ethical issues in critical care nursing

One example of a combination document is the Five Wishes advance directive in the US, created by the non-profit organisation Aging with Dignity.55 Although not legal documents, ‘good palliative care plans’ are used in some jurisdictions as a record of a discussion between the patient, family members and a doctor about palliative care or active treatment. After the physician leaves, the patient, who is visibly shaken, asks the nurse, Couldnt the doctor be wrong? Acts of Parliament); Further details of these Australian Acts can be found in the, One example of how statute law is applied in practice regards consent for life-sustaining measures; the, It should be noted that each Australian state and territory has differences in its Acts, which can cause confusion. (1978) ‘A contrary view of the nurse as patient advocate’, Adshead, G. and Dickenson, D. (1993) ‘Why do doctors and nurses disagree?’, in Dickensen, D. and Johnson, M. (eds). Ethical implications of brain death and organ donation that particularly relate to nursing practice are also reviewed. (ed.). Chapter 3: Ethical and Legal Issues in Critical Care Nursing Test Bank MULTIPLE CHOICE 1. Some of these principles and how they relate specifically to critical care nursing practice are discussed individually in this chapter. An autonomous person is an individual capable of deliberation and action about personal goals. People may also have a combination of both. ORDER NOW FOR CUSTOMIZED NURSING ESSAY PAPERS ON Discussion: legal and ethical issues in handling and reporting. Consent to treatment lies at the heart of the relationship between the patient and the health care professional. International Conference on Critical Care Nursing and Ethical Issues scheduled on October 07-08, 2022 at Tokyo, Japan is for the researchers, scientists, scholars, engineers, academic, scientific and university practitioners to present research activities that might want to attend events, meetings, seminars, congresses, workshops, summit, and symposiums. Advance directives can therefore inform health professionals how decisions are to be made, in addition to who is to make them. However, the decision-making process certainly must involve broad, detailed and documented consultation with family and team members. With advances in technology in health care, it is possible more than ever before to restore, sustain and prolong life with the use of complex technology and associated therapies, such as mechanical ventilation, extracorporeal oxygenation, intra-aortic balloon counterpulsation devices, haemodialysis and organ transplantation. Advance directives can be signed only by a competent person (before the onset of incompetence), and can be either instructional (e.g. Although the specific detail varies between organisations and jurisdictions, in general ‘consent to medical research documentation’ should include the following:19, • A statement that the study involves research, • An explanation of the purposes of the research, • The expected duration of the subject’s participation, • A description of the procedures to be followed, • Identification of any procedures which are experimental, • A description of any reasonably foreseeable risks or discomforts to the subject, • A description of any benefits to the subject or to others which may reasonably be expected from the research, • A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the subject, • A statement describing the extent, if any, to which confidentiality of records identifying the subject will be maintained. A comprehensive understanding of current legal and ethical frameworks facilitates the delivery of appropriate skilled nursing care. Söderberg, A. and Norberg, A. Other related ethical concepts include integrity, best interests, informed consent and advance directives. (See Chapter 8 for further details on cultural aspects of care.) To deny a competent individual autonomy is to treat that person paternalistically. Patients have cognitive and emotional limitations in understanding clinical information. Nurses value environmental ethics and a social, economic and ecologically sustainable environment that promotes health and wellbeing. When science travels, so does its ethics. be informed (the patient must understand the broad nature and effects of the proposed intervention and the material risks it entails). The lack of planning may produce morbidity and mortality that could otherwise have been prevented, thus creating a fundamental duty to … Acts such as the Consent to Medical Treatment and Palliative Care Act 1995 (SA) exist to facilitate choice in healthcare treatment that individuals may wish to have or refuse when they are unable to make their wishes known because of an illness.11, A substituted judgement is where an ‘appropriate surrogate attempts to determine what the patient would have wanted in his/her present circumstances’.50 The person making the decision should therefore attempt to utilise the values and preferences of the patient, implying that the proxy decision maker would need an in-depth knowledge of the patient’s values to do so. be given by a person legally competent to do so. © 2020 Springer Nature Switzerland AG. Related to this issue is that of the human rights of research subjects, as well as of health professionals as researchers in a variety of sociocultural contexts, and the contribution that international human rights instruments can make in the application of the general principles of ethics to research involving human subjects. consider the effects of having or not having the treatment). Consent is considered valid when the following criteria are fulfilled; consent must: • be informed (the patient must understand the broad nature and effects of the proposed intervention and the material risks it entails). It should also be noted that nurses must seek consent for all procedures that involve ‘doing something’ to a patient (e.g. infection, pneumothorax on insertion). With respect to negligence, the amount of information about risks required is that deemed by the court to be ‘reasonable’ in light of the choices that patients confront.25, If a person is assessed as not being competent, consent must be sought from someone who has lawful authority to consent on his or her behalf. Personal ethics may be described as a personal set of moral values that an individual chooses to live by, whereas professional ethics refer to agreed standards and behaviours expected of members of a particular professional group.2 Bioethics is a broad subject that is concerned with the moral issues raised by biological science developments, including clinical practice. Much ethically-desirable nursing practice, such as confidentiality, respect for persons and consent, is also legally required.4,10. University of Barcelona, Spain See all articles by this author. Abstract. While technology is capable of maintaining some of the vital functions of the body, it may be less able to provide a cure. Kendrick, K. (1993) ‘Understanding ethics in nursing practice’. As the provision of care to the critically ill becomes more complex due to technological advancement, and the profession of nursing more Rather, the role of proxy tends to be assumed on the basis of an existing relationship between proxy and patient. (1993) ‘Commentary on mortality in intensive care patients with respiratory disease: is age important?’