ETHICS AND SOCIAL RESPONSIBILITY – CONCEPTS AND THEORY
MN506M1-1: Apply theoretical frameworks and concepts to ethical dilemmas in the advanced practice role.
Based on your specialization, use the options below to create an ethical and legal decision-making dilemma involving an advanced practice nurse in the field of administration, education, or a nurse practitioner.
- Administration dilemma – Healthcare needs versus resource allocation
- Education dilemma – Nursing student’s religious beliefs versus provision of care
- Practice dilemma – Honesty versus withholding information
Apply relevant codes of conduct that apply to nursing and the chosen field of the APN.
Describe one ethical principle and one law that could be violated and whether the violation would constitute a civil or criminal act based on facts.
Construct a decision that demonstrates integrity, and that would prevent violation of the ethical principle and prevent the law from being violated.
List three recommendations that will resolve advanced practice nurses’ moral distress in the dilemma you have presented. Support your paper with a minimum of three scholarly references.
Practice Dilemma – Honesty versus Withholding Information
One of the most common ethical and legal decision-making dilemmas that an advanced practice nurse in the field of a nurse practitioner can encounter relates to honesty versus withholding information. An example of a case study involving a practice dilemma of honesty versus withholding information is a case study involving Mr. K, a 73-year-old Hispanic immigrant from Cuba. Mr K visits a primary care facility accompanied by his eldest son. Mr. K has a 30-year-old smoking history and has been receiving treatment for hypertension in the past ten years. In the past two months, Mr. K and his son highlightthat he has been experiencing signs of weight loss. The nurse practitioner orders for x-rays and refers the patient to an oncologist who produces results diagnosing the patient with cancer. The oncologist then sends the patient’s results back to the nurse practitioner, who is charged with revealing the patient’s diagnosis and advising the patient on where to receive specialized treatment for his cancer in a specialized cancer care facility. Mr K and his family have resided in the United States for the past 15 years and live with their eldest son and his family. Mr K and his wife are not that fluent in English and rely on their son to translate significant portions of the conversation. Before the initial discussion between the patient and the nurse practitioner, the eldest son asks to speak with the nurse practitioner alone and requests the NP not to discuss the diagnosis with Mr K. The eldest son fears the lung cancer diagnosis would make his father give up. The elder son highlights that he would like his father to start cancer treatment, including chemotherapy but would like the patient to be told that the treatment is to treat an infection.
This case study highlights an ethical and legal dilemma related to nondisclosure. Based on biomedical ethics, it is important for health care providers to disclose all the details of their decisions to patients and be honest and include the patients in making decisions related to medical care. In the case study, Mr. K’s eldest son appears determined to force the nurse practitioner not to reveal vital information to the patient and therefore causes an ethical and legal dilemma.
Codes of Conduct
The case study highlighted above relates to the first and second provisions of the code of ethics for nurses. The first provision of the code of ethics for nurses highlights that nurses should practice with respect, compassion, and inherent dignity and unique attributes of every individual patient (ANA, 2015). On the other hand, the second provision of the code of ethics for nurses highlights that the primary commitment of the nurse should be to a patient whether they are individuals, family, groups, communities, or populations (ANA, 2015). Through the first provision of the code of conduct for nurses, nurse practitioners are therefore required to respect human dignity and cultivate an open provider-patient relationship. Nurse practitioners are also required to respect the right to self-determination of patients (Varkey, 2020). By withholding information such as in the case study above where the eldest son of Mr K requests the nurse practitioner not to provide the cancer diagnosis information to his father, the nurse practitioner will therefore be going against the code of ethics. The code of ethics provides patients with the right to self-determination and calls for an open and honest relationship between patients and healthcare providers while also urging for respect for human dignity (Amer, 2019). In the case study above, if the nurse practitioner followed the request of Mr K’s son not to reveal the cancer diagnosis to the patient, they would be interfering with a patient’s right to self-determination while also not being honest with the patient. The nurse practitioner would also be going against the patient’s interest by not revealing a full diagnosis and advising the patient on where to obtain specialized care for cancer. In the case study, the nurse practitioner would also not be respectful of the patient’s dignity if they chose to withhold the information related to the patient’s cancer diagnosis (Varkey, 2020).
