Lucas Cavalier

Professor Tim Kirk

Biomedical Ethics Essay #2

 

1. What are the ethically significant issues in this case? What makes them ethical?

The case involved with Mr. S have some significantly ethical issues that need to attention. Chiefly, should the wander guard be applied to his ankle? This is an ethical question because it directly violates the patients request to not have the monitor, which could go against the patient’s autonomy. Another significant issue is the patient’s limited decision-making capacity. Mr. S is capable of current decisions but lacks coherent future decision-making capacity. This is an ethical issue because the decision to apply the ankle monitor is left to the clinical team and Mr. S’s surrogate. Moreover, Mr. S needs to be fully aware of the intricacies of the wander guard and if there are any misunderstandings that are influencing his decision. An ethical issue is also noted with the nurses and surrogate (patient’s sister) because they want to ensure Mr. S’s safety.  This is an ethical issue because it involves the need for a safety measure against the patient’s request.

2. What ethical principles should guide the team in developing a plan to address the nighttime ambulation/falls? (Please choose and explain three from among those we have discussed in class, at least one of which must be confidentiality, dignity, or truthfulness.) How are these principles relevant to, and good sources for guidance in, this situation?

The three ethical principles that will be used to come to a decision for Mr. S are autonomy, beneficence, and dignity. Autonomy is described as the ability for a patient to make his own decision about oneself (1). This ethical principle involves the specific components of autonomy which include free action and effective deliberation. These components of autonomy are relevant to Mr. S’s current situation because of his lack of full decision-making capacity. Free action involves the ability to willingly accept or reject treatment options that are consistent with Mr. S’s preferences. However, this is not the case with Mr. S, he is still having issues with decision-making capacity and lacks the full wherewithal to make a consistent decision that align with his overall care goals. In addition, Mr. S’s deficiency with rational thought, inability to weigh pros and cons and a decreased in competent judgement parallels the points of effective deliberation.

Beneficence is the next key element involved with the case. Beneficence is defined as the removing of harm to a patient, ensuring good outcomes, and the obligation for the clinical team to provide beneficial treatment to Mr. S (2). This is relevant to the clinical team because it incorporates the key aspect of preventing further harm. It is necessary to point out that applying the ankle monitor the clinical care team is reducing the chances of causing further injury to Mr. S. Beneficence also points out the fact that the clinical team has an obligation to the patient and with that involves the removal of harm, prevention of injury and balancing care with the patient and other clinical team members. Beneficence is relevant to this case because its fundamental element is removing harm from the patient. Through a decrease in decision-making capacity Mr. S must understand and appreciate the importance of removing and preventing harm. Through the application of the wander guard beneficence is accomplished.

The third ethical principle involves dignity. Dignity encompasses important elements including self-worth, moral status, and decision-making rights. Dignity sheds light on respecting patient’s values, privacy, and non-clinical life (3). By allowing Mr. S a sense of dignity he believes he can accomplish some daily activity functions under his own will power. Mr. S voices his concern about the importance of having the staff attend to his call in a timely manner. This is an important aspect to Mr. S’s request because it is an aspect of dignity that needs to be recognized. The moral status of this patient is an important factor into Mr. S’s overall care. The fact that Mr. S is able to use the toilet is important to him and makes for a necessary component to his healthcare. The clinical team needs to be made aware of this important component to Mr. S’s treatment.

 

3. What course of action do you recommend the team take?

As the ethical consultant, I recommend applying the wander guard. The course of action recommended for the clinical team is based on several factors. Chiefly, there is the possibility of the patient’s continued chances of falling while walking to the toilet.  It is necessary to add that the clinical team is committed to protecting the patient from any further harm. Another point is that Mr. S’s health care surrogate is in agreeance with the clinical team, and supports the fact that further intervention is needed for her brother.

4. How is your proposed course of action supported by two of the principles you selected and explained in (2)?

The choice made to apply the ankle monitor is based on two key ethical elements, autonomy and beneficence. Due to the limited decision-making capacity, it appears that he is refusing beneficial treatment that is consistent with his care goals. More specifically he is refusing the ankle monitor, which in turn will reduce the chances of falls and will likely improve his healing time and decrease the time at the physical rehabilitation center. This specific finding goes with autonomy and involves the specific key elements of free action and effective deliberation. In addition, Mr. S is showing an issue with rational thought process, the ability to weigh the pros and cons and the benefits of the ankle monitor.

Beneficence is the other ethical principle that correlates with the decision to use the wander guard. Beneficence is centered around removing harm. Applying the wander guard significantly decreases the chances of the patient falling. This alerts the medical staff and provides care for Mr. S when he needs it. Beneficence also incorporates the duty of the clinical team. The clinical care team are there to help Mr. S heal as quickly and thoroughly as possible. The implementation of the anklet makes that possible and betters the outcome of Mr. S by reducing his chances of falling.

 

5. How is your proposed course of action challenged by the third principle explained in (2)?

The proposed course of action for Mr. S is to apply the ankle monitor. This is challenged through an important ethical principle, dignity. Mr. S is striving for self-worth and feels that his dignity is being compromised. By having a healthcare staff assist him to and from the bathroom he feels that his moral status is being diminished. He feels that his dignity is being compromised by having the ankle monitor applied and feels like he can accomplish the simple daily task of using the bathroom unassisted. Mr. S feels like his dignity is compromised because the clinical staff is dismissing the importance of completely such basic bodily functions.

 

6. Why do the arguments explained in (4) outweigh the challenge posed in (5)?

The ethical principles that support the use of the ankle monitor outweigh the one that does not simply because of safety. Mr. S already has a history of falling out of bed and further falls could hinder or reverse current physical rehabilitation accomplishments. The clinical team has a duty to prevent further harm for their patients and attempt to incorporate the patient’s request whenever possible. However, due to Mr. S’s limited decision-making capacity the ankle monitor should be placed to add another level to safety.

 

References:

(1) Yeo, M. et al. (2010). Autonomy. Concepts and Cases in Nursing Ethics. Third Edition. Ontario. pp 91-94.

(2) Yeo, M. et al. (2010). Beneficence. Concepts and Cases in Nursing Ethics. Third edition. Ontario. pp. 103-116.

(3) Chochinov et al (2016). Dignity Model. Retrieved from http://www.dignityincare.ca/en/the-model-in-detail.html#model