Legal and Ethical Dimensions: Applying Principles to Nursing

This essay explores the application of Beauchamp and Childress' four ethical principles (respect for autonomy, beneficence, nonmaleficence, and justice) to a nursing case scenario involving a patient on life support. It examines how these principles guide decision-making when the patient is unable to provide consent, focusing on the roles of family members and healthcare practitioners. The analysis highlights the importance of informed consent, acting in the patient's best interest, avoiding harm, and ensuring fair resource allocation within the healthcare system, while also acknowledging the challenges and complexities that arise in such situations. The essay concludes that incorporating these principles in medical practice leads to better patient care.

Running head: EVIDENCE-BASED NURSING RESEARCH 1
Evidence-based Nursing Research
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EVIDENCE-BASED NURSING RESEARCH 2
Evidence-based Nursing Research
The healthcare practice experienced challenges in seeking the voice of the patient
where practitioners made decisions on behalf of patients involving their care as long as they
observed it as necessary and demanding. Beauchamp and Childress four ethical principles
provide legal and ethical considerations important to the medical fraternity in their day-to-day
operations. The four principles involved in their reflection include the respect for autonomy,
nonmaleficence, beneficence, and justice. The paper uses the case scenario to examine the
application of the four principles in the discussion given in the video concerning patient
decision making.
Respect for Autonomy
The principle surrounds the understanding that that persons are responsible for what
they do and the ultimate action taken amounts to a product of own choice. The principle
informs the basic freedom at the heart of humanity that guides the respect for autonomy and
thus guaranteeing an individual to be informed of any action and thus seek permission from
one before carrying out an action. In healthcare, it is important for a patient’s voice to be
considered whenever a given operation is to be done or in worse cases involve immediate
persons to the patient in decision making in cases where one cannot talk or be able to give
consent (Nieswiadomy & Bailey, 2017).
According to the principle, any notion of moral decision-making considers the
involvement of the parties involved in making voluntary and informed decision on a given
matter. The case involves the informed consent aspect based on the choice to convene a
meeting between the medical representative and the husband to the patients as well as the
daughter who at the time remain representatives of the patient (Blais, Hayes, Kozier, & Erb,
2015). The event involves a case where the patient is on a high-dependency machine and

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needed that rendered her unable to make the prime decision concerning her healthcare
situation.
As such, the involvement of the immediate party in the decision that supports
comfort and best experience of the patient was presented before the family members.
Therefore, the choice to involve the persons responsible for the patient protected the right to
informed consent in patient healthcare delivery. In previous circumstances before the coming
of the principle doctors used to do whatever they deemed good for the patient involving
ending lives through stopping of the life support machines for patient’s comfort through end
of suffering (Gillon, 2015). However, the case presents the reform that includes seeking
patient’s voice in decision making aspects concerning one’s healthcare.
The responses given by the daughter represent the wishes of the mother who preferred
not to be supported by machines in the wake of pain but rather opt for end of life which is
highly disputed by the husband. Despite the indecisive and sharp reaction from the husband
on the matter suggesting end of suffering and pain on the patient, the respect for autonomy is
observed and evident in the practitioners step in seeking consent from the persons responsible
since the patient was not in a position to offer the consent given the nature of condition
presented.
Beneficence
Beneficence refers to acting in best interest of the other parties in a given condition. In
reflection to the healthcare system, individuals are advised to act responsibly considering the
interests of the other party in question concerning good health and expenditures involved
therein. According to Beauchamp (2016), healthcare providers have a duty to remain of
benefit to the patients and take positive moves towards preventing and removing harm in the
way of a patient. A patient seeks medical services and thus trusts the doctor to provide the

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best service that would leave one feeling better and hence becomes a part of the process that
needs serious consideration.
The case scenario justifies the application of the principle as observed in the action of
the practitioner seeking to divulge information to the immediate family on the need to change
treatment to subject the patient to a more sound care pattern. In the information, the
individual cites the present condition of the patient as dire considering the pain involved and
suggests the end of life choice that would cease the pain of the patient as opposed to
maintaining the present state that would continue to be painful on the side of the patient. In
the present case, the state of the patient according to the practitioner continues to worsen and
registers no improvement and the more one remains on the support machine the more the
costs incurred rise. Therefore, it is evident that the practitioner acts in the best interest of the
patient and the immediate family.
On the other hand, the patient comfort is considered given the indication on setting
the best act towards maintaining a comfortable experience on the side of the patient. The
doctor acknowledges that they are doing their best to keep the patient out of pain as well as
preserve the life of the party involved. Moreover, the practitioner suggests the involvement of
another doctor that has not had experience on the patient to offer a consultancy on a different
treatment procedure that might save the patient from the pain. The consideration
acknowledges the good will of the individual in driving benefits to the patient in terms of
healthcare to offer a better feeling. Despite the reaction and non-decisive nature of their
engagement, the option seems viable in tackling the fears of the husband and avoiding the
end of life procedure that seems unethical and non-legal to the husband.
According to Ebbesen (2016), acting in the best interest of the patient remains a
serious principle in healthcare. Individuals entrust health providers to take care of their
medical condition and deliver the best result within the shortest time and in the best means

