The Role of Nurse Autonomy and Ethics in End-of-Life Care
The Role of Nurse Autonomy and Ethics in End-of-Life Care
As a patient, one can expect a certain amount of rights and responsibilities when requesting medical treatment. These rights include the right to make decisions, have questions answered accordingly prior to those decisions being made, and the right to have your decisions upheld and respected by the medical professionals from which care is obtained. However, in some circumstances, medical professionals often find themselves being asked to comply with the wishes of a patient who, due to the medical condition being treated, may not be able to make effective decisions for his or herself. It is at this time that the medical professional relies on the patient’s Power of Attorney (POA) for Healthcare or family to assist in the decision-making process. Ethical dilemmas arise, however, when the POA is unavailable. It is at this time that the medical professional may find themselves acting more as an advocate for the patient, than the caregiver.
This essay is in response a case study presented in which a patient with mental retardation, Mr. E., states he does not want a ventilator or feeding tube placed after presenting to the hospital with presumed aspiration pneumonia secondary to a lack of control of his esophagus. Per the case study, Mr. E. has advance directives stating his desire to have no life-sustaining treatment, including feeding tubes and ventilators. Yet, due the patient’s medical condition, he was placed on a ventilator and a feeding tube was inserted when the patient’s POA was unavailable and another family member arrived at the hospital and gave consent. This is a clearly ethical violation of this patient’s rights.
The State of Illinois Nurse Practice Act of 2007, lists in its Scope of Practice for a registered nurse the duty of “advocating for patients” (Nurse Practice Act, 2007). To advocate for someone is to “plead in favor of” that person, his or her wishes or desires (Merriam-Webster,
As a patient, one can expect a certain amount of rights and responsibilities when requesting medical treatment. These rights include the right to make decisions, have questions answered accordingly prior to those decisions being made, and the right to have your decisions upheld and respected by the medical professionals from which care is obtained. However, in some circumstances, medical professionals often find themselves being asked to comply with the wishes of a patient who, due to the medical condition being treated, may not be able to make effective decisions for his or herself. It is at this time that the medical professional relies on the patient’s Power of Attorney (POA) for Healthcare or family to assist in the decision-making process. Ethical dilemmas arise, however, when the POA is unavailable. It is at this time that the medical professional may find themselves acting more as an advocate for the patient, than the caregiver.
This essay is in response a case study presented in which a patient with mental retardation, Mr. E., states he does not want a ventilator or feeding tube placed after presenting to the hospital with presumed aspiration pneumonia secondary to a lack of control of his esophagus. Per the case study, Mr. E. has advance directives stating his desire to have no life-sustaining treatment, including feeding tubes and ventilators. Yet, due the patient’s medical condition, he was placed on a ventilator and a feeding tube was inserted when the patient’s POA was unavailable and another family member arrived at the hospital and gave consent. This is a clearly ethical violation of this patient’s rights.
The State of Illinois Nurse Practice Act of 2007, lists in its Scope of Practice for a registered nurse the duty of “advocating for patients” (Nurse Practice Act, 2007). To advocate for someone is to “plead in favor of” that person, his or her wishes or desires (Merriam-Webster,
References: American Nurses Association (2001). Code of Ethics for Nurses with Interpretive Statements. NursingWorld. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.aspx Merriam-Webster. (“n.d.”). Advocate. In Merriam-Webster Dictionary. Retrieved from http://www.merriam-webster.com/dictionary/advocate?show=1&t=1316198751 Nurse Practice Act, 2007 IL General Assembly §§ 1300.350-.360 (2007). Statement of Illinois Law on Advance Directives and DNR Orders. (2011). Retrieved from http://www.idph.state.il.us/public/books/advdir4.htm