Nurses are constantly confronting various ethical issues in their every day professional medical practice. An moral dilemma is sophisticated situation appearing from the turmoil between moral responsibilities where complying with one would cause contravening another (School of Nurses of Ontario [CNO], 2009). Nurses using CNO's ethical conducts and decision-making framework can help in directing their moral plan of action. This framework will involve the utilization of moral aspect such as claim, data, warrant, basis, rebuttal and moral decision to steer in resolving the discord (Arnold & Boggs, 2011). Thus, the aim of this paper is to use ethical decision-making framework detail by detail in checking out an ethical concern by studying a pediatric research study to make significant decisions.
Claim is the first moral component of the platform. It stresses on various problems arising from the case study such as pediatric progress directive, consent to treatment by being competent trivial and decision-making capacity. The honest dilemma arises from this research study is whether to choose wishes of adolescent patient considering his treatment or should the needs of his parents outweigh his question. The case study explains Kyle 14 years old male who may have stake in end result of the decision, and suffering from lymphocytic leukemia cancer. The case study requires Kyle as patient with doctors and his parents to look for the care and attention in best interest of patient. The involved Physicians in attention explained Kyle's health is deteriorating and not giving an answer to the chemotherapy treatment. Hence, the value of Kyle's parents is to keep with the chemotherapy treatment in desire to work and lengthen his life. However, Kyle having different perspective, refused to use any heroic measure and called for DNR order to be put in his graph. In this manner, his parents' value would be violated if nurse decides to accept your choice of Kyle. Matching to article by Tabak and zvi (2008), patient being adult slight competent has to refuse treatment and it is permitted to choose decisions regarding all the areas of his treatment. Hence, nurse is caught incompatible between parents and Kyle. Thus, Kyle being in customer center attention, whichever decision nurse decides from patient and parents will impact the Kyle's care and attention.
The facts is next moral component of the framework. According to the scenario, physician sharing information with patient about the health position shows their mutual trust in romantic relationship. This relationship reveals Kyle's right to know to be cognitively competent to understand benefits and drawbacks of the treatment and take part in the discussion. Relating to Tabak and zvi (2009), typical of enlightened consent is the fact patient has to know truthful information about his health position from healthcare pros to make informed decisions. From your case study another evidence indicates, Kyle being cognitively mature adolescent with a serious illness (at the age of 5), knowledge to make informed decisions (DNR) and, familiar with treatments (several medication dosage of chemotherapy). Based on the article by Tabak and Zvi (2008), if the adolescent being minor is dealing with long-term and life threatening situation then patient is cognitively alert to the type of the condition and has to give consent. With this reality, his parents are seizing over his autonomy by denying his alternatives or capacity to make decisions. Based on the article by Rogers, Alex, Macdoland, Gallant and Austin (2009), says that allowing children to express and offering options escalates their quality of life and dignity. In cases like this, parents emotional grief for child may prevent them understanding child's moral value or standard of living. It seems parents' connection with child making them not to understand child's belief of suffering from medications and needs to increase his life even if it is due to holding on to the anticipation of future medication to work (Macgrawth & Phillip, 2008). Because of this, parents 're going against standards rather than undertaking critical thinking. The evidences found in the research study are true, relevant to make decision, but lacks in sufficiency scheduled to having insufficient in-depth reasoning behind klye's decisions.
Warrant is another part of the framework. It requires using professional standard of care, and legal precedents and procedures. EASILY were a nurse confronting honest dilemma turmoil between patient and parents' decision over treatment, I'd critically examine selections using professional specifications. First thing I am going to take child's years into consideration for informed consent. As explained in pediatric Malignancy Culture (CPS) (2008), in Ontario there is no age group of consent. However, there may be "mature modest right" where patient not being adult in age group, but cognitively able are permitted to consider the procedure selections and alternatives based on the evaluation of results. This explains Kyle being only 14 years old is able to give consent of refusing treatment, which is on his best interest along with knowing his mother nature of treatment. Aswell as, according to CPS (2008), "when benefit for the treatment overweighs burden it should be respected". Similarly, Kyle's choosing to preserve his standard of living overweighs the option of treatment associated with pain and fighting that ought to be respected. Furthermore, regarding to CNA (2008) code of ethics, under promoting and respecting enlightened decision-making, nurses have right to advocate for the patient if his/her protection under the law are being influences by other's decisions. In this case, by abiding this code, I would understand the kyle's right and support his capability to withdraw or withhold the consent for treatment regardless of his parents' get. Furthermore, matching the CNO's (2009) practice standard ethics client's well-being and client choice are relevant ethical worth for nurse when parents and patient's view are differentiated in what's beneficial. I as a nurse without judging would assess, respect and determine the rationale for the chosen option by parents and patient in conditions of benefit vs. risk to aid in making decision. By abiding professional expectations and policies can help me as a nurse to obtain evidence established rationale to deliver ethical clinical care to Kyle.
