NURS FPX 4000 Assessment 1 Applying Ethical Principles

Applying ethical principles to an ethical dilemma

Summary of a suicidal patient case study 

There are many reasons why health care professionals have to deal with moral problems while they work. Some of the reasons include medical mistakes that foster a culture of blame, issues related to assisted suicide, patient privacy concerns, the right to make decisions about life support, negligence, and other moral dilemmas (Park et al., 2015). The objective of this paper is to examine a patient suicide case study ethical dilemma and to employ an ethical decision-making model to alleviate the issue.

The case involves a patient, Mr. Green, who exhibits suicidal tendencies following his admission to the healthcare facility. Mr. Green is a 57-year-old man. The patient was taken to the oncology unit of a hospital in Brisbane, Australia. Seven years ago, he found out he had prostate cancer, but he didn’t get surgery or medical care. The patient selected alternative therapy and treatment but has not subsequently followed up on his condition with the designated urologist. He now has anemia and hypoproteinemia. A series of diagnostic tests were performed, revealing that cancer has metastasized to the bones (Jie, 2015).

The spread has also reached lymph nodes, the tumor has invaded the bladder, and the left kidney is not working properly. The doctors thought he would live for six to twelve months, but the most recent diagnosis after the cystoscopy showed that the tumor was growing quickly and he would only live for four to six weeks. It was also found that medical or surgical interventions are not possible right now. The medical professionals recommended palliative care. The patient, however, told the nurse that he had had enough and wanted to end his life, but he asked the nurse to tell no one about his condition or his plans (Jie, 2015). This scenario presents an ethical dilemma, as maintaining communication with the patient, respecting their wishes, and advancing health by adhering to nursing responsibilities are in conflict (Suhonen et al., 2018). 

Ethical dilemma in the case study

The nurse’s responsibility is to present various options to the patient, facilitating a decision that reflects the patient’s preferences and desires (Awenat et al., 2017). For instance, a patient on life support may delegate decision-making authority to a family member to make appropriate choices when the patient is unable to do so (Campo-Engelstein et al., 2015). But in this case, the nurse’s main job is to end the life. Additionally, healthcare professionals must maintain confidentiality in their conversations with patients. But this issue raises legal, philosophical, moral, and professional questions because ending a life and keeping the information private goes against the code of ethics for nurses (Goligher et al., 2017). For instance, a nurse can talk a cancer patient who is dying into not smoking or drinking to give them a better chance of living longer. Another example is that midwives can point out how complicated a normal birth can be in a certain case and suggest a cesarean (Diema Konlan et al., 2019). Another consideration is that even if the nurse respects the patient’s wishes, the decision to terminate life should be carefully considered and based on clinical outcomes. Suicide attempts causing more intricate issues, where the patient survives, indicate inadequate decision-making, despite the consideration of the patient’s autonomy (Goligher et al., 2017). Health care-assisted suicide entails diminished risk relative to unassisted individual suicide attempts (Goligher et al., 2017). 

Individual ethical decision-making entails comprehending the moral implications of a case through the lens of personal, organizational, and cultural values and ethics. Subsequently, a judgment is rendered based on effective communication, thorough issue analysis, and the exploration of alternatives, culminating in action informed by various factors to arrive at the appropriate decision regarding the case (Snyder, Sulmasy, & Mueller, 2017). The nurse’s most significant ethical dilemma in this scenario is whether to disclose information to other healthcare professionals, thereby infringing on the patient’s consent and autonomy, or to maintain confidentiality, thereby compromising both moral and professional obligations as a nurse and as an individual (Jie, 2015). This is the moral awareness part of making ethical decisions. 

