Nursing Ethics: Case Study of an ATSI Patient and Ethics

This essay delves into the complexities of ethical decision-making in nursing, particularly within the context of palliative care for Aboriginal Torres Strait Islander (ATSI) patients. The core of the essay revolves around a case study of John, a 20-year-old ATSI man suffering from end-stage renal disease (ESRD) who is 500km from home and receiving dialysis. The essay analyzes how an interdisciplinary team can incorporate collaborative ethical decision-making principles, considering John's cultural beliefs and traditions while navigating his desire to return home, which could reduce his life expectancy. It examines the ethical decision-making model, including gathering factual information, evaluating arguments, developing a framework, and anticipating objections. The author, a registered nurse, reflects on how their personal beliefs impact professional interactions and strategies, particularly when balancing John's cultural needs with his medical condition, emphasizing the importance of cultural competence, family involvement, and respecting the patient's end-of-life wishes. The essay concludes with a summary of the key findings and the importance of prioritizing the patient's best interests while respecting their cultural background.

Running Head: NURSING 0
Nursing
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There are various collaborative ethical decision-making principles which are
necessary to be incorporated by interdisciplinary team while providing services to patients
with critical needs. Registered nurses must rely on ethical decision making in order to take
into consideration the best scenario for patients. While providing services to Aboriginal
Torres Strait Islander (ATSI), registered nurses must take into consideration the cultural
aspects of palliative care and they should give adequate significance to their traditions and
beliefs (Rix, Barclay, Stirling, Tong & Wilson, 2015). Registered nurses must evaluate their
personal beliefs and their impact on professional interactions and the strategies which are
used while managing patients. The objective of this essay is to analyse the case study of John,
who is a 20 years old ATSI man, suffering from ESRD (end stage renal disease). Currently,
John is 500km away from his home and receiving dialysis in order to maintain his health; it is
advised by the medical team that he will not survive any more than three months on this
treatment. He wants to avoid further treatment and go home which will further reduce his life
expectancy. This reflective essay will focus on analysing how collaborative ethical decision
making can be incorporated into the decision taken by interdisciplinary team. This essay will
also evaluate traditions and beliefs of John during palliative care and understand how my
personal beliefs as a registered nurse will impact my professional interactions and strategies.
In nursing profession, ethical decision making is crucial which is referred to the
process that enables them to combine caring and justice relating to moral reflection while
making decisions (Steinberg, 2011). In the case of John, the interdisciplinary team should
rely on ethical decision making model and principles in order to making satisfactory
resolution that will resolve ethical dilemma. John wants to return to his home which raises a
concern for interdisciplinary team as they know that it will reduce his life expectancy;
therefore, ethical decision making model should be applied on this case to make a sound
decision. The first step is collection and verification of relevant factual information (Rix,
Barclay, Stirling, Tong & Wilson, 2015). In the case of John, he is suffering from ESRD and
he is receiving dialysis; already his life expectancy is three months and it is likely to reduce if
he returns home. The second step is building and evaluating arguments relating to the case.
The first argument is John should not be allowed to return to his home as it will reduce his
life expectancy and he must be given proper support from his medical team to treat his
illness. The second argument is that John should be allowed to return to his home since he
has already three months to live which he should spend with his close ones. The third step is
developing a systematic framework for the patient; as per this systematic framework,
integrity should be promoted for providing common grounds to resolve this ethical dilemma

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(Wiles, Bahal, Engward & Papanikitas, 2016). The common ground in this scenario is
protection John’s life based on which the medical team should make him understand that his
life expectancy will reduce drastically; therefore, to increase his chances for survival, he
should not be allowed to return home. The fourth step is anticipating and responding to
objections. In this case, John will object the decision of his medical team since he will not be
able to meet his close ones. However, this decision is for his benefit and it should be
explained to him by medical professional. As a registered nurse, I should also remove his
objections in order to find a resolution to this ethical dilemma.
During palliative care, there are many cultural aspects which are necessary to be
considered by medical professional in relation to traditions and beliefs of the patient (Meeker,
McGinley & Jezewski, 2019). In the case of John, he belongs from ATSI and his cultural
beliefs and traditions must be taken into consideration by his medical team while making
decisions in this case. In this case, the medical professionals should focus on providing
flexible family-focused care for John that allows him to see his family members without
risking his life. He should be allowed to follow his traditions and beliefs while receiving
dialysis and I should also help him in achieving his cultural obligations. The services should
be based on his cultural values by finding ways to increase home dialysis and increasing
Aboriginal led cultural education (McDonald, 2013). As a registered nurse, I should focus on
mutual decision making that cultural values of John are not violated due to his treatment and
he is able to successfully receive those treatments without hindering his ability to follow his
cultural traditions. I will focus on achieving a meet-up between John and his family members
while also providing him facilities to fulfil traditions relating to ATSI. John may want to
follow sacred customary practices during end-of-life care and I will help him fulfilling those
customs and beliefs.
In this scenario, my personal beliefs also affect my professional interactions and
strategies related to John which are necessary to be taken into consideration. I personally
believe that person should spend time of his family at the end of his life and John should not
be deprived from this right as well. However, going back to his family will reduce his life
expectancy because he will not receive treatment of dialysis. It creates a contradiction
between by professional and personal values that will also impact my interactions with John
and the strategies which I found for him. I will try to contact as many family members of
John as I can to find out ways that allows them to meet him during this period. I will also try
to find ways of increasing home dialysis while also helping John in fulfilling his traditions,
beliefs and practices during end of life care. I will implement strategies to ensure cultural

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competencies are maintained and engagement between John and his family is increased.
These strategies will allow me to make sure that my professional and personal values are
followed accordingly while also ensuring that John is able to fulfil his cultural norms during
palliative care.
Based on the above observations, it can be concluded that interdisciplinary team
should rely on collaborative ethical decision making while taking a decision for John to make
sure that his interest is given priority. John should not be allowed to return home because it
can drastically reduce his chances of survival; however, he can receive support from medical
team to address these challenges. During palliative care, traditions, beliefs and practices of
John’s culture should be followed accordingly by giving him a chance to fulfil his cultural
norms at his end-of-life care. My personal beliefs will affect my professional interactions and
strategies relating to John since I will focus on making it easier for him to meet his family
while also giving him options to fulfil his cultural traditions, beliefs and practices relating to
ATSI.

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References
McDonald, S. P. (2013). End-stage kidney disease among indigenous peoples of Australia
and New Zealand. Kidney international supplements, 3(2), 170-173.
Meeker, M. A., McGinley, J. M., & Jezewski, M. A. (2019). Metasynthesis: Dying adults’
transition process from cure‐focused to comfort‐focused care. Journal of advanced
nursing, 75(10), 2059-2071.
Rix, E. F., Barclay, L., Stirling, J., Tong, A., & Wilson, S. (2015). The perspectives of A
boriginal patients and their health care providers on improving the quality of
hemodialysis services: A qualitative study. Hemodialysis International, 19(1), 80-89.
Steinberg, S. M. (2011). Cultural and religious aspects of palliative care. International
journal of critical illness and injury science, 1(2), 154.
Wiles, K., Bahal, N., Engward, H., & Papanikitas, A. (2016). Ethics in the interface between
multidisciplinary teams: a narrative in stages for inter-professional education. London
journal of primary care, 8(6), 100-104.