. If there is stated objection from a family member, especially if the person has medical power of attorney (or equivalent), the doctor must take this into consideration and respect the rights of any patient’s legal representative. 5. In principle, any procedure that involves intentional contact by a healthcare practitioner with the body of a patient is considered an invasion of the patient’s bodily integrity, and as such requires the patient’s consent. If there is stated objection from a family member, especially if the person has medical power of attorney (or equivalent), the doctor must take this into consideration and respect the rights of any patient’s legal representative. Common ethical principles that relate to critical care nursing practice are outlined in this chapter, with a description of how they may be applied to practical situations such as clinical decision making, obtaining informed consent and applied research. they must not be impervious to reason, divorced from reality or incapable of judgement after reflection), • be able to weigh that information up (i.e. For example, a shortage of intensive care beds may result in critically ill patients having to ‘compete’, in some way, for access to the ICU. Google Scholar | Medline Some believe that the present debates about the relative importance of generic and specific consent (particularly in the use of human tissues for research and in secondary studies) do not address this issue squarely, believing that since the point of consent procedures is to limit deception and coercion, they should be designed to give patients and others control over the amount of information they receive and the opportunity to rescind consent already given. A statement that participation is voluntary, refusal to participate will involve no penalty or loss of benefits to which the subject is otherwise entitled, and the subject may discontinue participation at any time without penalty or loss of benefits, to which the subject is otherwise entitled. However, it is incumbent on all critical care nurses, as patient advocates within the critical care areas of ICU, CCU and the emergency department (ED), to be aware of the potential impact and possible outcomes of therapies delivered in the critical care environment. Nurses fulfil the accountability and responsibility inherent in their roles. Directors and managers of ICU units have several ethics teaching options. Buy Membership for Critical Care Medicine Category to continue reading. The nurse respects the rights of patients/clients. ‘Statements of patients’ rights’ relate to particular moral interests that a person might have in healthcare contexts, and hence require special protection when a person assumes the role of a patient.4 Institutional ‘position statements’ or ‘policies’ are useful to remind patients, laypersons and health professionals that patients do have entitlements and special interests that need to be respected. Consent should never be implied, despite the fact that the patient is in a critical care area.17 Obtaining consent generally involves explaining the procedure and seeking affirmation from the patient (or guardian/family), ensuring that there is understanding and agreement to the treatment. When asked where they would rather be if they had a terminal illness with only a short time to live, more doctors and nurses preferred being home or in a hospice and more patients and families preferred being in an ICU. 31(4):236-240, July/August 2012. 157.230.157.59. Lack of communication creates a potential for patients to undergo burdensome and expensive treatments that they may not desire. Displaying issues in critical care nursing ethics legal PowerPoint Presentations Professinalisum And Legal Issues PPT Presentation Summary : professinalism and legal issues "Nursing is an art, and, if it is to be made an art, requires as exclusive a devotion, as hard a preparation, as any painter’s An understanding of the principle of consent is necessary for nurses practising in critical care. Personal ethics may be described as a personal set of moral values that an individual chooses to live by, whereas professional ethics refer to agreed standards and behaviours expected of members of a particular professional group. Observational studies demonstrate that North American health care workers consult families more often than do European workers,39,41 and some seriously ill patients wish to participate in end of life decisions whilst others do not.42, In most cases where there is doubt about the efficacy and appropriateness of a life-sustaining treatment, it may be considered preferable to commence treatment, with an option to review and cease treatment in particular circumstances after broad consultation. A substituted judgement is where an ‘appropriate surrogate attempts to determine what the patient would have wanted in his/her present circumstances’. The guidelines from the Council for International Organizations of Medical Sciences (CIOMS) – a body established jointly by WHO and UNESCO – take the position that research involving human subjects must not violate any universally applicable ethical standards, but acknowledge that, in superficial aspects, the application of the ethical principles, e.g. The Australian and New Zealand Intensive Care Society (ANZICS) recommends an ‘alternative care plan’ (comfort care) be implemented with a focus on dignity and comfort. Conditions of scarcity and competition result in the predominant problems associated with distributive justice. The first stage in this process will be to explore the preparation of critical care nurses to deal with ethical issues and to identify the nature and essence of nursing ethics in relation to the delivery of critical care. Patients that would probably have previously died can now be maintained for prolonged periods on life support systems, even if there is little or no chance of regaining a reasonable quality of life. A living will is one form of advance