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Ethical Dilemma in Nursing: Cardiology Section

Ethical Dilemma in Nursing: Cardiology Section

Abstract

Despite advances in modern medicine, some diseases, especially heart illnesses, have proven to be often incurable. Many families decide therefore to ‘pull the plug' rather than suffer emotionally and financially, knowing that the odds of one getting cured are very slim. The core question raised is "if one can prolong one's life through modern medicine, why not take one's life if the disease has been proven to be irrepressible?" This action is also known as euthanasia, and it is due to the widespread belief that human life stops after the person is considered brain dead. This research paper thus tries to analyses the ethical dilemma faced by medical professional when forced to make critical and sensitive decisions. This is one out of many situations, which nurses encounter during their daily lives. They have to follow medical code of ethics to make well-informed decisions instead of following their heart. However, each medical situation is unique and hence need a different approach.     

Introduction

Since there are only a few specialized cardiologists, heart diseases are considered a delicate issue in the field of medicine. Heart conditions are also the leading cause of death in men. Due to lifestyle changes and habits, including smoking and overindulgence in fast food, the situation is bound to worsen. Heart conditions have proven to be a very costly and emotion-draining disease not only for the patient but also for family and friends. The projected revenue from heart conditions is estimated to be about one hundred and nine billion dollars in the United States alone (Maxwell, Maxwell, & Wong, 2014). This figure includes treatment and the health care services costs. Nurses play the biggest role in the treatment of heart patients, since they are in charge of providing palliative care for patients. However, ethical dilemmas usually occur due to misinformation or lack of clear communication. The main dilemma involves the decision whether to follow the code of ethics or make choices based on emotional factors. However, immediate relatives of an afflicted heart patient usually have their wishes, and nurses need to know how to make informed decisions that consider the interests of both parties, while following the medical code of ethics. This paper aims to understand the ethical dilemma and ways to deal with such situation, while abiding by the code of ethics.

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Ethical Dilemma Involving Euthanasia

Matrix

Research Question: What are the ethical dilemmas that nurses face when dealing with the families of heart patients who are about to undergo euthanasia?

Corollary Question: How do heart patients deal with this issue according to the principles of autonomy and beneficence to make an informed decision?

The research explored the following works: Chambaere et al., 2016. It is explored and discussed, using a matrix that consists of the following questions:

  1. Location and legality of euthanasia in the respective areas.
  2. The role of nurses in the process and their relation to the family of the afflicted patient.
  3. Role of nurses in providing palliative care for a patient.

Principles used in solving the ethical dilemma of the situation: Autonomy and Beneficence.

Discussion

Despite euthanasia being legal in some countries, many activists have come forward to rebuke the act. The analysis of many cases has helped in concluding whether euthanasia is right or wrong. However, many have settled that euthanasia is a murder since it is still illegal in many countries such as Canada. The main dilemma is that prohibition of euthanasia prolongs the suffering of the patient. Despite euthanasia being legal in some countries, many activists have come forward to rebuke the act. 

In many cases involved, however, euthanasia is prohibited, and assisted suicide is still a delicate issue in today's society. Even though the patients make such decisions, the act of euthanasia is often followed by many lawsuits and litigations. The conclusion, hence, is that even though euthanasia can be of a huge benefit to the heart patients, it is still unethical. Besides, this act is only beneficial to the patient and not to other parties involved. However, nurses and medical professionals must use the fundamental pillars of medical ethics to make a decision about euthanasia. This situation applies to professionals working with artificial hearts as well as rare but fatal conditions like Hypertrophic cardiomyopathy. The four pillars of the medical code of ethics are autonomy, beneficence, justice and non-maleficence. Physician-assisted suicide mainly contradicts the most important code of medical ethics, sovereignty or the right to accept or refuse treatment. This moral component combined with human values, such as palliative care and compassion, can help make informed decisions about euthanasia.

