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- QUESTION
Title: Ethical Frameworks Essay
Consider the “Four Topics Approach†(or Four Box method) to ethical decision making on page 61, Table 2.1 in Butts (below). Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic areas as they pertain to your situation.
In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?
Your paper should be 1-2 pages. Adhere to APA formatting throughout and cite any outside sources you may use.
Review the rubric for further information on how your assignment will be graded.
Due: Sunday, 11:59 p.m. (Pacific time)
Points: 60
TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases
Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?
Source: Jonsen et al., 2010
Content Points Range:20.88 (34.8%) - 24 (40%)
The writer clearly and effectively responds to the assignment.
Focus and Detail Points Range:15.66 (26.1%) - 18 (30%)
There is one clear, well-focused topic. Main ideas are clear and are well supported
by detailed and accurate information.
Organization Points Range:10.44 (17.4%) - 12 (20%)
The introduction is inviting, states the main topic, and provides an overview of the paper.
Information is relevant and presented in a logical order. The conclusion is strong.
Mechanics and APA Points Range:5.22 (8.7%) - 6 (10%)
The assignment consistently follows current APA format and is free from errors in formatting,
citation, and references. No grammatical, spelling, or punctuation errors.
All sources are cited and referenced correctly.
| Subject | Essay Writing | Pages | 5 | Style | APA |
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Answer
The “Four Topics Approach” to Ethical Decision Making
MX is was 34-year-old man, who was also a member of the Jehovah’s Witness Church, was involved in an accident and presented with acute injuries with bleeding. This case is evaluated using the Four Topics Method for analysis of clinical ethics cases (Butts & Rich, 2016). Following a car accident, MX lost too much blood but refused blood transfusion that contributed to his death. The goal of blood transfusion was to save MX’s life. On the other hand, antihypertensive medications were contraindicated since MX was already registering very low blood pressure at the time of arrival to the hospital (Tinetti et al., 2014). Besides, the success of surgical operation could not have been ascertained in the absence of blood transfusion. MX’s life could have been saved if he had consented to blood transfusion and hence, a surgical operation to suture severed arteries and other blood vessels in the lower limbs.
As informed by the principle of respect for patient’s autonomy, MX wishes of care were observed. Blood transfusion was not done. Besides, he was mentally competent and was informed about the risks and consequences of not having blood transfusion but was firm on his stand. It was clear that the patient was not willing to cooperate with treatment due to his religious beliefs.
MX quality of life deteriorated with time since the care team had a shared decision that respect for autonomy principle had overruled principle of maleficence and beneficence in this case. Excessive bleeding without blood transfusion leads to death (Rossaint et al.., 2013). No aspects of this case were associated with the principle of justice and fairness. The only conflict of interest is that the patient’s decision contradicted care decisions by the multidisciplinary team in which the patient’s decisions were respected regardless of obvious consequences. A patient’s autonomy and wishes of care is superior to decisions made by a care team (Jonsen, Siegler, & Winslade, 2010).
In conclusion, the Four Topics process enabled me to reach a decision that respect for MX’s autonomy overruled care team’s best decision to carrying out life-saving blood transfusion. In my view, the Four Topics process is a valid process for analysing clinical ethics cases.
References
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Butts, J.B., & Rich, K.L. (2016). Nursing ethics: A cross the curriculum and into practice (4th ed.). Burlington, MA: Jones & Barlett Learning. Jonsen, A.R., Siegler, M., & Winslade, W.J. (2010). Clinical ethics: A practical approach to ethical decisions in clinical medicine (6th ed.). Pennsylvania: McGraw Hill Professional. Rossaint, R., Bouillon, B., Cerny, V., Coats, T.J., Duranteau, J., Ferandez-Mondejar, E., Filipescu, D., Hunt, B.J., Komadina, R., Maegele, M., Nardi, G., Neugebauer, E., et al. (2013). The STOP the bleeding campaign. Critical Care, 17, 136. https://doi.org/10.1186/cc12579 Tinetti, M.E., Han, L., Lee, D.S., McAvay, G.J., Peduzzi, P., Gross, C.P., Zhou, B., & Haiqun, L. (2014). Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med., 174(4), 588-595. DOI: 10.1001/jamainternmed.2013.14764. |