directive, leaving instructions for treatment. Ethical and Legal Issues in nursing The nursing regulatory body, the Nursing and Midwifery Council requires all registered nurses to have an understanding of the ethical and legal principles which underpin all aspects of nursing practice(NMC,2010). Critical care nurses need to be aware of the relevant policies and procedures to have an understanding of their individual obligations and responsibilities. Nurses respect individual’s needs, values, culture and vulnerability in the provision of nursing care. Common ethical principles that relate to critical care nursing practice are outlined in this chapter, with a description of how they may be applied to practical situations such as clinical decision making, obtaining informed consent and applied research. In addition, individual preferences may change over time. Another form authorises a specific type of power of attorney or health care proxy, where someone is appointed by the individual to make decisions on their behalf when they are incapacitated. Discussion: legal and ethical issues in handling and reporting. Hence, decisions regarding withdrawal and withholding of life support treatment(s) are not made without substantial consideration by the critical care team. A common ethical dilemma found in critical care is related to the opposing positions of ‘maintaining life at all costs’ and ‘relieving suffering associated with prolonging life ineffectively’. While it is essential that all members of the critical care team be able to contribute and be heard, the final decision (and ultimately legal accountability in Australia and New Zealand for the act of withdrawal of therapy) rests with the treating medical officer. (1993) ‘Intensive care: situations of ethical difficulty’, Timmermann, A.M. (1996) ‘Intensive care: nursing, staffing and training in the EC’, in Tinker, J., Browne, D.R.G. For example, codes relevant to nurses have been developed by the Australian Nursing and Midwifery Council (2002). Although the nursing role in critical care is pivotal to implementing clinical decisions, it is sometimes unacknowledged and devalued. Inconsistency exists in decision making about when and how to withdraw life-sustaining treatment, and the level of communication among staff and family. However, even for formally-appointed guardians, certain procedures are not allowed and the consent of a guardianship authority is required. Download preview PDF. People may also have a combination of both. The New Zealand Bill of Rights and the. Abrahams, N.A. 1. However, it is usually recognised that justice does not always require equal sharing of all possible social benefits. Moral rightness or wrongness may be quite distinct from legal rightness or wrongness, and although ethical decision making will always require consideration of the law, there may be disagreement about the morality of some law. The use of the basic ethical principles in these administrative issues may be less familiar. Accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy yet there are distinct conceptions of individual autonomy, and their ethical importance varies. If there is no guardianship order then, strictly speaking, consents for healthcare treatment may be given only by the guardianship authority. Quickly memorize the terms, phrases and much more. The New Zealand Code particularly notes that nurses need to practise in a manner that is ‘culturally safe’ and that they should practise in compliance with the Treaty of Waitangi. However, the code cannot and does not give direction in all situations nurses encounter in practice. In addition, new medication treatment options contribute significant promises of added benefits, and fewer side effects, and are heralded by drug companies and journals across the world. The majority of the community and doctors favour active life-ending procedures for terminally-ill patients. (eds), Noc, M. and Weil, M.H. In situations where there is not enough of a resource to be equally distributed, often guidelines or policies (e.g. An autonomous person is an individual capable of deliberation and action about personal goals. • Discuss ethical principles as they relate to critical care patients. For example, John may have stated in the past that he would never want to live should he be confined to a wheelchair; however, after an accident has rendered him a quadriplegic his preference may well be different. For example, John may have stated in the past that he would never want to live should he be confined to a wheelchair; however, after an accident has rendered him a quadriplegic his preference may well be different. Seeking consent in this type of everyday situation is less formal than obtaining consent for a surgical intervention, although it still represents ethically (and legally) prudent practice. Dimingo, J. In critical care nursing, there are ethical issues that come up all of the time. Ethics deal with all aspects of human behaviour and are often complex and contentious. For example, a shortage of intensive care beds may result in critically ill patients having to ‘compete’, in some way, for access to the ICU. The withholding and withdrawing of therapies is considered passive euthanasia and is legal and accepted practice in terminally-ill ICU patients in most of Europe, however in parts of Europe, life-sustaining treatments are withheld but not withdrawn as the withdrawal of therapies leading to death is considered illegal and unethical. Patients that would probably have previously died can now be maintained for prolonged periods on life support systems, even if there is little or no chance of regaining a reasonable quality of life. In Australia this predominantly includes the National Health and Medical Research Council (NHMRC) and the National Statement on Ethical Conduct in Human Research (2007); Although the specific detail varies between organisations and jurisdictions, in general ‘consent to medical research documentation’ should include the following: A statement that the study involves research, An explanation of the purposes of the research, The expected duration of the subject’s participation, A description of the procedures to be followed, Identification of any procedures which are experimental, A description of any reasonably foreseeable risks or discomforts to the subject, A description of any benefits to the subject or to others which may reasonably be expected from the research, A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the subject, A statement describing the extent, if any, to which confidentiality of records identifying the subject will be maintained. 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