Ethical Principles and Laws
The ethical principle that would be violated in the case study above related to honesty versus withholding information would be autonomy. If the nurse practitioner in the case study decided to honor Mr. K’s eldest son’s request to withhold the cancer diagnosis of the patient, they would be going against the patient’s right to autonomy. Patients, therefore, need to receive honest information from healthcare practitioners so that they can be truly autonomous and make informed decisions related to their health(Amer, 2019). For instance, in the case study above, an honest revelation of the cancer diagnosis to Mr. K’s would help him to make a decision on whether to begin chemotherapy treatment or not. Mr. K, therefore not have any right to make your decision for his father because the patient appears to be of sound mind.
The law that could be violated in the case study relating to withholding of information among patients relates to the 22 U.S. Code § 2702 – malpractice protection(Varkey, 2020). It is therefore a crime for a healthcare practitioner to withhold any form of information from a patient considering 22 U.S. Code § 2702 – malpractice protection. In the case study above, the nurse practitioner would therefore be liable for medical malpractice if they knowingly withheld any information related to the cancer diagnosis of Mr. K despite his son’s request not to reveal such information to the patient.
The decision that would demonstrate integrity and eventually prevent the violation of the autonomy of the patient highlighted in the case study while also preventing the law from being violated would be to reveal the cancer diagnosis to Mr. K and all his family members. Revealing the cancer diagnosis to Mr. K would therefore allow the patient to receive sufficient information both from the nurse practitioner and cancer treatment specialists. Such information would help the patient to decide whether they would begin chemotherapy treatment or not. Allowing the patient to make an informed decision would therefore honor the ethical principle of autonomy (Razai, 2018).
Recommendations to resolve NPs Moral distress
Three central recommendations that can help to resolve the nurse practitioner’s moral distress would include educating the patient’s family members on the importance of an honest relationship between patient and healthcare provider, sharing the case study with colleagues to receive input, and sharing the case study with a professional psychotherapist. By educating the patient’s family members on the importance of an honest relationship the NP would be able to reconcile their moral distress. On the other hand sharing the case with colleagues and receiving different opinions would help the nurse practitioner resolve their moral distress and receive support. Finally sharing the case with a professional psychotherapist would allow the nurse practitioner to receive professional counseling and effectively resolve their moral distress.
In summary cases related to honesty versus withholding information will involve the first and the second provision the code of ethics for nurses The first provision of the code of ethics for nurses therefore requires nurses cultivate an open patient-provider relationship and respect the dignity of their patients. In this regard nurses are required to respect the autonomy of patients. withholding information would therefore be going against the first provision of the code of ethics for nurses.On the other hand the second provision of the code of ethics for nurses highlight the importance of nurses to have a primary commitment to the patient which will promote honesty and help nurses to avoid withholding information from patients.The ethical principle that would be violated in the case study above related to honesty versus withholding information would be autonomy. On the other hand the law that could be violated in the case study relating to withholding of information among patients relates to the 22 U.S. Code § 2702 – malpractice protection.The decision that would demonstrate integrity and eventually prevent the violation of the autonomy of the patient highlighted in the case study while also preventing the law from being violated would be to reveal the cancer diagnosis to Mr. K and all his family members.
American Nurses Association (ANA). (2015). Code of Ethics for Nurses With Interpretive Statements.
Amer, A. B. (2019). The Ethics of Veracity and It Is Importance in the Medical Ethics. Open Journal of Nursing, 09(02), 194–198. https://doi.org/10.4236/ojn.2019.92019
Bell, L. (2015). Code of Ethics for Nurses With Interpretive Statements. Critical Care Nurse, 35(4), 84. https://doi.org/10.4037/ccn2015639
Razai, M. (2018). Truth-telling to a cancer patient about poor prognosis: A clinical case report in cross-cultural communication. Clinical Ethics, 13(3), 159–164. https://doi.org/10.1177/1477750918779303
Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice. https://doi.org/10.1159/000509119