Basis is another part in the construction involves ethical guidelines. In this scenario, autonomy, beneficence, and veracity are moral principles used as guide to analyze ethical concern (Arnold & Boggs, 2011). Autonomy refers to patient's right to make enlightened decision about his/her health care without having anyone's influence onto it. In cases like this, parents' desired decision gets control Kyle's autonomy by contradicting his decision-making capacity (being minor) regarding his treatment and DNR options. Hence, allowing Kyle' to make prepared decision by allowing him expressing his choice, concerns, and hopes would respect his autonomy and can preserve his dignity (Whitty-Rogers et al. , 2009). Another basic principle, beneficence requires to prevent injury to others. With this scenario, kyle's going right through chemotherapy treatment shows no improvement (beneficences), yet him going through this technique for prolong life increase his pain and fighting. From parental notion, treatment assisting to prolong lifetime signifies harm in trust of beneficences. For parents, treatment increasing survival period over area effects seems as convenient option to simply accept (Mcgrath & Phillip, 2008). Previous ethical process veracity identifies responsibility of showing truth. In this case scenario physician or HCP has provided truthful information to patient and family regarding health status and efficiency of treatment. Hence, there is absolutely no other information concealed from patient to help making up to date decision. Hence, it is significance for nurse to continue using this process to support and oppose argument made by each person to solve the issue.
In addition, rebuttal is another component of framework. It focuses on costs and benefits associated with each selections. The benefit for the choice created by Kyle will relieve his anguish by refusing the unresponsive treatment and DNR, that may increase his quality of life. It will fortify the trust in nurse-patient relationship. Alternatively the chance associated with Kyle's choice shortens the amount of life due to having no treatment and DNR actions to save his life. Another injury associated is the fact it would impede the partnership between parents-patient and nurse-family scheduled to opposing their get. Furthermore, the huge benefits associated with parental options of continuing treatment will lengthen their and Kyle's time of togetherness. Aswell as, risk associated with parent's choice will escalate the pain and fighting of patient by lowering the quality of life. This violates the ethical concept of choosing non-maleficence for the wish of beneficence and reducing patient's autonomy and dignity. As denying parents inclination can impede trusting nurse-patient marriage. Particularly when trust, value and honesty are essential to meet up with the health care needs of patient and in facilitating end of life care decision making (RNAO, 2006). Although, alternatives could be planning ending up in parents and patient will understand each other's perception, as well as allowing to allow for/negotiate any options to reach mutual decision. This way parents might be able to see the fighting and pain that treatment brings for child to be able to prolong time. Also, Kyle can understand emotional side of parents where his life is more valuable and beneficial over side-effect of the procedure. Because of this, palliative treatment could be an alternative solution option in intensifying illness to help ease quality of life with quantity of life. Palliative treatment can benefit in minimizing the anguish in holistic way of patient's life. For example, chemotherapy used can have medications to alleviate side ramifications of nausea to reduce the suffering (Mcgrath & phillip, 2008). Aswell as, choosing to keep with the unresponsive chemotherapy treatment (side results) with palliative good care may limit the patient's quality of life.
At last, a nurse being reasonably prudent and moral should apply moral principles in decision-making. The primary thing of the nurse would be to identify ethical concern. The ethical issue in this case review is adolescent's treatment decision issues with parent's decision in determining expert for decision-making. Then nurse will evaluate the evident data to obtain all the relevant and sufficient information. Additionally, nurse must have understanding of CNA, CNO's code of ethics, and RNAO BPGs to possess knowledge regarding laws, legal action also to have evidence-based rationale in guiding the decision-making process. Nurse would measure the claim by realizing moral reasoning in each person's point of view. Regarding to CNA (2008) values, under consumer wellbeing and alternatives, nurse should value family and patient's view. Nurse should make parents recognize about the adolescent's right in making decision. If patient is mature minor and qualified to make prepared decision then nurse should advocate for patient even if its opposes parental get. Finally, nurse should think about risk and benefits associated with each person's options in conditions of possible long conditions and short-term effects. Hence, nurse can provide different options by collaborating with other HCP if essential to balance and develop common goal between HCP, patient and parents.
In conclusion, to attain resolution in moral dilemma includes critical thinking. This newspaper has examined an ethical problem in determining whether is it Kyle or parents, that has authority to take decision regarding treatment. It examined others factors such as pediatric get older consent, and being cognitively skilled to understand the consequences that could influence the decision-making. Paper also included three nursing journal to aid the evidence, professional benchmarks, and ethical rules to immediate decision-making. At last, being moral nurse, to find out decision in patient's best interest, possible results from the choices were outweighed in conditions of risk and benefits. Thus, the use of decision making platform facilitated in deciding what's morally and ethically acceptable in patient's best interest while facing honest dilemma.
Kyle is a 14 season old male diagnosed with serious lymphocytic leukemia at get older 5. He has endured multiple relapses demanding several rounds of chemotherapy with short periods of remission. He has been readmitted to the paediatric oncology product after metastases to his lungs and brain have been found. Throughout a family meeting to discuss treatment options, Kyle's attending medical professional points out that the cancer tumor is rapidly progressing and unresponsive to treatment. Kyle feels that he has endured enough and will not want any further heroic measures and has asked a DNR (do not resuscitate order) be positioned in his chart. Kyle's parents do not trust this program of action and are keeping to pray that more treatment may lengthen his life.