Since nurses are the most involved parties in the ‘Assisted suicide' process; they have to be guided by the principles of ethics when making their decisions. In addition, they are emotionally involved with the patient and immediate family, since they take care of the patient. However, the nurses who get too attached to their patients and, thus, face an issue in a scenario when patients exercise their sovereignty by applying to euthanasia. Furthermore, this becomes a concern when the nurse believes that this decision will not benefit all parties. The nurse then faces the dilemma of choosing whether to practice the principle of autonomy or beneficence. In an Australian study, medical professionals were told to give their views on euthanasia. They had enquired about the most frequent requests of euthanasia administration. The common reasons for such decisions were persistent pain, terminal illness, fatal condition, and infirmities of old age (Chambaere et al., 2016). Nurses, therefore, need to be ethical in the way they process the euthanasia requests of heart patients. Moreover, they have to inform the party on possible alternatives to the process of euthanasia, so that the patient can make informed decisions.

Ethical Dilemma Involving Social Media

Matrix

Research Question: What principles should guide cardiology nurses in their active participation in social media?

Corollary Question: What are the effects of contradicting the guidelines and policies that safeguard the sensitivity and safety of heart patients' information? 

The research explored the following works: The Press Association, 2013. It is explored and discussed, using a matrix consisting questions on the following issues:

  1. Guidelines for using social media in the nursing profession
  2. Implications of contradicting the guidelines
  3. Principles guiding decision-making at work concerning patients’ privacy.

Principles used in solving the ethical dilemma of the situation: Dignity

Discussion

Recently, Allison Marie got suspended from her nursing job at Ty Hagan because she had posted inappropriate opinions on Facebook despite knowing the Nurses and Midwifery Council advice on the use of social media sites (The Press Association, 2013). It clearly states that nurses have to understand that everything they post online is public. Further investigation by the Nursing and Midwifery Council also showed that she had posted a photo of a co-worker seated on a bedpan (The Press Association, 2013). According to the council, this was highly unethical because not only it reflected poorly on the profession and the hospital but also it was very insensitive to their patients and their families at the hospital. This case is just one example of many involving nurses who post patients details or inappropriate photos and posts contradicting their code of conduct. The Nurses and Midwifery Council rebuked the act, and the nurse got suspended for half a year. In her defense, she said she did not see the problem with venting out her emotions on Facebook, since she was only human after all. Moreover, she has a right to express herself as long as it does interfere with the rights of others. The nurse, therefore, faces an ethical dilemma of whether to express herself or to uphold the principles of dignity in her profession in cardiology section. A heart patient in critical condition may need financial assistance to undergo surgery. Thus, the nurse may post information of the patient on social media to attract well-wishers to assist in raising funds, which can cover the medical expenses of the victim. Even though the intention of the nurse is good and she aims at saving a life, her actions contradict the medical ethical principle of dignity. Every heart patient has a right to privacy of health information, and any nurse who does otherwise is considered to act unethically. Institutions and the justice system should be responsible for creating and implementing guidelines for nurses. These guidelines will solve dilemmas that involve fundamental human rights.

Ethical Dilemma Involving Allocation of Resources

Matrix

               Research Question: What principles should guide the allocation of resources for heart patients with different health statuses?

            Corollary Question: What values should the nurse convey when making decisions about allocating resources? 

         The research explored the following works: Swetz & Mansel, 2013. It is explored and discussed, using a matrix consisting of questions on the following issues:

  1. Ethics employed in the allocation of resources.
  2. Principles used in conveying decisions on withdrawing resources from a dying patient.
  3. Values used when conveying information about life support resources.

 

Principles used in solving the ethical dilemma of the situation: Justice and non-maleficence.

Discussion

Nurses juggle different roles, similarly to physicians. They are the primary caregivers of medical services to the patient, patients’ advocates, but above all the resource allocators of medicine and medical equipment. When a patient has slim chances of survival and is in almost vegetative state and neither the patient nor family members want to withdraw the resources, a nurse in the cardiology section has tough choices to make.

Nurses dealing with heart patients, therefore, face an ethical dilemma when administering resources especially to patients who can be saved rather than those who are in a ‘vegetative state.' They are dealing with this issue almost every day in their careers. This dilemma is especially critical when a heart patient is financially secure, and thus uses his/her money to afford the resources that can be used to save a life. In such situation, the immediate family believes that no resources are too much. This case falls under the ethical principle of justice. The nurse is supposed to distribute health resources equitably rather than base their decision on the financial ability of a patient. Nurses usually have a hard time drawing the line, on what is a personal decision and what is a financial decision. 

