Florida National University Ethical Issues in Professional Nursing Practice Paper After reading Chapter 14 and reviewing the lecture powerpoint (located in

Florida National University Ethical Issues in Professional Nursing Practice Paper After reading Chapter 14 and reviewing the lecture powerpoint (located in lectures tab), please answer the following questions. Each question must have at least 3 paragraphs and you must use at 3 least references (APA) included in your post.1. What signs might alert you to a potential professional boundary violation or crossing?2. Contrast the terms terminal sedation , rational suicide, and physician-assisted suicide. Chapter 14
Ethical Issues in
Professional
Nursing Practice
Relationships and
Professional Ethics
• Nurse–physician relationships
• Nurse–patient–family relationships
– Unavoidable trust
– Boundaries
– Dignity
– Patient advocacy
• Nurse–nurse relationships
The National Council of State Boards
of Nursing’s Professional Boundaries
in Nursing Video
https://www.ncsbn.org/464.htm
Moral Rights and Autonomy (1 of 2)
• Moral rights are defined as rights to perform
certain activities
– Because they conform to accepted standards or
ideas of a community
– Because they will not harm, coerce, restrain, or
infringe on the interests of others
– Because there are good rational arguments in
support of the value of such activities
Moral Rights and Autonomy (2 of 2)
• Two types of moral rights
– Welfare rights
– Liberty rights
• Informed consent
• Patient Self-Determination Act
• Advance directives
– Living will
– Durable power of attorney
Social Justice
• Sicilian priest first used term in 1840; in 1848,
popularized by Antonio Rosmini-Serbati
• Center for Economic and Social Justice
definition
• John Rawls’ concept of veil of ignorance
• Robert Nozick’s concepts of entitlement
system
Allocation and Rationing of
Healthcare Resources
• Does every person have a right to health care?
• How should resources be distributed so
everyone receives a fair and equitable share of
health care?
• Should healthcare rationing ever be considered
as an option in the face of scarce healthcare
resources? If so, how?
Organ Transplant Ethical Issues
• Moral acceptability of transplanting an
organ from one person to another
• Procurement of organs
• Allocation of organs
– Justice
– Medical utility
Balanced Caring and Fairness
Approach for Nurses (1 of 2)
• Encourage patients and families to express
their feelings and attitudes about ethical issues
involving end-of-life, organ donation, and
organ transplantation
• Support, listen, and maintain confidentiality
with patients and families
• Assist in monitoring patients for organ needs
Balanced Caring and Fairness
Approach for Nurses (2 of 2)
• Be continually mindful of inequalities and
injustices in the healthcare system and how the
nurse might help balance the care
• Assist in the care of patients undergoing surgery
for organ transplant and donation patients and
their families
• Provide educational programs for particular
target populations at a broader community level
Definitions of Death
• Uniform Determination of Death Act definition of
death: “An individual who has sustained either (1)
irreversible cessation of circulatory and respiratory
functions or (2) irreversible cessation of all functions
of the entire brain, including the brain stem is dead.
A determination of death must be made in
accordance with accepted medical standards.”
• Traditional, whole-brain, higher brain, personhood.
Euthanasia
• Types of euthanasia:
– Active euthanasia
– Passive euthanasia
– Voluntary euthanasia
– Nonvoluntary euthanasia
• Blending of types may occur
• “Is there a moral difference between actively
killing and letting die?”
Rational Suicide
• Self-slaying
• Categorized as voluntary active euthanasia
• Person has made a reasoned choice of rational
suicide, which seems to make sense to others at
the time
– Realistic assessment of life circumstances
– Free from severe emotional distress
– Has motivation that would seem understandable to
most uninvolved people within the community
Palliative Care
• Approach that improves the quality of life of
patients associated with life-threatening illness,
through prevention and relief of suffering
• Do-not-resuscitate order:
– There is no medical benefit that can come from
cardiopulmonary resuscitation (CPR)
– The person has a very poor quality of life before CPR
– The person’s life after CPR is anticipated to be very
poor
Rule of Double Effect
• Use of high doses of pain medication to lessen
the chronic and intractable pain of terminally
ill patients even if doing so hastens death
• Critical aspects of the rule:
– The act must be good or at lease morally neutral
– The agent must intend the good effect not the evil
– The evil effect must not be the means to the good
effect
– There must be a proportionally grave reason to risk
the evil effect
Deciding for Others
• A surrogate, or proxy, is either chosen by
the patient, is court appointed, or has other
authority to make decisions
• Three types of surrogate decision makers:
– Standard of substituted judgment
– Pure autonomy standard
– Best interest standard
Withholding and Withdrawing
Treatment: 3 Cases
• Case 1: Karen Ann Quinlan
• Case 2: Nancy Cruzan
• Case 3: Terri Schiavo
Terminal Sedation
• “When a suffering patient is sedated to
unconsciousness…the patient then dies of
dehydration, starvation, or some other
intervening complication, as all other lifesustaining interventions are withheld”
• Has been used in situations when patients
need relief of pain to the point of
unconsciousness
Physician-Assisted Suicide
• Act of providing a lethal dose of medication for
the patient to self-administer
• Oregon Nurses Association special guidelines
related to the Death with Dignity Act
– Maintaining support, comfort, and confidentiality
– Discussing end-of-life options with patient and family
– Being present for patient’s self-administration of
medication and death
– Nurses may not administer the medication
– Nurses may not refuse care to the patient or breach
confidentiality
End-of-Life Decisions and Moral
Conflicts with the Nurse
• Communicating truthfully with patients about death due to
fear of destroying all hope
• Managing pain symptoms because of fear of hastening
death
• Feeling forced to collaborate relative to medical treatments
that in the nurses’ opinion are futile or too burdensome
• Feeling insecure and not adequately informed about
reasons for treatment
• Trying to maintain their own moral integrity

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