Consider the “Four Topics Approach” (or Four Box method) to ethical decision making in Butts (below). Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.
In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?
Your paper should be 1-2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.
TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases
Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?
THE ETHICAL DILEMMA: A TERMINALLY ILL CANCER PATIENT WANTED HOSPICE SERVICES AND STOP ALL TREATMENT BUT THE FAMILY DID NOT WANT THAT. * THE PATIENT WAS CAPABLE OF MAKING THEIR OWN DECISIONS SO I RESPECTED THE PATIENTS DECISION *
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Introduction:
In my nursing career, I encountered a challenging situation that required me to consider the ethical dimensions of a patient case and the role I played in providing care. The situation involved a terminally ill cancer patient who expressed a desire for hospice services and to stop all treatment, yet their family disagreed with this decision. As the patient was capable of making their own decisions, I had to carefully navigate the ethical dilemma and ensure that the patient’s autonomy and best interests were respected.
1. Medical Indications: The Principles of Beneficence and Nonmaleficence
– The patient’s medical problem was terminal cancer, indicating a critical and irreversible condition.
– The goals of treatment shifted from curative to comfort-focused care in line with the patient’s wishes and the principles of nonmaleficence.
– Continued aggressive medical treatments were not indicated as they would not provide a cure and might cause further harm.
– The probability of success for various treatment options was low, and focusing on palliative care could potentially benefit the patient by improving their quality of life and avoiding further harm.
2. Patient Preferences: The Principle of Respect for Autonomy
– The patient was fully informed of the benefits and risks associated with their treatment options.
– The patient was mentally capable and legally competent, with no evidence of incapacity.
– The patient expressed a clear preference for hospice services and stopping all treatment.
– As the patient was able to make decisions, their expressed preferences were considered of utmost importance.
– In this case, the patient’s autonomy was respected, and their decision was followed.
3. Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
– The prospects for a return to a normal life were negligible, considering the terminal nature of the cancer.
– Even with treatment, the patient would likely experience physical, mental, and social deficits.
– There were no grounds to judge that a specific quality of life would be undesirable for the patient who could not express such a judgment.
– Biases did not prejudice the evaluation of the patient’s quality of life.
– The focus was on improving the patient’s quality of life through hospice care rather than attempting to cure the incurable.
4. Contextual Features: The Principles of Justice and Fairness
– While the patient’s family had a vested interest in the clinical decision, the patient’s autonomy took precedence.
– The patient’s confidentiality was maintained as there were no legitimate interests of third parties that required breaching it.
– Financial factors did not create conflicts of interest in the clinical decision-making process.
– The allocation of scarce health resources did not affect the clinical decision in this case.
– Religious issues did not influence the clinical decision.
– Legal, clinical research, education, public health, and safety considerations did not significantly impact the decision-making process.
– Conflicts of interest within institutions and organizations did not affect the clinical decision or patient welfare.
Conclusion:
Applying the Four Topics Approach to this challenging situation significantly shaped my decision-making process. By addressing each topic area, I was able to thoroughly analyze the ethical dimensions of the patient case while considering the principles of beneficence, nonmaleficence, respect for autonomy, and justice. The Four Topics process provided a systematic framework for evaluating complex ethical dilemmas, ensuring that the patient’s autonomy was respected, and their best interests were upheld. This approach seems valid and applicable in my practice, as it facilitates a comprehensive evaluation of ethical decisions, allows for a holistic consideration of patient care, and safeguards against potential biases or conflicts of interest.
