Patient who informed nurse of suicide attempt-A nursing ethics dilemma case study
Nurses usually face many ethical dilemmas when in practice, mostly when handling patients on their end age of aggressive disease. The study illustrates dilemma that is ethical for a nurse who is handling ovarian cancer patient. Mrs. Johnson informed one nursing staff of her suicidal thought but requested that nurse to keep secret not to inform others. The ethical dilemma in this study is “whether the nurse should tell other nurses about Mrs. Johnson’s attempt without her consent”. Getting the best solution for this case favorable moral choice, ethical theories, esthetical ethics, and the American nurses’ code of ethics standards declaration, the related writing to this case are considered before making the decision.
After considering all this factors, in this situation, the most favorable ethical choice for as nurse was to share the information with colleagues. The nurse chose to share information with the colleagues. Nurses together followed suicide and self-harm protocol of the hospital firmly while maintaining effective commutations to identify the cause of her suicidal attempt. Appropriate nursing intervention is provided to tackle this risk situation. The patient is transferred to palliative care service without any signs of suicide attempts or self-harm but peacefully passed away 40 days later after being discharged (Burkhardt& Nathaniel, 2008).
Nurses usually face so many dilemmas when in practice, mostly when nursing staff have a duty to handle patients with incurable diseases like cancer. The study illustrates ethical predicament concerning a nurse handling and end stage aggressive ovarian cancer patient Mrs. Johnson who opened up to the nurse about her intention to commit suicide but requested the nurse to keep that underground. The essay illustrates the medical case regarding Mrs. Johnson suicide attempt, indicate the ethical predicament arising, elaborate ethical hypothesis and values applicable, application of American nurses policy and standards regarding related to the case, examine view to related prose and provide suggestions how to overcome this ethical predicament (Fry & Veatch, 2006).
The patient Mrs. Johnson is 57 years old lady with aggressive ovarian cancer who is under the care of a nursing team. Mrs. Johnson was diagnosed with ovarian cancer five years ago but did not allow any medical and surgical treatment at that particular time. She opted to go for another treatment and rarely followed the herbalist for that five years’ time. Mrs. Johnson has now been diagnosed hypoproteinemia and anemia. Diagnostic results indicate cancer had metastasized her bones. Also spreading to her lymph nodes and the main tumor was attacking the bladder and partly affecting the right kidney. Mrs. Johnson had been admitted severally over three weeks for a range of reasons. On the most recent admission, Mrs. Johnson was informed that she probably have four to six weeks to be alive after cystoscopy indicating increased development of the tumor, it was resolute that other surgical or medical interventions could not be suitable for her situation and that a palliate concern regimen was the just next walk. Mrs. Johnson informed the health officers she had resigned to live as she was going to die soon. She confided her intention to commit suicide to one of the nurses but requested not to tell anyone (Burkhardt& Nathaniel, 2008).
According to this case, the patient Mrs.Johnson put the nurse she confided within a hard state which can be termed as an ethical predicament. The ethical dilemma is ethical which happens when an ethical challenge involving several mutually special, ethically right measures. In Mrs. Johnson case, following the patient disclosing her decision, the nurse had two morally choices to make. If the nurses choose to keep secret as the patient had requested, that would be respecting patient’s decision that is right. However, this decision would lead to patient committing suicide with no health care interventions. If the nurse chooses to disclose the information to other health care staffs concerning the patient’s suicide decision, the staffs would be concerned in prevention, regulating and escaping suicide but the patient’s choice and secrecy would be dishonored. Hence, main ethical predicament, in this case, can be known as “the nurse was supposed to inform other health care staffs concerning patients suicide attempt without her permission.” (Fry & Veatch, 2006)
A research done identified that relationship between ethical principles and ethical dilemma shows that the reasonable incongruity among these two principles can lead to the ethical predicament, mostly if the ethical state that have two unlike ethical ideology can be useful, but applying single principal leads to violation of the other principle. For Mrs. Johnson’s case, the moral principal independence and beneficence can also be applied same, but applying any leads to violation of the next. The important, reasonable inappropriateness between independence and beneficence in Mrs. Johnson’s case is the main reason that leads to an ethical predicament. Also, the moral principle of non-maleficence is applied in this ethical condition that infringes independence principle but concurs with beneficence principle. Therefore, when given Mrs. Johnson’s case there three moral principles come into play and they are conflicting; beneficence, respect for autonomy and non-maleficence (Burkhardt& Nathaniel, 2008).