NURS FPX 4000 Assessment 1 Applying Ethical Principles

Analysis of the case

It is essential to discern the connection between an ethical dilemma and an ethical principle. The initial factor is the patient’s autonomy (Jie, 2015). The choice to end life is the patient’s autonomy; however, it is made with the understanding that he will survive for four to six weeks. He is not mentally stable and is going through a rough time emotionally. This condition makes it hard to make decisions. So, the nurse should first talk to the patient to get rid of any thoughts of suicide. It is her job to suggest the best option for the patient. Snyder, Sulmasy, and Mueller (2017) contended that even when the patient possesses full autonomy, it remains the nurse’s duty to exercise clinical judgment by mitigating cognitive biases. Goligher et al. (2017) endorsed physician-assisted suicide for patients in a vegetative state but opposed it for patients capable of functioning adequately and continuing their lives. Jie (2015) suggested that the nurse make a decision that would prolong the patient’s life and encourage the patient to talk to other professionals before making it. This approach is because the ethical conflict between beneficence, non-maleficence, and the principle of autonomy should work in the patient’s favor.  

The nurse’s main job is to keep Mr. Green alive, which is part of the moral decision-making process that leads to doing good. The nurse should act in a positive way, even if it goes against the patient’s freedom. Large et al. (2017) determined in their study that nurses must identify patients at risk of suicide to avert such occurrences. Talking to nurses and other health care workers can help you figure out what’s going on based on your own and the organization’s values, rules, morals, and laws (Campo-Engelstein et al., 2015). Additionally, Awenat et al. (2017) found that nurses experience psychological problems after helping someone die by suicide, keeping information about suicide from their patients, or seeing their patients die by suicide. The evidence shows that nurses are negatively affected by this. 

Another thing is avoiding harm. This moral rule says that you must avoid hurting patients on purpose or by accident. The nurse must make a choice that will hurt the patient. For instance, suicide attempts may not succeed and could result in additional complications. The research conducted by Shand et al. (2017) indicated that the suicide survivors perceived their decision as instinctual, believing that external assistance could have averted their actions. Barnfield et al. (2018) also stressed the importance of stopping people from trying to kill themselves to lower the risk of self-harm. Consequently, infringing upon the patient’s autonomy and advising others to make the correct decision is the appropriate course of action in this instance. Nonetheless, elucidating the advantages and disadvantages of various actions to Mr. Green is essential for comprehending his viewpoint, which may facilitate the resolution of the issue (Large et al., 2017). Even with euthanasia, patients can’t end their lives however they want, so autonomy shouldn’t be prioritized over beneficence and non-maleficence (Jie, 2015). Because of this, the nurse should tell others and try to talk the patient out of killing themselves through therapy, communication, and other means. 

Effectiveness of communication approaches

Asking the patient about their suicidal thoughts and then responding to them can help the patient understand how a bad recent event has affected them. Fostering paraprofessional or professional-patient interactions can accomplish this by cultivating trust and understanding the patient’s perspectives. Additionally, emphasizing the potential negative consequences of suicide and the prospects for extended life through examples of former patients can help alleviate suicidal ideation (McCabe et al., 2016). It is preferable to initiate one-on-one communication prior to engaging in group discussion regarding the issue, including with family members. It is also suggested that patients interact in the institutional or community setting to encourage confidence (Shand et al., 2017). It is preferable to focus on suicidal ideations rather than conditions. Avoiding highlighting the possibility of healthcare complications is preferable. It’s also best not to talk about serious family or personal problems (McCabe et al., 2016). 

Ramberg et al. (2016), in their case study, emphasized that nurses utilized education to help patients comprehend the ramifications of their actions. As part of the process, the nurse and patient had to build a relationship based on trust and emotional support. It is best to have a positive attitude and use a persuasive way of talking to people. Additionally, the inclusion of adequately trained psychiatric nurses contributes to the prevention of suicidal ideation (Ramberg et al., 2016). 

Ethical principles

The ethical principles of beneficence, non-maleficence, and professional and moral obligation dictate that communication, patient education, trust-building, collaboration with other healthcare personnel, provision of support, and the cultivation of a suicide-prevention mindset aimed at enhancing patient well-being to extend life are imperative (Ramberg et al., 2016). The ethical analysis section says that the action plan is to help the patient by understanding his perspective and promoting health. Consequently, the suggested solution is grounded in the ethical principles of beneficence, non-maleficence, and moral and professional duty (Jie, 2015).