• What is the patient’s medical problem? History? Diagnosis? Prognosis?
Analysis of a Current Ethical Dilemma in Health Care Guidelines The purpose of this paper is to apply the concepts and theories discussed in the course to a clinical ethical issue of interest to you. Your topic may be individual, system or community based. Select a topic from your clinical practice, your past experience, the literature or the lay media. The topic must be related to health care and have identified ethical implications. The paper should be concise, typewritten and utilize APA format. The approximate page length is 8-10 pages excluding title and reference pages. Submit the assignment electronically as an attachment (.doc or .docx) to the Assignment Drop Box. Prepare a PowerPoint presentation to share with your classmates on the date noted in the course calendar. Submit the assignment electronically as an attachment (.ppt or .pptx) to the Assignment Drop Box and in the Weekly Discussion Board, unless instructed otherwise by the instructor. There should be 10-15 slides, excluding title and reference sl. NUR3650: Ethical Decision Making: Application to Nursing Four Topics Method for Analysis of Clinical Ethics Cases Jonsen, A.R., Siegler, M., & Winslade W.J. (2006) Clinical ethics: A practical approach to ethical decisions in clinical medicine (6th ed.) New York: McGraw-Hill. Medical Indications - The Principles of Beneficence and Non-maleficence Questions: • What is the patient’s medical problem? History? Diagnosis? Prognosis? • Is the problem acute? Chronic? Critical? Emergent? Reversible? • What are the goals of treatment? • What are the probabilities of success? • What are the plans in case of therapeutic failure? • In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided? Patient Preferences - Principles of Respect for Autonomy • Is the patient mentally capable and legally competent? Is there evidence of incapacity? • If competent, what is the patient stating about preferences for treatment? • Has the patient been informed of benefits and risks, understood this information, and given consent? • If incapacitated, who is the appropriate surrogate? Is the surrogate using appropriate standards for decision making? • Has the patient expressed prior preferences, e.g. Advance Directives? • Is the patient unwilling or unable to cooperate with medical treatment? If so, why? • In sum, is the patient’s right to choose being respected to the extent possible in ethics and law. Quality of Life - Principles of Beneficence and Non-maleficence and Respect for Autonomy • What are the prospects, with or without treatment, for a return to normal life? • What physical, mental, and social deficits is the person likely to experience if treatment succeeds? • Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life? • Is the patient’s present or future condition such that his or her continued life might be judged undesirable? • Is there any plan and rationale to forgo treatment? • Are there plans for comfort and palliative care? Contextual Features - Principles of Loyalty and Fairness • Are there family issues that might influence treatment decisions? • Are there provider (physicians and nurses) issues that might influence treatment decisions? • Are there financial and economic factors? • Are there religious and cultural factors? • Are there limits on confidentiality? • Are there problems of allocation of resources? • How does the law affect treatment decisions? • Is clinical research or teaching involved? • Is there any conflict of interest on the part of the providers or the institution?
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