Beneficence being the value of doing good, making positive steps to assist others, or desire to do or promote actions to benefit others. In light terms, it can be thought to be an action that majority focus is to benefit others.in the health care facility, one of the most required duty of a nurse is to have positive actions that endorse health and comfort of the patient. This means that the nurse has to judge that choice will benefit the patient. Applying beneficence principle in Mrs. Johnson’s case, the nursing staff has to consider which option will best suit Mrs. Johnson’s. Obviously, the nurse tells other health care staffs about Mrs. Johnson suicidal attempt; thus, the health care can intervene to protect actual action from taking place and this will be a better choice and will suit the beneficence principle (Lachman, 2006).
Apart from beneficence principle, non-maleficence invokes the responsibility not to harm anybody. There is the emphasis on the medical facility that every medical staff has to ensure that their dealing causes no harm to the patient. For Mrs. Johnsons case, the non-maleficence principle needs the nursing staff to take steps to ensure patient do not impose harm on herself in place of ignoring patients probable self-harm. For this matter, the decision of telling other heal care staffs ensures no more self-harm deeds of the patient corresponds with non-maleficence thought. However, it is important when applying these two principles to consider the patient’s own perceptive concerning benefit and harm needs to be assessed. In Mrs. Johnson case, Mrs. Johnson’s point of view of benefit and harm need to be put into considerations. Mrs. Johnson’s perception of maximum benefit would be to be allowed to commit suicide. From this perspective nurse decision to keep silent would not be seen as harmful (Burkhardt& Nathaniel, 2008).
Autonomy, being a form of choice personal actions whereby one determines his or her line of measures regarding the route taken by him or herself. This implies that the autonomy principle allows patients right to make their individual decisions. On the same note autonomy principle commands the nurse to respect patient’s confidentiality and make sure nurse action have informed permission of their patients. Applying this principle to Mrs.Johnsoncase, the decision of keeping secret honors patient’s right to self-determination and informed permission (Fry & Veatch, 2006).
Deciding to keep secret would lead to ignorance of patients probable suicide, this would result in patients self-harm deeds. Most probably Mrs. Johnson would find a solution by seeking a solution to death. Assisting a dying behavior of the nurse would be abstaining from interventions to stop or discourage the patient from committing suicide. In Mrs. Johnson’s case, the option of maintaining secret would be regarded as assisting the patient to die. The ethical principle of independence does not hold regulation concerning euthanasia and assisted suicide because people do not have the authority to be helped to die at any given time they opt to. Although Mrs. Johnson independence should be guaranteed, it can’t supersede the ordinary law that indicates professional’s actions of helped dying are forbidden restrictedly (Lachman, 2006).
A study shows, if a patient in some extraordinary condition made the reckless choice that would bring brutal results to themselves or others, the medic should supersede their desires so that to lessen and avoid these results. For Mrs. Johnson’s case, the suicide effort can be seen as a choice that impacts grave self-harm effect. Therefore, Mrs. Johnson independence can be superseded so that to prevent her suicide effort. Additionally, evaluation of Mrs. Johnson present condition when she made the verdict is required because various research indicates that patient with the psychological disorder or unsound disturbing state cannot be measured as an able person who can make on their own (Burkhardt& Nathaniel, 2008).
Apart from the ethical principles, the utilitarian theory can be applied to the case to decide the superior ethical choice. Singer argues that utilitarianism emphasized the fine deed is the deed that increases enjoyment and decreases tenderness to the majority. Utility principle becomes the essential principle of morals. From this code, right ethical act refers to the acts that create the finest results for the majority. Mrs. Johnson, her relatives and health care professionals, are concerned, in this case, thus, the morally appropriate option should be a deed that benefits for the majority of them (Fry & Veatch, 2006).
In comparison, the two choices for the nursing staff, the option of not disclosing this information would result in the Mrs. Johnson committing suicide. This result only helps Mrs. Johnson because this deed fulfills her desire to die. Moreover, some study shows that suicide has an unconstructive result to relatives and medical professionals’, particularly disturbing impact. Usually, individuals who lose relatives through suicide have the high probability to feel guilty, upset and shame. Obviously, maintaining secret would not be the ethical, appropriate deed (Ulrich, 2012).
