INTRODUCTION:
Nurses often face challenges in the healthcare settings to provide a safe and holistic
environment for the patients. At the same time, they will be heavily challenge by ethical
issues as well. This essay will state more about Staff Nurse (SN) Grace and her patient, Mr.
Jerry who was diagnosed with cancer and wants to discontinue treatment. This essay will
evaluate more about the ethical issues involving autonomy, beneficence and non-maleficence.
It will also evaluate more on legal issues involving the legal acts and discuss more about the
implications for this patient.
This is a case of Mr. Jerry, a widower aged 67, has been diagnosed with Stage 4 Lung Cancer
and is currently undergoing treatment for two months.
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Ethical and legal are referred to having a good nursing practice
(Hall, 1996). The ethical dilemma in this case of SN Grace and Mr. Jerry is autonomy,
beneficence and non-maleficence. The fist ethical principle is autonomy which is respecting
Mr. Jerry’s rights to choose and make decision whereby he wants to discontinue the
treatment. Autonomy are made by the laws to enforce the values. The laws enforce and
protect one’s individual power to decide and to do what is wanted (Hall, 1996). According to
the Mental Capacity Act, Mr. Jerry falls into the category of competent. This is because he is
a mentally competent person aged 21 years old and above, a married person and the ability to
understand the nature and consequences of treatment he is undergoing (“Singapore Statutes
Online – 177A – Mental Capacity Act”, 2017). To go against his requests is a violation of his
autonomy. The second ethical principle is beneficence which is to do good for Mr.
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SN Grace have already identified the dilemma and have already obtained the
information of the values and needs of Mr. Jerry. SN Grace will discuss this issue with the
Oncologist and suggest on having a family discussion will be the best. SN Grace have come
up with a choice to allow the patient to discontinue the treatment and determine on the action
plan. The action plan to provide palliative care for Mr. Jerry. Palliative care improves the
qualitive of life for the patients and families who are facing terminal illness (Campbell,
2009). Hospice care is a place where patient no longer benefits from treatment and believe
that their life expectancy is less than 12 months. Hospice care will also focus more on pain
and symptom control. Patient is best to believe that they will spend their last days with
dignity and have quality of life (“Overview of Services | HCA Hospice Care”, 2017).
CONCLUSION
At the end of the day, patient has the rights to refuse treatments as it is their life and their
decision matters. We should show the best of interest in patient’s values and needs.
Not all cases is patient autonomy the most important thing to respect and honor. There will always be situations where Medical paternalism is justified. Justifiable paternalism in a medical perspective is prolonging patients’ lives allowing them to exercise their autonomy. Failing to respect a patient’s treatment requests or denials is a violation of the autonomy at that point in time during their illness. While the previous statement is true, the medical professional is violating a patient’s future autonomy. For this reason, medical professionals have the right to act paternalistically, therefore medical paternalism is justified by means of future autonomy and obligations to promote patient
Facts: Ahmad Edwards who had been diagnosed with schizophrenia tried to steal shoes at a department store in Indiana in July 1999. After being discovered, the man took his gun and fired at a security officer. Besides, Edwards accidentally injured a bystander. An FBI agent apprehended Edwards. Before Edwards was arrested, the agent shot him in his thigh, because the man had refused to drop the gun. The man was accused in attempted murder, theft, and criminal recklessness. Afterwards, his mental state became the subject of 3 competency hearings and 2 requests of self-representation. After his competency had been questioned during the first three hearings, Edwards appealed to the appellate court in the State of Indiana as he believed that his
Being in hospice care is a better alternative than being stuck in the hospital to try to avoid the unavoidable. Common misconceptions about Hospice could include that hospice makes life more miserable; however, a physician expressed his findings in Hospice,“You can only fail a patient if you fail to understand and respond to their needs. We may not be able to cure all of our patients, but if we can make them comfortable in the last moments of their lives, we will not have failed them”..Hospice care gradually emerged in the 1970s, when groups like the National Hospice Organization were formed “in response to the unmet needs of dying patients and their families for whom traditional medical care was no longer effective.”Herbert Hendin, an executive director of the American Suicide Foundations illustrates a story of a young man diagnosed with acute myelocytic leukemia and was expected to have only a few months before he died. He persistently asked the doctor to assist him, but he eventually accepted the medical treatment. His doctor told him he can use his time wisely to become close to his family. Two days before he died, Tim talked about what he would have missed without the opportunity for a
Palliative Care: medical and related care provided to a patient with a serious, life-threatening, or terminal illness that is not intended to provide curative treatment but rather to manage symptoms, relieve pain and discomfort, improve quality of life, and meet the emotional, social, and spiritual needs of the patient. (Palliative Care Medical Definition)
Individuals who exhibit cognitive impairment that limits or otherwise compromises their ability to understand consequence and make decisions and/or control their actions in accordance due to physical illness, disease, or disability at the time of legal offense cannot be reasonably held accountable for their actions, nor should they be legally judged by the same criteria as those criteria regarding mentally healthy individuals. A pardon or remission should be granted by the court, the affected individual should receive prompt, appropriate medical and psychological treatment, and further reprimand should be reserved for cases of repeat offense.
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
The individual will need to be encouraged to make decisions about the care they receive and the type of life they want to live and also ensure that their families are part of the decision making process.
