Application: Taking a Stand
Describe your role as a moral agent or advocate for a specific issue in your work environment or an organization with which you are familiar.
One of the ethical issues in nursing arises from the pro- choice versus pro- life dilemma. Nurses face the challenge when caring for patients who procure abortion when the nurses consider it murder. They also face the issue when caring for palliative care patients who consider euthanasia when the nurses may also consider it murder (Fernades & Moreira, 2013). As an intensive care nurse, ethical issues are complicated by the complex clinical situation of intensive care unit (ICU) care inpatients and the technological advances in the settings. Clinical decision in the setting requires using different types of knowledge to protect and respect the dignity of the human being (Fernades & Moreira, 2013).
Nurses in the ICUs make end of life decisions when faced with issues related to euthanasia and do-not-resuscitate (DNR) orders. Other decisions for patients are often arrived at within a short period of time and with limited knowledge of the clinical situation. The physician may not consider the benefits of medium and long-term therapeutics because they focus on the immediate situation. Physicians do not always follow common orientation and comply with consistent standards (Fernades & Moreira, 2013). The decisions are made without an overall analysis of the situation and without a broad discussion involving other professionals and family members (Halvorsen, Ferde, & Nortvedt, 2008).
Care is the central part of the nursing profession and a direct or indirect request for euthanasia from a patient or order by a physician may change the interpersonal and professional relationship between health care professionals and the patient and the family. Reports show that there are mixed perceptions about acceptability of euthanasia among nurses. Some actively perform euthanasia sometimes even without a patient’s explicit request (Brzostek, dekkers, Zalewski, Januszewska, & Gorkiewicz, 2008). In making decisions on euthanasia, there are several factors to consider. They include having a philosophy of life, experience and knowledge, adhering to a professional deontological code and abiding by the law (Brzostek, dekkers, Zalewski, Januszewska, & Gorkiewicz, 2008). In as much as it is essential to involve all the necessary healthcare professionals, the family and the patient in euthanasia decision making, euthanasia remains a violation of the Hippocratic Oath as well as a violation of my religious beliefs. This thus necessitates adopting a pro-life stand based on personal philosophy of life that is informed by religious beliefs about the sanctity of life.
Faced with the euthanasia ethical issue, it would be necessary to make effort in changing the organizational culture to accommodate varying nurse’s perceptions. This would remove the blanket obligation of all nurses to perform euthanasia. It would also remove the burden of guilt among the nurses that are opposed to euthanasia but would be forced to administer it as a matter of procedure or duty. It is reported that older and more experienced nurses adopt a psychosocial focus in their decision making while the younger nurses focus more on the physical aspects of work. Thus, older nurses’ ethical conscience, experience, courage to work and a sense of personal empowerment inform their effort in trying to change organizational values (Leino-Kilpi, Souminen, & Makela, 2002).
Borrowing from these older nurses’ tendencies, advocacy on organizational change would promote aspects of personal choice in nurses’ participation in Euthanasia. It would also advocate for involvement of all the interested parties before euthanasia and DNR procedures can be allowed. The patient, the patient’s family and all relevant health care professionals require being involved in euthanasia decision making. Most importantly, the policy change would indicate that only nurses agreeable to euthanasia would be tasked to administer the procedure.
What are the potential outcomes if you do not execute that role?
Failure to advocate for change would sustain the lack of an overall analysis that prevents decision making from focusing on a holistic view of the situation. It sometimes results in lack of concern for what would be significant to the patient. These situations cause restlessness and discomfort in nurses as they result from the perception that some of their decisions and applications has led to more suffering for the patient. The nurses concern lies in providing a dignified death and feeling that they are able to respect their autonomous area of intervention in terms of preparing the family for what is happening to their family member (Beca, Koppmann, & Chavez, 2010). Decisions to administer or not to administer euthanasia and other interventions require both the patients consent and the nurse’s willingness to practice. Additionally, patient preferences should prevail over family wishes or the healthcare team values. Physicians should not bypass the patient’s clearly stated end of life wishes. This honors the patient’s dignity and rights.
Another negative outcome of failing to develop clear policy on end of life procedures is hopelessness, helplessness and burnout among the nurses that are comfortable with euthanasia. The nurses suffer emotional trauma caused by regrets about being unable to be better advocate for the patient. They regret not adequately preparing the patient and the patients’ family for impending death and administering life extending aggressive treatments that increases patient’s suffering and lowers their quality of life. Essentially, failure to advocate for change leave nurses in the middle of situations created by others and without power to change the situations (Pavlish, Brown-Saltzman, Hersh, Shirk, & Rounkle, 2011).
What skills, dispositions and or strategies would help to fulfill this role?
