Advocacy Paper: Bioethical Decision Making
Ethics in healthcare consists of moral values and principles that guide healthcare practice and decision-making. Ethical practice is the foundation of nursing practice. Nurses encounter ethical issues daily during their practice. Nurses frequently face ethical dilemmas while caring for patients.
According to Robert et al. (2020), an ethical dilemma is a situation where nurses are forced to decide between competing values, with each choice bearing consequences. Examples of ethical dilemmas encountered during nursing practice include protecting patients’ rights, providing informed consent to treatment, shared decision-making, and addressing advanced care planning.
Nurses must be able to understand and solve these dilemmas since the consequences of avoiding these dilemmas include experiencing burnout, loss of licensure, loss of employment, and legal issues. Ethical decision-making models offer a relevant case-based tool for nurses to navigate ethical dilemmas. Examples of these models include the bioethical decision-making model and the four-topics approach.
The subsequent sections of this paper will explore and apply the bioethical decision-making model to an ethical dilemma and discuss the role of a nurse as a patient advocate.
In the selected hypothetical situation, the patient is Ann, a 24-year-old female college student who is 12 weeks pregnant. She is currently anemic. Additionally, she has a history of cardiac disease that has worsened because of her pregnancy.
On examination, the patient is severely anemic, and her physician recommends blood transfusion and termination of pregnancy within 3 weeks. Ann is reluctant to terminate the pregnancy because she is a Christian and believes that life begins at conception and is sacred. She believes abortion is wrong, and she believes that God will heal her.
The above case scenario depicts an ethical dilemma in which spirituality and science conflict. Forte et al. (2018) state that health and nursing care are result-driven and based on science. However, the science behind patient care often conflicts with personal, cultural, and religious beliefs.
Additionally, patients, as well as their families, find it difficult to accept a poor prognosis and instead cling to religious beliefs. The bioethical decision-making model can be used to navigate through the above ethical dilemma. This model deals with ethical issues in medical and biological research and clinical practice, including individual and broader healthcare concerns such as genetic testing, resource allocation, access to healthcare, and confidentiality (Levine-Ariff & Groh, 1990). As discussed in the subsequent paragraphs, the model can be applied to the above situation.
Bioethical Decision-Making Model
The initial step of this model is to define the ethical dilemma. The aforementioned ethical scenario vividly depicts an ethical dilemma. The scenario outlines a contradiction between science and religious beliefs. Ann must decide whether to terminate the pregnancy, which is in accordance with science or keep the pregnancy in accordance with her religious beliefs.
The second step of the model relates to the identification of the medical facts. In the above ethical situation, anemia and cardiac disease in pregnancy are medical facts. Pregnancy worsens anemia and cardiac disease, putting maternal and fetal health at risk. Consequently, Ann’s condition will deteriorate with the continuation of pregnancy.
According to Mehta et al. (2020), cardiac disease in pregnancy can precipitate cardiovascular events, heart failure, and obstetrical complications such as pre-eclampsia, which can be severe and life-changing.
The third step is the definition of nonmedical facts. The nonmedical facts result from the patient, family, and external influences. In the above ethical situation, the principal non-medical facts stem from the patient’s religious beliefs.
For instance, Ann is a Christian and strongly believes in God. Despite her situation, she is against the termination of her pregnancy as she believes that all life forms are sacred and that life begins at conception. She even has faith that God, the ultimate healer, will heal and rescue her from her current situation. These moral values are pro-life.
Similarly, assumptions, as well as external influences, must be identified. According to Levine-Ariff and Groh (1990), assumptions must be distinguished from medical and non-medical facts as they interfere with decision-making. Lack of patient comfort is an assumption.
Consequently, the patient should be engaged and given time to discuss with family and friends before deciding. On the other hand, external influences include the Nursing code of ethics and ethical principles. Nurses and other healthcare providers must make decisions guided by the code of ethics and ethical principles. For instance, nurses are expected to observe the provisions of the code of ethics as well as principles of non-maleficence, beneficence, autonomy, and justice during their decision-making.
The patient is the principal decision maker in the above ethical situation. However, the patient must rely on other stakeholders such as healthcare providers, family, friends, and religious leaders for such a critical decision hence the three weeks.
A conflict between different ethical principles is evident. For instance, a conflict between autonomy and beneficence. Termination of pregnancy is in the best interest of the patient since it is a risky pregnancy. Meanwhile, the patient decision represents the principle of autonomy.
Finally, alternatives and follow-ups must be decided. Patient alternatives such as spiritual interventions must be weighed against medical interventions. Keeping the pregnancy dictates that the patient’s state deteriorates. Consequently, careful conversation and counseling must be deployed to guide Ann through this critical period. Follow-ups must be done within three weeks, as highlighted by her physician. Subsequently, in collaboration with healthcare providers, family, and friends, Ann must make a decision within the stipulated time.
