Paper Example on Ethical-Legal Dilemma of Advanced Practice Nurses

Introduction

Advanced nurses are regularly confronted with legal and ethical dilemmas while working with patients. Nurses face many situations where they need to use the nursing ethics to deal with difficult occasions. Davis, Aroskar and Fowler (1983), explain that ethical issues and dilemmas arise as a result of conflicts between healthcare professionals, and patients or families. Nurses in almost all departments need to use the American Nurses Association Code of Ethics and principles to solve the dilemmas. Nurses can be held liable to harm that occurs to employers and patients. It is imperative that nurses understand the various legal and ethical issues they face while undertaking their duties. The nurses conduct many duties and hence have to act in accordance with the duty of confidentiality and the duty of care. The nurses have to adhere to the principles of beneficence and non-maleficence (American Nurses Association, 2010). The dilemma in the case study is whether the nurse should respect the autonomy of the patient or act in accordance with her duty and save his life.

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Case Information

Desmond, a Hispanic male aged 30 has presented to the hospital after being in a motor vehicle accident and sustained serious injuries. The nurse practitioner in charge has been working in this hospital for ten years now. Previous records found in the hospital show that Desmond had mental problems, and he is on medication. The nurse directed that Desmond should be taken in the emergency department to receive more attention since his condition was serious. In the emergency room, the nurse practitioner worked together with a physician and after diagnosing the patient and found some signs and symptoms of internal bleeding. They recommended that Desmond should get a blood transfusion to replace the blood loss due to internal bleeding. In addition, the physician also recommended an immediate surgery to identify and stop internal bleeding. Desmond is a Jehovah's witness and cannot accept the recommended treatments because they were against the will of God. He urged that a surgery was against Gods will because God is the only creator, and no one should interfere with his creation. The nurse practitioner insisted that he should accept the medication because failure to do so, could result in death, but Desmond refused. He said that he would rather die than go against the will of God.

The case study involves ethical-legal principles in nursing which protect the patient's life and independence. The patient has a right to refuse treatment and make independent decisions without any interference. The nurse practitioner has a duty to protect the life of the patient and should ensure that the patient is protected from harm. As a nurse practitioner, one has a duty to promote the well-being of the patient despite their race or religious beliefs. Nursing rules, policies, and standards are set with the intention of protecting the privacy of the patient's medical data and prevents an unpremeditated and deliberate breach in the patient's confidentiality.

Ethical-Legal Dilemma

The nurse practitioner is faced with an ethical-legal dilemma in this case because she is not certain whether she should respect the patient's decisions and save his life. The nurse is confused because she is required to follow the standards of care enumerated by the American Nurses Association (2010). One of them is that nurses should ensure that all the patients receive appropriate care despite their religious beliefs; hence no one should be left to die. The nurse should ensure that she provides reasoned treatment to Desmond as stated in the standard of care because failure to do so can result in a negligence case in court. The dilemma is whether the nurse should disrespect the patient independence and prepares him for operation. According to the principle of informed consent, the nurse should disclose all the consequences of a treatment to the patient. In addition, the patient has a right to choose the type of medication he should be given. On the other hand, the nurse should follow the beneficence principle which states that a nurse should act in the patient's best interest to promote his welfare. Moreover, the nurse should also follow the principle of non-maleficence by avoiding conditions that cause harm to the patient. In the case study, internal bleeding is causing harm to the patient as the nurse should stop it by having him operated by a surgeon. The nurse would be acting in Desmond's best interest when she provides a blood transfusion and prepare him for an immediate surgery as she will save his life.

One Ethical Principle and One Law That Could Be Violated

One ethical principle that could be violated in this case is the autonomous principle. It is the rule of self-independence that prohibits intervention from others to promote self-choice. The nurse needs to respect the independence right of Desmond to make his treatment choice. The nurse is not only required to allow a patient to make independent choices but also create necessary conditions for autonomous decision in others (Cherry & Jacob, 2016). The respect for autonomy includes respecting the right to a personal decision and also the creation of necessary conditions for autonomous decision. Sometimes patients do not have information to make an informed decision and depend on information provided by healthcare providers. In this case, the patient has a right to refuse treatment that has been recommended by the nurse in accordance with the autonomy principle or the freedom of choice. However, the nurse has to violate this principle to save the life of the patient. While working with patients the nurse has a duty to protect the patient's life by all means. The nurse can choose to override patient independence and forcefully treat him against his will. However, the fact that Desmond is suffering from mental illness mandate the nurse to override his right to refuse medication because he does not reason logically. He fails to understand the consequences of his refusal even after nurse efforts to explain his critical condition. If the advance nurse decides to have Desmond operated against his will, she would save his life. However, this would be a civil action because she would violate the Equality Act 2015 (Congress. Gov., 2015) prohibits against discrimination on race, gender, and religion. The nurse, in this case, would discriminate against Desmond based on his mental status and also his religion when she insisted that it was a must for him to undergo an operation.

