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Nurses are confronted by largely controversial ethical issues related to healthcare and medical practice. Suppose that you are a “pro-life” faction member and you happen to work in a medical facility that provides abortion services. If you were required to take part in an abortion procedure, what would you do? Or maybe you are asked by a patient to assist him or her die peacefully because of his or her condition. Regardless of his current quality of life, would you help the patient end his life to end his unavoidable suffering and pain? These are ethical dilemmas that nurses confront in their practice. Controversial ethical issues affect nurses on a personal level because they may conflict with a nurse’s personal values. They may also conflict with the patient’s values or the society’s ideal values. The ethical issues are wide ranging. In this essay only abortion and euthanasia are discussed.
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The first ethical dilemma is abortion. Abortion is still a hotly debated issue, a hot potato if you may, in the society today much as it was centuries ago. As Patil, Dode, and Ahirrao (2014), in some places elections have even been lost over the issue of abortion. While abortion was still a major issue years back, physicians had the last word on what procedure was applied on a patient. With the coming of bioethics, various theories including situational, teleological, deontological, virtue, and care ethics among others have gained wide application. Physicians now have to consider a wide range of possibilities when making decisions on behalf of patients.
Additionally, medical practitioners including nurses have to uphold a set of principles; autonomy, beneficence, non-maleficence, and justice. Autonomy acknowledges that the patient has right to choose treatment or refuse based on his or her beliefs, values, and interests. Beneficence requires that the doctor only put the patient’s best interests first. Based on the principle of non-maleficence, a doctor should always make sure that he does not harm the patient. Finally, a health practitioner has to ensure justice in allocation of health resources including treatment. All these factors are considered when reviewing abortions. The greatest questions however include the right to life, when life begins, whether fetuses have rights, and whether fetus’ rights are superior to those of the mother.
At an individual level, I believe that every individual has a right to choose and a right to life. My position on abortion is that an individual should have a right to an abortion. This is because placing limitations only worsens the situation. Those who are excluded from procuring a legally sanctioned abortion will still seek it elsewhere. Such illegal abortions endanger the life of the mother. That is my position as a health practitioner. My personal belief however, is that life begins immediately at inception. Once fertilized the basic biological processes kick in to support the new life. These processes are automated but work towards creating an autonomous being. In that regard, I would not personally procure an abortion unless it was a matter of life and death. My stand is that of a pro-life group which identifies the fetus as an individual and abortion as a violation of its rights. This however does not prevent me from helping patients seeking an abortion. If it is legally allowed, I would have no reason to impose my will upon a patient. To apply Kant’s ethic, that people should act on that maxim they will to become universal law, I do believe that abortion should not be made illegal. Making it illegal would be suggest that abortion is bad under all circumstances. This would mean, by the universal law, that even when the mother is to die as a result of the pregnancy she should still carry the pregnancy. Nobody would wish such on their wife, mother, or daughter. Additionally, not all women seek abortions anyway.
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Euthanasia goes by many names including mercy killing. With Euthanasia, “a physician administers a lethal dose of medication with the intention of ending a patient’s life” for an individual afflicted with a painful and incurable disease. Euthanasia is illegal in most parts of the world. Euthanasia is further divided into active, passive and voluntary euthanasia. Active euthanasia is one that calls for administration of a drug to terminate the life of a patient and his or her suffering. This version is illegal almost everywhere. Passive version comes in the form of withdrawal of life support. The voluntary version on the other hand is when an individual expresses, through a living will, his or her desires about his time and management of death to a physician. The physician assists by providing the patient with a means to obtain a lethal medication.
Nurses are very much involved in the patients including the end-of-life patients. According to Yousefy, Rezaei, and Beigzadeh (2015), nurses are very much involved in euthanasia. In a survey of physicians, 38 physicians who agreed that they had helped a patient end their life 57 percent did it by asking a nurse to administer the medication. In some states, it allowed for physicians to assist patients in dying. In such cases, the nurse and the physician are released from criminal responsibility regarding the patient’s death. Aside from the fact that it is illegal, euthanasia poses strong moral, social, and ethical challenges.
Nursing practice ethics bar nurses from taking part in actions that help end the life of a patient. Instead, a nurse should help a patient by providing medical interventions that relieve the patient of pain and other uncomfortable symptoms and should not have the intent to end life. In most nursing societies the involvement of nurses in euthanasia is expressly prohibited. Some, however, allow nurses to make a determination as to whether their ethical and moral values allow or bar them from involvement in providing care to a patient who wishes to end his or her life. Personal values are essential in making a determination whether to be involved in assisting a patient who wishes to terminate life. My moral value system does not concur with assisted death of any kind. Much as I differ, I may not have to impose my will on a patient who may want to exercise his or her right to die. Respecting patient’s wishes is one of the requirements of healthcare best practices based on the principle of autonomy. Regardless, I would not assist a patient in dying. If it comes to that, I would have to request that someone else do it on my behalf.
In making the decisions affecting patients, nurses have to apply ethical reasoning. Ethical decision-making process can be based on three commonly used modes. The first model is the deontological ethical reasoning. The deontological model assumes all life to be worthy of respect and deserving similar treatment. Deontological model however, seems to fall short because of its rigid nature. Actions are prescribed based on set beliefs and values and there is not consideration of right and wrong. For instance, if applied in the abortion issue in a culture where life is thought to begin at inception, a woman may not procure abortion irrespective of the reasons.
Another model is teleological ethical reasoning. The teleological approach to ethical reasoning considers the end as a justification of the means. An action that causes a good outcome is a good action. The results therefore govern the actions and are based on majority. If an action causes a good outcome to most people, it is good even if it harms a few. On this basis for instance, if an abortion saves the life of a mother, it is a good thing or because euthanasia ends a person’s suffering and pain, it is a good thing.
The final approach is the situational approach to ethical reasoning. Situational approach to ethical reasoning holds that no prescribed norms, rules, majority good results for every situation. This is to say that generalizations cannot be made from one situation to another. Every situation brings its unique moral and ethical issues which must be considered for each specific situation. The challenge with this approach is arbitrary decision making. The lack of uniformity can breed chaos. However, it is useful in the sense that it allows for a case by case analysis and therefore more relevant decisions can be arrived at for every unique situation.
Ethical dilemma in nursing is a source of controversy today as they were a hundred years ago. Application of the ethical reasoning approaches to decision making process can however make it easier to arrive at morally optimal decisions. Some situations will require deontological approaches while others will require teleological approaches or situational approaches. Others may require a combination of all three approaches. For instance, a situation analysis can show the merits of an abortion in a specific instance based on the circumstances. A teleological approach can add weight to the decision by affirming that if the mother’s life will be saved, then the abortion is good. A deontological approach can further lend credibility to the decision to administer an abortion by affirming all human life should be treated with respect. A woman should not be left to die of a problematic pregnancy just as she would not be left to die from a bad tooth. The approaches can be used to validate decisions rather than be used in isolation.
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