NURS 330 Legal and Ethical Issues in Nursing : Theoretical Framework

NURS 330 Legal and Ethical Issues in Nursing : Theoretical Framework

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NURS330 Legal and Ethical Issues in Nursing

Task:

Students will upload their individual case analyses via Moodle by the Friday on which the assignment is due. Group members are required to read and grade each of their fellow students’ submissions using the “Peer Grading of Individual Case Analysis” tool on Moodle by the following Friday. Each group member must submit their feedback once for each group member. Students have one week to complete this task. Then the grade will be determined by averaging the individual grades assigned by fellow group members (e.g., if two students assign a case analysis a grade of 3.0 and two assign it a grade of 4.0, the grade submitted to the instructor will be 3.5). The instructor will then post them online. Each individual case analysis is worth a maximum of 5 points. The four case analyses are thus collectively worth 20% of students’ final grade. With regard to the individual and group case analyses you will be asked to formally respond to questions pertaining to cases included in the textbooks. As with the discussion forum questions, you are expected to use the theoretical framework set forth in lesson one to respond to the questions that follow each case but are free to disagree with the views expressed by Keatings and Adams and Yeo and colleagues as long as you present a persuasive and coherent line of reasoning. In other words, you should first define the ethical theories and principles that we use to guide our discussions and apply these to the case at hand. In some instances, the questions will pertain to legal issues or governmental or institutional policies that are not open to discussion. For instance, when discussing legal issues such as negligence or battery there are accepted legal definitions with which students are expected to familiarize themselves. There are also issues that are open to interpretation, such as the constituent elements of consent. Here, for instance, you may take issue with the disputed component of competence, which may be treated as either an element of consent or a threshold notion. Finally, there are opaque, amorphous subjects like autonomy that have an infinite number of facets and may be discussed in many different ways depending on the context and the parties involved. Thus, there are questions and responses to which there are right and wrong answers, there are questions that are open to debate and there are questions or issues that are speculative or philosophical. You should therefore use the theoretical framework outlined in lesson one in conjunction with your own practical experience, to arrive at ethically defensible conclusions. You should answer questions posed as fully as possible and provide adequate references and citations for any supporting sources. In the case of the individual case analyses, you must evaluate the extent to which your fellow students satisfy these criteria in their responses. With regard to the group case analyses the professor will evaluate the sufficiency of students’ responses based on the criteria described above. Chapter 2 in Keatings and Adams’ textbook provides guidance on the manner in which you should analyze and respond to the questions that follow each individual or group case analysis. On p. 16 the authors include the scenario, “Margaret’s Story”, which recounts the dilemma faced by a novice nurse attempting to care for a patient who has had a cardiac arrest and whose wife insists on being permitted to stay by him while the healthcare team attempts to care for him. On the following pages, authors introduce the ethical theories, e.g., utilitarianism and deontology, described in lesson one of this course and then apply them to the case at hand. For instance, the authors explain that Utilitarianism is not concerned with the motivation of actions but, rather, focuses on the consequences of an act. The right action will be that, compared with all possible alternatives, which produces the greatest amount of good for the greatest number of people. Classically expressed by Mill, the good that is to be maximized is happiness. The authors then apply this theory to the case at hand (see p. 23) and observe that “Utilitarians would certainly be concerned with the short- and long-term consequences of whatever decision Margaret arrives at. If the patient’s wife is allowed into his room during the team’s resuscitation efforts, team members might be distracted when they should be focused on saving her husband’s life.” On the other hand, “[p]erhaps her presence would positively influence the outcome, and resuscitation efforts would be successful.” The authors then turn to a discussion of deontology and Kantian ethics. As they observe, a feature of all deontological theories is the fact that they are concerned with the motivations behind actions and are not concerned with the consequences of actions. Perhaps the best-known example of a deontological theory is that of the German philosopher Kant. Moral duties for Kant ultimately derive from the fact that human beings have a rational faculty. Kant’s dictum, “treat others as ends in themselves rather than merely as means to an end,” is commonly invoked in health care ethics and is taken to mean that human beings ought to be afforded respect and not treated in ways that do not show respect for their humanity. The authors then apply this theory to Margaret’s story (see. p. 27) and observe that “[f]rom a deontological perspective Margaret has a duty to her patient and to his family—in this scenario, his wife. She also has a duty to her team members, who expressed their concern about bringing the wife into the room.” The authors next turn to an examination of the moral principles set forth in lesson one and focus primarily on autonomy, beneficence, non-maleficence and justice. They describe how the principle of autonomy means that health care providers ought to take seriously the choices expressed by persons capable of making their own decisions. An important corollary of this is that those who are incapable of making their own decisions, such as children or adults with dementia, are entitled to protection. The principle of beneficence, meanwhile, has two components. The first is that one ought to do no harm (this is referred to by some as a separate principle of non-maleficence). The second is that one ought to act in such a way as to maximize potential benefits to the patient while minimizing harms. The principle of justice, finally, requires that health care providers treat patients equitably. The nurse must treat patients differently only as their medical condition requires. Patients may not be treated differently on non-medical grounds, such as race, ethnic background, age, or sexual orientation. In other words, health care providers must not engage in discrimination. The authors apply these principles to the case at hand (see. p. 33) and argue as follows: “[t]he principle of autonomy would suggest that it is the patient’s right to decide who or who may not be present at any time…Adherence to the principle of beneficence, which requires that health care professionals act to benefit others, might also require that Margaret allow the wife to be with her husband to provide him comfort…On the basis of the principle of nonmaleficence, the team might argue that there is the possibility of harm to both the patient…and the wife…beyond this situation, the principle of justice would require that the hospital review its policy to ensure fairness to all patients and families.” 

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