The nurse has been practicing for ten years and hence she has gained experience in how to use her integrity in such cases. Patient autonomy provides him with the right to make a choice without the interference of a nurse. Once the nurse decides to have a surgeon operate on Desmond the surgery she would save his life but, override his right to make independent choices. The nurse and the doctor should present an alternative treatment that favors his religious beliefs, although they recommended immediate surgery due to the patient condition. The nurse would have to evaluate treatment options that protect the life of the patient. Respecting the patient's autonomy results in individual contentment but, can result in severe consequences such as imposing pain and suffering to the patient. Obeying to the patient independence takes over the principle of beneficence because healthcare is proposed care and therefore, the nurse would evaluate the medical treatment alternatives that keep Desmond alive. This would prevent the violation of the autonomous principle as well as the Equality Act 2015. It would also prevent the violation of the sanctity of human life act because the life the patient would be saved. If there is no other option to save Desmond's life, the nurse practitioner should provide counseling for him pertaining to his critical condition and emphasize on the need for emergency surgery (Epstein & Turner, 2015). Nurses may also involve a family member who would be able to persuade him to accept the medication.

The Legal Principles and Laws That Apply To the Ethical Dilemma

There several principles that the advance nurse must apply in this case. They include autonomy, beneficence, non-maleficence, and justice. The autonomy legal principle allows the patient to make an independent decision on the recommended treatment. He has control over his body and the advance nurse can only advise him on the best medical treatment for his condition. The nurse cannot coerce him into making a particular decision that is against his religious belief (Epstein & Turner, 2015). The principle of beneficence makes the advance nurse do all she can to benefit Desmond. The nurse should only recommend treatment and procedures with the intention of doing well to the patient. The non-maleficence principle prohibits the advance nurse from recommending treatment that would harm the patient. All patients should be treated equally irrespective of their race, gender or religion. The principle of justice provides that Desmond should be treated fairly despite his religious beliefs.

Equality Act 2015 is not the only law that applies in this case. Others include Americans with Disabilities Act of 1990 (Congress, U. S., 1990) which state that it is a civil crime to discriminate a person on the basis of religious beliefs. The law ensures that individuals with disabilities are treated the same as everyone else in public places (Congress, U. S., 1990). American patients are also protected by the Health Insurance and Accountability Act 1996 (HIPAA) (Ackley, Ladwig & Makic, 2016) which provides the right of all patients to be treated with respect. A patient should not be forced to undertake a medication that he feels it's against his religion. The nurse would violate a criminal act if he forced Desmond to accept the medication. Nurses have a duty to care Right to life is protected under the Sanctity of Human Life Act (Congress. gov, 2007) and nurses have a duty to preserve the human life of all patients in the hospital.

The Ethical and Legal Reasoning

Ethical reasoning according to Blais et al. (2006) is the ability of the nurse to apply the appropriate role of ethical reasoning to improve the well-being of all patients. This is crucial since nurses are human who can develop a tendency of self-justification, egotism, and prejudice. The case involves patient independence in medical treatment and the nurse needs to follow the ethical principle to make a decision. However, the nurse should also evaluate the patient's knowledge of his risk of health and the consequences of his decisions. The nurse should disclose all the medical information that indicates that the patient is in a critical condition and recommend the treatment. The nurse should treat the patient using alternative methods that favor his religious beliefs but if his condition worsens the nurse should have the surgeon operate on him and then resolve the conflict of reciprocal autonomy (Moorhead, Johnson, Maas, & Swanson, 2018). Davis & Fowler (2010) defines legal reasoning as the ability to understand certain health conditions of a patient and application of inductive and deductive skills when dealing with a scenario. (Blais, Hayes, Kozier, & Erb, 2006). One difference between ethical and legal reasoning is that ethical reasoning is based on human rights or what is right or wrong. On the other hand, ethical reasoning is based on what is written in the law. Legal reasoning dictates what people should do under any circumstances while ethical reasoning leaves the decision to the nurse. In ethical reasoning, the nurse has a right to choose the best medication to save the patient's life.

To solve the dilemma, the nurse can apply the ethical-legal mo...