Assignment: NSGCB 426 Competency 2

Assignment: NSGCB 426 Competency 2

Assignment: NSGCB 426 Competency 2

Assessment Details

Review “An integrated ethical decision-making model for nurses” from the University Library Readings.

Apply the ethical decision-making model in the article to access this case study from the Center for Practical Bioethics: Our Pregnant Daughter Didn’t Want This…

Review the Questions for Discussion following the case.

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Follow the steps provided in the model, including the following:

Step 1: Explain the ethical issues, other relevant ethical considerations, and ethical principles relevant to this case study and how they affect the nursing practice.

Step 2: Collect and analyze additional information related to this case study, including researching and explaining any legal considerations.

Step 3: Develop alternatives (different options) and compare them.

Step 4: Determine your position and justify it:

What specific actions should be taken to ensure an appropriate outcome?

Why is your position important, needed, or beneficial for vulnerable populations?

Are the legal and ethical responsibilities in alignment with each other? If they are not in alignment, how does your position deal with that conflict?

Step 5: Find strategies to implement the plan:

What ethical arguments could you use to persuade someone who disagrees with your position?

Format your assignment as an 875- to 1,050-word paper.

Cite at least 3 peer-reviewed sources published within the last 5 years.

Note: At least 1 of the sources should provide evidence for your resolution recommendation or plan of action.

Include an APA-formatted reference list.

Submit your assignment.

Assignment: NSGCB 426 Competency 2 Sample

An ethical dilemma refers to a situation of conflicting requirements in that there is no right or wrong choice. The most useful decision depends on the circumstances. When an ethical dilemma occurs, healthcare providers must choose between two equally unsatisfactory alternatives. The purpose of this paper is to discuss the ethical and legal considerations in the case study, “Our Pregnant Daughter Didn’t Want This…” and explain the various options.

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Ethical Issues, Other Relevant Ethical Considerations, And Ethical Principles Relevant To This Case Study and How They Affect The Nursing Practice

The ethical issues relevant to Janet’s case include Respect for bodily autonomy and the Patient’s right to refuse treatment. Bodily autonomy is an individual’s freedom to make decisions concerning their body. Keeping Janet under life support against her formerly conveyed wishes would equal objectifying and treating her as a consumable body. She will serve as a means to preserve the fetus life if she is kept on life support against her wishes during pregnancy when the fetus has a low likelihood of survival (Sperling, 2020). An ethical issue will arise when the state’s interest in the fetus life overrides Janet’s right to personal autonomy and dignity. In addition, overlooking Janet’s previously conveyed wish not to be placed on life support just because she is expectant violates her right to decline medical treatment or any form of medical intervention, which will be unjust and unfair treatment.

Other ethical considerations related to this case pertain to the child’s best interest. Maintaining Janet on life-support until delivery, if it happens to be a successful pregnancy, is an intentional act of having the child be an orphan. It can be questioned whether it is in the child’s best interest to live in and serve as the memory of her deceased and artificially maintained mother (Trawick et al., 2020). Thus, there must be proper consideration of the child’s psychological well-being in the future. The ethical principle related to the case is nonmaleficence, the moral duty to cause no harm. The providers have a duty to cause no harm to the fetus or the mother (Rachid et al., 2019). This affects nursing practice since nurses are left with a dilemma regarding the appropriate course of action.

Additional Information Related To This Case Study And Legal Considerations

            It is logical to argue that a pregnant woman’s rights and interests should be overlooked by those of the fetus when there is a rational prospect of the fetus surviving. This should occur only when the fetus’ survival involves bearable complications, illness, or disability (Trawick et al., 2020). In this case, there is no adequate evidence supporting that the nine-week fetus will survive without complications or disability, considering the mother will be on life-support.