Nurse’s Role as a Patient Advocate
Patient advocacy is a central component of nursing practice. It saves lives, reduces workload, sustains good health, minimizes burdens on healthcare systems, facilitates a quick recovery, and ensures quality care (Nsiah et al., 2019). The patient should always be the primary concern in nursing practice. Nurses must therefore put patients’ interests as their priority.
Nurses must act competently according to the nursing code of ethics. Provision 3 of the nursing code of ethics necessitates that nurses promote, advocate for, and protect patients’ rights, health, and safety. As patient advocates, nurses involve the patients as well as their families in healthcare decision-making, fostering patient-centered care.
Additionally, nurses enlighten and educate patients regarding their rights and healthcare needs which enhances patient safety. Finally, nurses advocate for patients’ rights and safety by facilitating effective communication and interprofessional collaboration, ensuring that quality healthcare is accrued.
Ethical practice is the foundation of nursing practice. Nurses encounter ethical dilemmas while delivering care. It is critical to solve these dilemmas to avoid consequences such as loss of employment and licensure. Ethical decision-making models, particularly the bioethical decision-making model, effectively evaluate ethical dilemmas encountered in medical and biological research and clinical practice. Nurses are the principal patient advocates and must put patients as their primary concern.
Forte, D. N., Kawai, F., & Cohen, C. (2018). A bioethical framework to guide the decision-making process in the care of seriously ill patients. BMC Medical Ethics, 19(1). https://doi.org/10.1186/s12910-018-0317-y
Levine-Ariff, J., & Groh, D. H. (1990). Creating an ethical environment. Nurse Managers’ Bookshelf, 2(1), 41–61.
Mehta, L. S., Warnes, C. A., Bradley, E., Burton, T., Economy, K., Mehran, R., Safdar, B., Sharma, G., Wood, M., Valente, A. M., Volgman, A. S., & On behalf of the American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and Stroke Council. (2020). Cardiovascular considerations in caring for pregnant patients: A scientific statement from the American heart association. Circulation, 141(23). https://doi.org/10.1161/cir.0000000000000772
Nsiah, C., Siakwa, M., & Ninnoni, J. P. K. (2019). Registered Nurses’ description of patient advocacy in the clinical setting. Nursing Open, 6(3), 1124–1132. https://doi.org/10.1002/nop2.307
Robert, R., Kentish-Barnes, N., Boyer, A., Laurent, A., Azoulay, E., & Reignier, J. (2020). Ethical dilemmas due to the Covid-19 pandemic. Annals of Intensive Care, 10(1), 84. https://doi.org/10.1186/s13613-020-00702-7
Advocacy Paper: Bioethical Decision Making Assignment Instructions
Choose a patient-care situation in which the RN should intervene and advocate for the patient. An example of such a situation might be when a patient has not been given complete informed consent.
Include the following in your paper:
Describe the clinical situation concisely and descriptively. It can be an actual situation or a hypothetical one.
Apply the Bioethical Decision Making Model to the specific clinical ethical situation that you choose. Address each section of the model in your paper.
Conclude with a discussion of nursing advocacy in the clinical setting and the nurseâ€™s role as a patient advocate.
Your paper should be 4-5 pages.
You must reference and cite 1-2 scholarly sources other than your text. Include a title page and a reference page to cite your text and adhere to APA formatting.
Bioethical Decision Making Mode:
1. Define the dilemma: Use your own words to describe the problem. State it in a way that others can quickly understand your dilemma. Review
2. Identify the medical facts: Describe the facts that are relevant to the dilemma.
3. Remember that the diagnosis and prognosis are medical facts.
4. Identify the non-medical facts (patient and family, external influences):
a. Patient and family facts such as culture, religion, social, economic, the
existence of an Advance Healthcare Directive, verbal preferences made by
the patient, how the patient lived his/her life.
b. Those that you discuss should be relevant to the situation.
5. External influences include: organizational policies, federal and state laws, practice acts, code of ethics. These should be relevant to the situation.
6. For both step 2 or 3, separate the facts from the assumptions: Sometimes all healthcare professionals allow assumptions to guide their decision-making. These must be identified so that these assumptions do not interfere with the process.
7. Identify items that need clarification. Your paper should identify facts that you need to clarify. When initially discussing an ethical situation, it is not unusual to not have all of the answers.
8. Identify the decision makers: Is the patient an adult competent to make their own choices? Is the patient a child who is old enough to have a say in the decision. If the patient cannot make their own decision, who is the decision maker? How was this person selected?
9. Review the underlying ethical principles: Review which ones and why they apply t this particular case: beneficence, nonmaleficience, veracity, fidelity, autonomy and justice.
10. Define alternatives: One-Way to proceed may be apparent at this point. However, sometimes there are different choices. They should be addressed identifying the benefits and burdens for doing one thing versus the other.
11. Follow-up: Define the process to be used with the chosen alternative.
Reference Source: Levine-Ariff, J. & Groh, D.H. (1990). Creating an Ethical Environment. Nurse managers\’ bookshelf a quarterly series: 2:1. Baltimore, Maryland: Williams & Wilkins. 41-61.