My personal stand against euthanasia is based on my philosophical predisposition about sanctity of life and the Hippocratic Oath on preservation of life. However, this stance does not bar nurses that are pro-choice from administering euthanasia on the basis of ensuring quality of life. The stance advocates for the development of a policy that considers that not all nurses are comfortable in practicing euthanasia procedures. It also advocates for consideration of the patient’s wishes, involvement of the patient family and the relevant health care professionals in decision making for euthanasia.
Advocating for development of a policy for end of life procedures for nurses would be guided the strategy to reducing high turnover rates and underperformance caused by moral distress. Moral distress is associated with ethical dimensions of nursing practice and concerns related to difficulties in navigating practices while upholding professional values, responsibilities and duties. Moral distress has been shown to contribute to emotional distress, withdrawal from patients, unsafe or poor quality patient care, decreasing job satisfaction and attrition in nursing (Paully, Varcoe, & Storch, 2012). To keep nurses from leaving the profession persistent lobbying with health care leaders is required. Advocacy and lobbying skills would be essential in convincing the nursing fraternity to support the move for establishing a clear policy outlining the roles and liberties of nurses in end of life procedures.
The ICN code of ethics that provides guidance for nurses and supports their refusal to participate in activities that are contrary to caring and healing would also form a strong tenet for lobbying for the policy. Additionally, Provision 1 of the ANA Code of ethics that mandates that nurse’s practice with compassion and respect for patients’ inherent dignity and right to self-determination would inform the lobbying activities (Pavlish, Brown-Saltzman, Hersh, Shirk, & Rounkle, 2011). Lobbying would advocate the importance of prioritizing patient’s suffering and autonomy in exploring patient’s preferences for treatments and advocate for their care in a non-paternalistic way. It would indicate values that require nurses to query gently and empathically listen to patient’s preferences (Pavlish, Brown-Saltzman, Hersh, Shirk, & Rounkle, 2011).
What motivation do you see for taking a stand on an important issue even when it is difficult to do so?
It is difficult to take a stance that allows patients preference to override that of nurses and other healthcare professionals particularly where it concerns requesting euthanasia. However based on the professional obligation to improve the quality of life of patients with uncontrollable pain and those with poor quality of life, euthanasia would be permissible albeit practiced by nurses comfortable with practicing euthanasia procedures. Research has indicated that physicians are favorable towards legalization of euthanasia in the US but show little enthusiasm when asked to perform it (Dickinson, Clark, Winslow, & Marples, 2005). This indicates that physicians would not misuse the policy. This is because research has shown that even if euthanasia were to be made legal, an overwhelming majority would not practice it. Therefore, my support for its practice by other nurses would not lead to a large increase in the willingness to hasten death unnecessarily.
This role in advocating for change of policy would also allow for proactive counsel for patients and families on end-of life values and preferences. Additionally, the possibility of discussing pain control and the sharing of values between the patient and physician would assist in obviating end of life care conflicts while being respectful of both parties (Dickinson, Clark, Winslow, & Marples, 2005). Essentially, this change in organizational policy would ensure more accuracy and fairness because the decisions would be made only after sufficient consultation with all interested parties.
References
Beca, J., Koppmann, A., & Chavez, P. (2010). Analysis of a Clinical Ethics Consultation Experience in Intensive Care. Rev Med Chil, 815-820.
Brzostek, T., dekkers, W., Zalewski, Z., Januszewska, A., & Gorkiewicz, m. (2008). Perception of Palliative Care and Euthanasia Among Recently Graduated and experienced Nurses. Nursing Ethics, 15(6), 762-774.
Dickinson, G. E., Clark, D., Winslow, M., & Marples, R. (2005). US Physicians’ Attitudes Concerning Euthanasia and Physician-assisted Death: A Systematic Literature Review. Mortality, 10(1), 43-52.
Fernades, M. I., & Moreira, I. M. (2013). Ethical Issues experienced by Intensive Care Unit Nurses in Everyday Practice. Nursing Ethics, 20(1), 72-82.
Halvorsen, K., Ferde, R., & Nortvedt, P. (2008). Professional Challenges of Bedside rationing in Intensive Care. Nurs Ethics, 15, 715-728.
Leino-Kilpi, H., Souminen, T., & Makela, M. (2002). Organizational Ethics in Finnish Intensive Care Units. Nurse Ethics, 9, 126-136.
Paully, B. M., Varcoe, C., & Storch, J. (2012). Framing the Issues: Moral Distress in Health Care. HEC Forum, 24, 1-11.
Pavlish, C., Brown-Saltzman, K., Hersh, M., Shirk, M., & Rounkle, A.-M. (2011). Nursing Priorities, Actions and Regrets in Ethical Situations in Clinical Practice. Journal of Nursing, 43(4), 385-395.
Use the order calculator below and get started! Contact our live support team for any assistance or inquiry.
[order_calculator]