Kansas is one of the nine states that invalidate a pregnant woman’s advance directive, in spite of whether or not the fetus can survive. Kansas law directs that a woman who is only a month pregnant and whose fetus has no chance of survival could, however, be kept artificially alive against their expressed wishes for the duration of the pregnancy (DeMartino et al., 2019). The aim of this law is to safeguard life and guard the state’s interest in the fetus. Legal implications may arise if the health care providers fail to comply with the Kansas law and act per the patient’s advanced directive. Sperling (2020) explains that healthcare providers may choose not to abide by this law. In such a scenario, their penalty will be denial of legal immunity that could have been given if they complied with the law. However, if the practitioners implement Janet’s previous directive to not extend her life through medically assisted nutrition, hydration, ventilator, or other life support, they may still enjoy legal immunity. This is under state and case law that upholds the legal validity of advance directives.

Develop Alternatives And Compare Them

The options, in this case, are to postpone palliative care and keep Janet on continued life support or to allow Janet’s parents to continue with the advanced directives. If Janet is placed on life support, there is a chance that healthcare practitioners will establish the chances of survival for the fetus (Warren et al., 2021). This will also give them time to establish the best interventions to maintain the pregnancy and improve the outcome. Furthermore, keeping Janet on life support has the chance that both the mother and fetus may survive, although that is unlikely for the mother. The other option is to take Janet off life support and allow the parents to take her to palliative care. The implication of continuing with the advanced directives is the high risk of losing the mother and the fetus (Warren et al., 2021).

Determine Your Position And Justify It

            My position will be to allow Janet’s parents to take her to palliative care and keep their daughter’s wishes since they are determined that this is what she would have wanted. This will be respecting the ethical principle of respect for person. DeMartino et al. (2019) explain that ethics prioritize patient self-determination and freedom from unwanted medical interventions. When a person’s decision-making capacity is lost, I can uphold self-determination and freedom by using a patient’s advance directives or respecting the surrogate decision-makers choices. Legal responsibilities will include enlightening Janet’s parents on the Kansas invalidation law for advanced directives for pregnant persons.  

Strategies to Implement The Plan

            The plan will be implemented by first discussing with the medical team the ethical and legal implications involved with the option of keeping the patient on life support or allowing the parents to take her to palliative care. I would also talk to Janet’s parents about the same. I would also seek legal consultation on the steps to take to address the justice system’s legal issues (Sperling, 2020). I would persuade other practitioners that putting the patient on life support against her advance directive violates her autonomy and human dignity.

Conclusion

The ethical factors relevant to the case pertain to respect for bodily autonomy, the right to refuse treatment, and the child’s best interest. Legal considerations should be made with regard to the state’s law on invalidating advanced directives for a pregnant person. In this case, I would allow the patient’s parents to proceed with her advanced directives.

References

DeMartino, E. S., Sperry, B. P., Doyle, C. K., Chor, J., Kramer, D. B., Dudzinski, D. M., & Mueller, P. S. (2019). US State Regulation of Decisions for Pregnant Women Without Decisional Capacity. JAMA, 321(16), 1629–1631. https://doi.org/10.1001/jama.2019.2587

Rachid, M. M., Sehring, M., Taneja, D., & Nair, D. (2019). Doing more harm than good? Sustaining life support in maternal brain death during pregnancy. In D49. Critical Care Case Reports: Neurocritical Care, Sedation, And Delirium (pp. A6668-A6668). American Thoracic Society. https://doi.org/10.1164/ajrccm-conference.2019.199.1

Sperling, D. (2020). Should a Patient Who Is Pregnant and Brain Dead Receive Life Support, Despite Objection From Her Appointed Surrogate?. AMA Journal of Ethics, 22(12), 1004–1009.

Trawick, E., Sampson, A., Goldman, K., Campo-Engelstein, L., Caplan, A., Keefe, D. L., & Quinn, G. P. (2020). Posthumous assisted reproduction policies among a cohort of United States in vitro fertilization clinics. F&S Reports, 1(2), 66–70. https://doi.org/10.1016/j.xfre.2020.06.005

Warren, A., Kelly, S., Karus-McElvogue, A., & Burnstein, R. (2021). Brain death in early pregnancy: A legal and ethical challenge coming to your intensive care unit?. Journal of the Intensive Care Society, 22(3), 214–219. DOI: 10.1177/1751143720918974