Nursing Ethics: Should Substance Abusers Be Denied ICU Access?

This essay delves into the contentious issue of denying intensive care unit (ICU) access to individuals with drug and alcohol abuse problems. The author argues against such denial, emphasizing the fundamental right to healthcare as outlined in the Australian Charter of Healthcare Rights, and highlighting that saving a life should be the priority. The essay addresses concerns about potential harm, insurance coverage, and the challenges faced by healthcare professionals, advocating for a compassionate approach that prioritizes patient autonomy and access to treatment. It further suggests that denial of ICU admission can erode community trust in caregivers and emphasizes that while treatment may be challenging, it can also be rewarding for health care professionals. The essay also addresses the role of primary care physicians in the treatment process. The paper refutes the notion of denying care based on substance abuse, reinforcing the importance of ethical considerations in healthcare decisions and patient care, and supports the position that those who abuse drugs and alcohol must not be denied access to intensive care units.

1Running head: NURSING
Nursing Health Care Ethics
Name of student:
Name of university:
Author note:

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The topic of the present debate on a nursing ethical issue is “People who abuse drugs
and alcohol should be denied access to intensive care units”. The present paper talks against
the motion and refutes the statement, aiming to establish a standpoint that people who abuse
drugs and alcohol must not be denied access to intensive care units.
As the instances of patients with alcohol or substance abuse being brought to
intensive care units (ICU) are increasing, there is a growing concern around their admission.
Intensive care units are the specialised treatment units where patients suffering from acute
medical conditions are brought in for treatment; such a unit is to provide life support and
decrease the chances of mortality. It is evident that saving the life of the patient is the priority
under such circumstances and there is no denial of this. Speaking on humanitarian ground, no
human has the right to deny care being given to an individual irrespective of what his
condition is in relation to drug or alcohol abuse (Luce & White, 2009). As per the Australian
Charter of Healthcare Rights, “everyone has the right to be able to access health care”
(safetyandquality.gov.au, 2012). Moreover, since treatment of this concern is prominent in
the present era, it is not a challenge to guide the patient to change his substance dependency
once he is discharged from the ICU (Ulrich, 2014).
ICUs deliver potential benefit at massive public cost, and thus the interventions
rendered must be considered as symbols of promise. Patient autonomy and fundamental
rights to access to care stand against the chances of potential harm being done to others if
patients with alcohol and substance abuse are admitted to ICUs. Though patient might be a
concern due to multi-faceted issues, their primary right to autonomy cannot be suspended
(Medrano et al., 2014). If patients are denied admission to ICUs, the community’s trust on the
care givers will loose out. Admission of such patient might be a reason for harm to others, but
it is to be noted that there is no certainty that such harm would be done. The mere probability
of causing harm to others must not take over the need to save the life of the patient.

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Protection of common good does not justify the abridgement of individual rights (Mulaudzi
et al., 2010).
The second aspect that draws the attention is that insurance companies are not willing
to pay for the medical expenses for such patient. This can be disproved by the fact that health
insurers must rely on the evidence-based standards of patient care and consider the right level
of coverage, the right combination of treatment and the right site of coverage. Insurance
companies often stop paying, and the healthcare centres are to discharge the patients before
the complete treatment is done. However, if the family members are notified that the patient
is half-treated, is it clear, on morale and human grounds, that the family members would
arrange for the medical expenses under any circumstances. They would go out of their way to
arrange for the expenses so that the treatment is complete. The medical facilities are not to
depend solely on the medical insurance companies for the expenses. A bill is to be passed
that would force the companies to approve authorisation of substance abuse care. It would
need all policies to provide medical coverage for alcohol and drug abuse services as thought
necessary by the care unit (Connors et al., 2013).
It is also to be highlighted that though treatment of patients with alcohol or drug abuse
history might be frustrating and difficult, it is also a rewarding process for the heath care
professionals. There are nonphysicians, and physicians who specialise in this area of practice
and a number of communities referral to a special is a part of the regular care process.
Admission to intensive care unit implies that such professionals would be referred to for the
patient care. Denial of admission cannot be therefore justified (Mays et a., 2017). Moreover,
in the present medicinal practice, the primary physician also has a significant part in the care
of patients who are chemically dependent even though the referral is not there. The primary
care physician might be the first professional to identify the relapse and do the treatment. The
physician can be the trusted guardian and work for the patient’s well being. The concern of

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the physician that the patient stays away from the use of the drug can be sighted as a strong
motivator (Levit et al., 2013).
Facts to support the topic-
 Treatment for such patients are hugely expensive
 Insurance companies are not in a position to pay for such patients
 Health care professionals face issues in providing appropriate care for the patient on
an individual basis
 Even if survival is possible, relapse is common, leading to failure of treatment

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References
Australian charter of healthcare rights. (2012). Retrieved 12 September 2017, from
https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Charter-PDf.pdf
Connors, G. J., DiClemente, C. C., Velasquez, M. M., & Donovan, D. M. (2013). Substance
abuse treatment and the stages of change: Selecting and planning interventions.
Guilford Press.
Levit, K. R., Stranges, E., Coffey, R. M., Kassed, C., Mark, T. L., Buck, J. A., & Vandivort-
Warren, R. (2013). Current and future funding sources for specialty mental health and
substance abuse treatment providers. Psychiatric Services, 64(6), 512-519.
Luce, J. M., & White, D. B. (2009). A History of Ethics and Law in the Intensive Care
Unit. Critical Care Clinics, 25(1), 221–x. http://doi.org/10.1016/j.ccc.2008.10.002
Mays, V. M., Jones, A. L., Delany-Brumsey, A., Coles, C., & Cochran, S. D. (2017).
Perceived Discrimination in Health Care and Mental Health/Substance Abuse
Treatment Among Blacks, Latinos, and Whites. Medical care, 55(2), 173-181.
Medrano, J., Álvaro-Meca, A., Boyer, A., Jiménez-Sousa, M. A., & Resino, S. (2014).
Mortality of patients infected with HIV in the intensive care unit (2005 through
2010): significant role of chronic hepatitis C and severe sepsis. Critical Care, 18(4),
475.
Mulaudzi, F., Mokoena, J., & Troskie, R. (2010). Basic nursing ethics in practice.
Johannesburg: Heinemann.
Ulrich, C. (2014). Nursing Ethics in Everyday Practice. Indianapolis: Sigma Theta Tau
International.