacts on the patient. Thus, Mary and the concerned
healthcare authorities should try to inform Mr. Jerry of the probable benefits of medications on
lung cancer and should try to influence him to show compliance to the treatment. The nurse
should respect the decisions of the patient as long as Mr. Jerry is able to meet the criteria for

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taking an autonomous decision. However, efforts should be taken by the nurse to convince him
to show compliance for the treatment (Faden et al., 2014).
These ethical issues will adversely affect the relationship between him and Mary.
Therefore, it is of prime importance that his Moreover, Mr. Jerry does not want to continue the
treatment as he feels it will be a burden on his daughter, who is already engaged in taking care of
her family. These conflicts can be avoided if the nurse discusses the financial issues with the
healthcare team and a medical social worker. The major legal issues associated with this case are
the presence of informed consent (Moulton et al., 2013). The Universal Declaration of Human
Rights states that a patient has all rights to decide for the continuation of treatment services. It is
the role of the nurse to ensure that his rights are recognized by the other healthcare members and
the treatment services are carried out with the aim of advocating his best interests (Who.int,
2017).
Ethical decision making process- The value statement 1 of the SNB code of ethics state
that a patient must receive care from nurses and that care should determine the demands and
values of the patients. This code of practice puts a restriction on client discrimination on the
basis of ethnicity, gender, age, religion, and socio-economic status. Further, the nurse Mary is
bound by the standards of practice that mention that nurses should help their clients to express
individual needs and should take them into these into consideration during formulating an
optimal care plan. Moreover, the value statement 2 states that the client’s autonomy should be
protected and the patient should be given all necessary support to obtain information from
appropriate sources (Healthypeople.gov, 2017). Therefore, in order to obtain an optimal health
outcome, it is imperative for the nurse to develop a collaborative relationship between her
patient, his daughter and the staff of the healthcare organization (Engel & Prentice, 2013). On

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getting informed, his daughter may assist the nurse in helping him understand the benefits of the
treatment and the anticipated outcomes that can arise if it is not followed.
If the hospital authorities and his daughter are unable to convince Mr. Jerry to continue
with his treatment, he may be discharged from the hospital against the medical advice of the
oncologist. Further, it will be the duty of the nurse to take his word that he will be responsible for
any adverse consequences that might arise due to refusal of the treatment. Mary should prepare a
consent form or AOR form that will contain signatures of a witness, and that of a person who
advocates for the patient (Ivanov & Oden, 2013). The decisions will be documented and an
evaluation will be done to ensure that Mr. Jerry and his daughter are able to cope if any adverse
effects arise after his discharge.
Thus, it can be stated that nursing practices encompass several legal and ethical issues
that create serious concerns for nurses. It is extremely essential for nurses to have a thorough
knowledge of the professional nursing standards in their profession, which will guide them while
making such conflicting ethical decisions. Nursing is a complex task and the nurses often face
difficulties in delivering holistic care to their patients. Their actions should be consistent with the
ethical regulations and the laws, and they should always be involved in discussing the ethical and
legal problems with the healthcare authorities before any decision is implemented. Protecting a
patient’s autonomy is one of the most essential practices. An analysis of this case study will help
nurses to gain the ability to apply their clinical knowledge in practice. Moreover, the nurses
should be aware of the duties they need to carry out, if a patient refuses treatment, regardless of
the fact that it may have beneficial health outcomes. Thus, it can be stated that providing care to
a terminally ill patient may require larger efforts from nurses to identify individual patient needs
and make the best ethical decisions to promote patient wellbeing.

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References
Engel, J., & Prentice, D. (2013). The ethics of interprofessional collaboration. Nursing
ethics, 20(4), 426-435.
Faden, R. R., Beauchamp, T. L., & Kass, N. E. (2014). Informed consent, comparative
effectiveness, and learning health care. N Engl J Med, 370(8), 766-768.
Healthypeople.gov. (2017). Search the Data | Healthy People 2020. Healthypeople.gov.
Retrieved 11 November 2017, from
https://www.healthypeople.gov/2020/data-search/Search-the-Data#objid=4971;
Holt, J., & Convey, H. (2012). Ethical practice in nursing care. Nursing Standard, 27(13), 51-58.
Iacobucci, T. A., Daly, B. J., Lindell, D., & Griffin, M. Q. (2013). Professional values, self-
esteem, and ethical confidence of baccalaureate nursing students. Nursing ethics, 20(4),
479-490.
Ivanov, L. L., & Oden, T. L. (2013). Public health nursing, ethics and human rights. Public
Health Nursing, 30(3), 231-238.
Moulton, B., Collins, P. A., Burns-Cox, N., & Coulter, A. (2013). From informed consent to
informed request: do we need a new gold standard?. Journal of the Royal Society of
Medicine, 106(10), 391-394.
Rubin, M. A. (2014). The collaborative autonomy model of medical decision-
making. Neurocritical care, 20(2), 311-318.

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Who.int. (2017). The Health Manager's Website. World Health Organization. Retrieved 7
November 2017, from http://www.who.int/management/en/