Despite the wide range of advanced, life-prolonging technologies available today, heart patients may decide that such therapies are no longer concordant with their goals of care. Patients have the right to request to refuse treatment, saying that it is not similar to euthanasia. However, how patients live and die with or without such interventions can vary, and this point requires a deep analysis. The discontinuity of such resources, such as mechanical or life support systems, is under the control of people who are comfortable with the logistics of the situation. In the era of advanced medical technologies, new ethical issues arise. The problem of inserting or deactivating a pacemaker, for example, needs both parties, the patient and the family, to be informed about how it works. The nurse, therefore, has the task of raising the sensitive ethical issues with patients and immediate family. The Heart Rhythm Society recently released the guidelines that outline the moral and legal principles for extraction of devices such as a pacemaker. There is also the need to administer concurrent patient comfort and family support (Swetz & Mansel, 2013). However, nurses should practice the medical code of ethic of justice when making an informed decision about allocation of resources.

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Involvement of Family Members

Matrix

Research Questions: How do family members affect the palliative care of patients with heart conditions?

Corollary Questions: What are the roles of family in care of a heart patient and what are the necessary standards?

The research explored the following works: Mandal, 2016. It is explored and discussed, using a matrix consisting of questions on the following issues:

  1. What are the set boundaries that involve the care of cardiac arrest patients?
  2. What are the principles used when voicing the sensitive news to family members of a heart patient?

Principles used in solving the ethical dilemma of the situation: Truth, honesty, and autonomy.

Discussion

Various ethical dilemmas involve the care of cardiac arrest patients. In most countries, even trained health professional must have the consent of the cardiac arrest patient to provide assistance. The patient or guardian retains the right to independence and self-government. Treating the patient without his permission is technically an assault, and the victim can claim compensations even without a proof of injury or carelessness (Mandal, 2016). Some situations, however, do not require their consent. These circumstances are rare cases when patients cannot inform a nurse of their decisions, thus the professional acts with the goal to safeguard the interest of the patient. Therefore, medical nurses in cardiology section need to practice the medical code ethics of dignity, truthfulness, and honesty. Another issue that affects nurses when taking care of patients with cardiac arrest is the presence of family members in the intensive care unit or during resuscitation. Family members of the afflicted person may want to be present during the procedure although, this may interfere with the palliative care. An informed decision should therefore be made. The American Heart Association (AHA) made public a scientific report in 2012, focusing on the challenges and prospects for promotion of decision making in advanced heart failure situation (Maxwell, Maxwell, &Wong, 2014). Thus, medical professionals should be able to make an informed choice under these regulations.

However, upholding the principle of truth and honesty can be difficult especially when dealing with the immediate family of the patient. Nurses usually face the dilemma of whether, to tell the truth, or deceive the affected parties. In the medical profession, some facts can be difficult to tell to an afflicted patient. There can be many motives to be dishonest, but in most cases, the emotional aspect outwits the rational thinking. Family members may want to hide information about treatment or their status. Therefore, the nurse faces an ethical dilemma, since she has a duty to inform the patient about procedures or information related to their condition. For example, the family may want to withhold information in fear of emotional repercussions. Nurses should be able to deal with these situations, while upholding the ethics of medical practice. They should be able to act benefiting the patient and involved parties. However, if the patients insist on knowing information about their conditions, then the nurse is obliged to inform him about the situation.

Conclusion

Nurses face sensitive ethical dilemmas in the course of their work. They need a code of ethics to determine the best course of actions for both parties, including the immediate family and the patients themselves. Therefore, they should follow a strict code of ethics when dealing with such issues rather than following their emotions in making informed decisions.

 

However, there are resolutions that can ease such situations. First, universal rules and guidelines should be set to determine the best course of actions when faced with ethical dilemmas. Second, professionals and medical institutions as a whole need to research on moral dilemma cases to be able to set the best course of action.

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