... doctors the order to end treatment. Since the patient's doctors have this in writing, it is usually followed.
Mental disorders plays pivotal role in a person’s actions. An insane or mentally ill person has a hard time controlling their actions and behavior. The criminal justice system is well aware that everyone does not have the same mental state. An insane person or a person who has no control over their actions, or thought process who commits a crime will be seen as incompetent to stand trial. Daily functions for those who suffer from a mental disorder are harder for them to deal with. There is no treatment for the illness, however there is treatment that could assist in making that person’s life easier and productive. The diagnostic and statistical manual of mental disorders (DSM) helps many clinicians diagnose certain mental disorders (Bartol, 2014). The DSM also can help officials link certain disorders with crime. With the help of the DSM it helps the criminal justice system realize that these disorders are the reason behind the defendant’s actions, versus it being free will. The disorders that are present in the DSM are also broken down into one of four categories: schizophrenic disorders, paranoid disorders, mood disorders and the personality disorder (Bartol, 2014). Although a person’sa mental state may be disoriented, they are still accountable for their actions if they commit a crime. While there are a select few people who suffer from a mental illness or disorder who cannot control their actions, there are also some who can. The insanity defense is also used and abused by some defendants seeking to receive a less punitive punishment. One major reason why the insanity defense was enforced in courts proceedings is because it will be cruel and unusual punishment to imprison someone who does not understand the charges they ar...
An ongoing and growing controversy is that of the increasing number of mentally ill offenders incarcerated and released into the community. For the most part, these individuals tend to be among the main contributors of the most violent offenses. While some believe it is best to lock such individuals so that they do not commit any more crimes. Others believe that they too have rights and should also be eligible for early release prison. A common belief is that with mentally ill offenders put away, crime will reduce immensely. Although that may be the case, it is best to treat a mentally ill offender the same as that of an average offender, meaning that the prosecution and judicial process of such individuals must not differ from that of any
One landmark case in regards to competency to stand trial (CST) is the Supreme Court case of Dusky v. U.S. (1960). This case established the minimum standard for competency. Milton Dusky was a man charged with assisting in a kidnapping and rape of an underage female. Even though he suffered from schizophrenia he was found competent to stand trial and was convicted and sentenced to 45 years. There was a petition to reverse his conviction on the grounds that he was not, in fact, competent to stand trial. The courts granted a retrial which resulted in his sentenced being reduced to 20 years.
... used in other situations other than terminal illness is old age and being able to die with dignity before they are unable to go through with simple tasks such as going toilet alone, this is usually they don’t burden their families and retain pride.
Many elderly and terminal ill patients may argue the fact that they have a “right to die”. Many patients have the idea that they have the right to decide when to prematurely end their lives, to prevent any suffering and continuous burdens on their family. Many terminally ill patients suffer from severe depression and thus trigger a desire for death. Patients in a persistent vegetative state or chronic illness do not want to be a burden on their family members. Euthanasia can be considered as a way to upheld the ‘Right to life’ by honoring ‘Right to die’ with dignity (Math & Chaturvedi, 2012). For instance, in the Nancy Cruzan case, the young lady was in a persistent vegetative state for 4 years. Her life was maintained by artificial hydration and nutrition. The US Supreme Court decided not to allow discontinuation of the treatment since there was no clear and convincing evidence that she would want her treatment to be discontinued. However, the court stated that individual states could not ignore the expressed wishes of patient when satisfactory evidence was presented (Chao & Chan, 2001). Aside from the patient the caregiver may file for a similar request to identify alternative options to preserving the life of the patient. The caregiver tends to carry a large burden which involves financial obligations, emotional,
The National Council on Disability developed ten recommendations to address civil right protection in mental health disabilities. These recommendations address civil rights for people with mental disabilities and promote equal opportunity, self-sufficiency, and integration of disabled person. The first one I picked out of the ten recommendations from the National Council on Disability is where federal, state, and local governments, including education, healthcare, social services, juvenile justice, and civil rights enforcement agencies, must work together to reduce the placement of children and young adults with disabilities, particularly those labeled seriously emotionally disturbed, in correctional facilities and other segregated settings.
The 8th Amendment to the US Constitution that protects against, “Cruel and Unusual Punishment” is often violated by the prisons system. The Americans Disabilities Act (ADA) and the Rehabilitation Act are the two most commonly ignored rights mentally ill inmates inadvertently endure. Of the inmates in solitary confinement, 30% or more suffer from a mental illness. The (ADA) is supposed to protect mentally ill inmates from discrimination on the basis of their disability. Most prisons, due to lack or ill-equipped staff or facilities to handle severe mentally ill inmates, often slip into gross negligence or violations of basic constitutional rights. Examples of these violations are when they isolate mentally ill inmates directly because of their actual mental illness, prolong mentally ill inmates in solitary confinement causing deterioration, or failure to provide access to aids, benefits, or services to the mentally ill inmates (Knowles, 2015). The United States incarcerates more prisoners in solitary confinement than any other country in the world an estimated 80,000 prisoners nationwide (Knowles, 2015). This extreme form of isolation often lasts for years and sometimes decades. By contrast, the United Kingdom confines just 500 prisoners in isolation, and only for limited periods of time (Jacobi J. V., 2005). The United States also imprisons a disproportionate number of mentally ill inmates in solitary confinement, also