Contradiction, the probable result of informing others is Mrs. Johnson’s suicide deeds would be barred and avoided by medic’s staff interventions. Leading to prolonging Mrs. Johnson’s life and maintains her safety that ensures the happiness of the relatives and health professional staffs. Also, research indicates that suicide many relatives would be grateful and pleased if could utilize prolonged moment with their vanishing family members. Medic staffs will be contented when duty is executed. Therefore, the choice of disclosing information would be ethically right option since it helps many people in Mrs. Johnson’s case (Lachman, 2006).
Research indicating and evaluating nurse feelings and attitudes when handling similar cases like that of Mrs. Johnson states that more than half of the nurses in their study showed professional, and personal ethics prevents nursing staff from helping with suicide and motivates nursing staff to take positive action in suicide stoppage. Research indicates that about 40% of nursing staff agreed that it’s their professional duty to avoid any suicidal patient from vanishing. This indicates that most nurses would take positive measures so as to protect suicide considering both moral and proficient thought. Various researches insisted that patient trying to commit suicide is trying to call for sympathy from other peoples. They are seeking special attention from health care staffs. Therefore, nursing staffs should provide help such as communicating effectively in an attempt to handle and resolve the patient’s suicidal attempt (Hall, 1996). To add on that, some nurses exhibit those other health care personnel’s such as physicians’ plays major role in suicide avoidance; this means that they should be told first if nurses discover such an attempt.
Obviously, the opinions of contemporary literature concur with nursing staff to take positive action and inform other staffs so as to avoid suicide. For Mrs.Johnson’s case, the option of informing other agrees with the opinions of the modern literature (Burkhardt& Nathaniel, 2008).
Considering all ethical principles, value statement, utilitarian theory, view in the contemporary literature and legal concept, it would be both morally and lawfully impressible for the nursing staff to maintain the secret of Mrs. Johnson attempt to commit suicide. The decision of informing other staffs fits the moral concern of non-maleficence and beneficence principle. It brings benefits majority of the people in this case; thus making it correct ethical option regarding utilitarianism theory. Apart from this nursing, moral worth declaration stresses on nursing staff to give quality medical services and to quantify admission to excellence nursing and medical services to all people who were backing nursing staff to take positive action to evade suicides. Therefore, the most suitable ethical option for the patient is that the nursing staffs disclose the information of Mrs. Johnson suicide effort to the colleagues (Fry & Veatch, 2006).
Once the nursing staff noticed Mrs. Johnson suicidal attempt, she offered psychological comfort to her to stabilize Mrs. Johnson mood and prevent her immediate suicidal action. The nursing staff informed the nurses’ manager. The nursing staff team that composed three nurses was established immediately. The nursing manager being the leader of the team divided the suicide avoidance protocol into three steps. The first step was effective communication by one of the nurses and Mrs. Johnson to identify the possible facts that lead to such decision. During the conversation the nurse that Mrs. Johnson regularly complained about unbearable renal pain and that her son had not contacted for a while. This continuous pain and denied family support were factors behind suicidal thoughts. The second step was the purposeful nursing intervention where the head of the team requested the physician to try and curb the renal pain. The third step involved a psychological evaluation address other risk reasons and symptoms related to patients suicidal thoughts. Her son was contacted to come and visit her in the hospital (Fry & Veatch, 2006).
Nowadays in the nursing field cases of patients expression on the suicide or self-harm have become rampant. This calls for an ethical issue such as that of Mrs. Johnson wants to be given huge importance. Nursing staffs have the proficient duties to be informed of the good and right complications that concern to their proficient field. For better resolving such type of ethical predicaments, the evaluation of patient’s immediate condition when they are making the choice is necessary. This may help nurses to make a decision whether the patient can make decisions like committing suicide and think taking the right action to handle the ethical predicament. After nursing staff have made the best decision, the required response should be initiated right away to handle such an attempt. Health care facilities self-harm and suicide protocol must be the efficient tool for nurses to tackle patients’ suicide attempt. Additionally, collaborating with other healthcare providers is of great importance. This would enable nurses to provide the intensive care plan for patient (Burkhardt& Nathaniel, 2008).
Ulrich, C. (2012). Nursing ethics in everyday practice. Indianapolis, Ind.: Sigma Theta Tau International.
Lachman, V. (2006).Applied ethics in nursing. New York: Springer Pub. Co.
Fry, S., & Veatch, R. (2006).Case studies in nursing ethics. Sudbury, Mass.: Jones and Bartlett Publishers. Lachman, V. (2006).Applied ethics in nursing. New York: Springer Pub. Co.
Hall, J. (1996). Nursing ethics and law. Philadelphia: Saunders.
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