Drug and Alcohol Abuse: ICU Access Debate

This assignment presents a debate on whether drug and alcohol abusers should be denied access to intensive care units (ICUs). The author argues against denial of access, citing ethical principles like beneficence, non-maleficence, and virtue ethics. The paper emphasizes the neurological aspects of addiction and advocates for harm reduction strategies instead of punishment.

Running Head: NURSING ETHICS – DEBATE
Nursing ethics – debate
Name of the Student
Name of the University
Author Note

1NURSING ETHICS – DEBATE
Introduction
Good afternoon Maddam Chairman, Ladies and Gentlemen.
The topic for the debate is “Drug and alcohol abusers should be denied access to
intensive care units”.
I believe that the statement is not true. I believe that the people who use and abuse drugs
should not be denied access to ICU.
Debate
The previous speaker’s argument that the child with diminished autonomy should be
preferred over the substance abuser may appear correct from the perspective of autonomy.
However, the drug abusers should be given equal preference considering the risk of harm (such
as reinjury if already injured and presented to emergency ward) to treat them paternalistically.
They are entitled to protection as in medical ethics. More than value to the autonomy, it is
important that the health care providers are liable to consider what is good or bad for the patient
as per the theory of virtue ethics. The examples of virtue ethics are found in the ANMC code of
conduct and guidance on “good health and good character”. It emphasise on the virtues of the
individual and on the moral character (Wilson et al., 2017). The health care providers cannot
influence the decisions of the patients about their medical care. Addict’s have apparent desire to
engage in a harmful act (Noggle, 2016). It is morally correct to save them first. If denying ICU
may lead to patient’s threat than it is justified to admit the autonomous substance abuser first,
then the child, whose autonomy is diminished. If the patient is aggressive then he/she may harm
others as well. Therefore, it is not justified to save one child in ICU and harm two other people.

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This also aligns with two ethical principles of the theory of Principlism- beneficence and non-
maleficence (Kerkhoff & Hanson, 2015).
Alcohol and drug abuse are conditions that are diagnosable with effective treatments.
Untreatment would lead to serious medical conditions. Traumatic injury and reinjury is strongly
associated with alcoholism and there is no valid reason to deny ICU access and address injury of
drug and alcohol abuse. The care provider also have ethical obligation to protect society from
those patients whose actions may cause great financial cost through serious harm to themselves
or others. As per the ethical theory of Consequentialism, “the correct moral response is related to
the outcome, or consequence, of the act” (Kerkhoff & Hanson, 2015). Therefore, the argument of
the previous speaker about denying access to ICU due to increasing health care cost by substance
abusers is invalid. How significant this financial cost may be it does not approach or be
compared to the personal cost of the individual and the family members and the society. Thus,
considering the consequences, it is appropriate to treat a drug abuser willing to seek life-
changing treatment. It is justified if the patient may harm others and increase hospital cost
further.
Lastly, I would like argue that emphasising on the use of harm reducing strategies to deal
with substance abusers is necessary as it will give them opportunity to learn about treatment they
need and its significance as addiction can be treated.
Alcoholism or drug abuse should not be considered a moral failing or mere condition of
poor self-control. Instead, it is currently considered a “chronic brain disease often associated
with relapses” (Bartlett et al., 2014). Why should they be denied access to ICU when they cannot
control negative behaviour due to altered neurotransmitter pathways? These harm reducing

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strategies will help honour the rights of substance abusers. It is justified because it was found by
some researchers that different people are effected in different manner by the social inequality
(Bartlett et al., 2014). Therefore, giving them the opportunity to engage in healthy behaviour by
giving access to ICU is justified.
Further, It should not be neglected that the addiction is driven by neurochemical
changes, genetic factors other than the environmental and behavioural attitudes. With increase in
dopamine and high, more substance is needed to perform normal functioning. Then why should a
person be punished if he/she has no control over genetic influence? This brain disease is not a
choice after all. Therefore, the health care providers should not reject care to the substance
abuser who approached them in disdain and rejection, even if they subtly reject the care offered
by providers (Lank & Crandall, 2014).
Conclusion
Therefore, Madam Chairman, Ladies and Gentlemen, in conclusion, intensive care units
revolve around ethical issues and the use of principles of ethical reasoning. With this being said,
I would emphasise on the argument that people who use and abuse drugs should not be denied
access to intensive care units. I would like to ask what would you do if your own son or daughter
is addicted and needs to intense treatment to survive?
I will now pass onto---
Thank you

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References
Bartlett, R., Brown, L., Shattell, M., Wright, T., & Lewallen, L. (2013). Harm reduction:
Compassionate care of persons with addictions. Medsurg nursing: official journal of the
Academy of Medical-Surgical Nurses, 22(6), 349.
Henden, E. (2016). Addiction, compulsion, and weakness of the will: A dual process perspective.
Kerkhoff, T. R., & Hanson, S. L. (2015). Applied ethics: Have we lost a crucial opportunity?.
Lank, P. M., & Crandall, M. L. (2014). Outcomes for older trauma patients in the emergency
department screening positive for alcohol, cocaine, or marijuana use. The American
journal of drug and alcohol abuse, 40(2), 118-124.
Noggle, R. (2016). Addiction, Compulsion, and Persistent Temptation. Neuroethics, 9(3), 213-
223.
Wilson, M. W., Bonnecaze, A. K., Dharod, A., & Miller, P. J. (2017). Analysis of Intensive Care
Unit Admission and Sequelae in Patients Intravenously Abusing Extended-release Oral
Oxymorphone. Southern medical journal, 110(3), 217-222.