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possible. The recovery of patients depends on the efforts placed by health providers and the
willing nature bound by professional ethics to deliver benefits to persons involved. The
physicians’ intervention in providing the option for another consultant in the case of the
patient provides a willing spirit towards providing benefit to the patient as opposed to the
monetary value that the facility can get from the prolonged stay. As such, the considerations
remain evident in the case thus proving the application of the same towards an improved
experience.
The Principle of Nonmaleficence
The principle requires individuals to avoid intentional affliction of pain or harm to the
patients in their actions or events involved in the treatment of patients. An act is considered
neglect if one was in a position to prevent a situation from occurring that may render a patient
in dire pain or negative experience in line with getting better (Ebbesen & Sundby, 2015).
Thus, the provision of a proper standard of care is needed in minimizing the risk of such
occurrences. The principle affirms the need for medical personnel to remain competent and
focused to their call to service delivery through prevention of harm and increasing better
experience for patients.
The case presents a situation where a patient is in pain despite the efforts employed by
the practitioners in keeping her away from the pain. Consequently, acting in the best interest
of the patient, the individuals seeks the decision of the immediate family in determining the
next course of action which involve the removal from the life supporting machine to
completely end the pain. However, the decision means end of life for the patient which is
highly disputable by the husband. In remaining responsible and acting in favour of the
patient, who in the present condition seems not to improve and in pain, the option of removal
from the support machine seems viable and in the best interest of the patient. The decision to
keep the patient in the support given the pain endured would amount to a continuation of life

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but then increase the cost of medical facilitation as well as the painful experience on the
patient with no further hope towards recovery.
The daughter to the patient notes of the wishes of the mother to have a painless
experience and opts for end of life in a situation where little hope exists in further medical
procedures. The narrations offers the feelings of the mother and the wishes that would be
expressed by one were the patient in good condition to offer consent on her case. In goodwill
and support of lesser pain subjected to the patient, the doctor recommends a change of
professional handling the patient by exploring the services of an independent practitioner to
trace the history and try to recommend a treatment that might end or lessen the pain
experienced by the patient (Gillon, 2015). The act of seeking consent as well as that of
exploring the option of an independent doctor to examine the case presents the application of
the principle of nonmaleficence in the case scenario provided. The doctor would not be acting
in the best interest of the patient by continuing with the treatment which continues to subject
the patient into pain and thus had to intervene to avoid subjecting the patient into more pain.
Principle of Justice
The principle of justice is applicable in the healthcare system where each patient
needs to be treated fairly in increasing their experience. Healthcare operates with limited
resources thus limiting the ability and capability of practitioners to fully dispense their
service towards delivery of improved healthcare (Walter, 2017). It is common to note
insufficient number of doctors, beds, nurses, and medication in a given facility. The principle
of justice determines the priority and right to accord each a specialized care given the nature
of care a patient requires (Matwick & Woodgate, 2017). In line with the considerations by
Beauchamp and Childress, an observation on the resource distribution and affording care to
patients in a just nature is essential.

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The case scenario presents a patient whose care and medical support yields no hope
for further recovery and total healing of the patient from the medical condition. As such, the
principle of justice applies in subjecting or seeking further patient support towards bettering
the condition. In this case, the patient is to be accorded specialized care in the same or
different facility in trying to find the perfect match and experience that would positively alter
the condition of the patient. The options explored in such a case ought to lead towards best
care and experience of the patient as well as cumulative expenses on the side of the family
members.
The justice principle is applicable and evident in the case represented by the
practitioner’s suggestion to seek the services of an independent specialist in re-examining the
situation of the patient as well as the history in the process of finding the best care for the
patient. In consideration of the fact that the facility might be lacking the necessary personnel,
the suggestion pointed towards a better professional experience that would change the case of
the patient. The suggestion is offered in light of providing the best care and reducing the pain
experienced while limiting the options of ending the life. The option comes after the sharp
criticism by the husband to the patient who perceived end of life suggestion as a deliberate
option to separate him from the wife regardless of the pain. The husband opted to have the
wife kept alive through all other options possible. As such, the suggestion once adopted
would offer justice to the patient with the hopes that a specialized care or an independent
observation might lead to a change in the condition.
Conclusion
Beauchamp and Childress principles act in good faith to the medical fraternity which
previously remained out of consideration. Doctors used their experience and intuition while
ignoring the desire and voice of the patient in medical care. The four principles lead to better
experience as observed in their practicability and evident nature in the case. Respect for

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autonomy has been justified through the seeking consent from the family members,
nonmaleficence observed through seeking specialized care and option for end of life
procedure, beneficence achieved through specialized care option by an independent
professional, and justice by according the patient access and possibility of referral to
specialized unit where better resources can manage the case.

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References
Beauchamp, T. L. (2016). Principlism in Bioethics. In Bioethical Decision Making and
Argumentation (pp. 1-16). Springer, Cham.
Blais, K., Hayes, J. S., Kozier, B., & Erb, G. L. (2015). Professional nursing practice:
Concepts and perspectives (p. 530). NJ: Prentice Hall.
Ebbesen, M. (2016). Clinical Research & Bioethics.
Ebbesen, M., & Sundby, A. (2015). A Philosophical Analysis of Informed Consent for Whole
Genome Sequencing in Biobank Research by use of Beauchamp and Childress’ Four
Principles of Biomedical Ethics.
Gillon, R. (2015). Defending the four principles approach as a good basis for good medical
practice and therefore for good medical ethics. Journal of medical ethics, 41(1), 111-
116.
Matwick, A. L., & Woodgate, R. L. (2017). Social justice: A concept analysis. Public Health
Nursing, 34(2), 176-184.
Nieswiadomy, R. M., & Bailey, C. (2017). Foundations of nursing research. Pearson.
Walter, R. R. (2017). Emancipatory nursing praxis: A theory of social justice in
nursing. Advances in Nursing Science, 40(3), 225-243.