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Case Studies in Nursing Ethics, Fourth Edition (Fry, Case Studies in Nursing Ethics) PDF

537 Pages·2010·2.52 MB·English
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CASE STUDIES IN NURSING ETHICS FOURTH EDITION Sara T. Fry, PhD, RN Brewster, Massachusetts Robert M. Veatch, PhD Georgetown University Kennedy Institute of Ethics Washington, DC Carol Taylor, PhD, RN Georgetown University Center for Clinical Bioethics Washington, DC 80319_FMXx_ttlpg.indd 1 6/24/10 3:31 PM World Headquarters Jones & Bartlett Learning Jones & Bartlett Learning Jones & Bartlett Learning 40 Tall Pine Drive Canada International Sudbury, MA 01776 6339 Ormindale Way Barb House, Barb Mews 978-443-5000 Mississauga, Ontario L5V 1J2 London W6 7PA [email protected] Canada United Kingdom www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to [email protected]. Copyright © 2011 by Jones & Bartlett Learning, LLC All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no re- sponsibility for the use of the products and procedures described. Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used. Production Credits V.P., Manufacturing and Inventory Control: Publisher: Kevin Sullivan Therese Connell Acquisitions Editor: Amy Sibley Composition: DataStream Content Solutions, Associate Editor: Patricia Donnelly LLC, Absolute Service Inc. Editorial Assistant: Rachel Shuster Cover Design: Scott Moden Associate Production Editor: Katie Spiegel Printing and Binding: Malloy, Inc. Associate Marketing Manager: Katie Hennessy Cover Printing: Malloy, Inc. Library of Congress Cataloging-in-Publication Data Fry, Sara T. Case studies in nursing ethics / Sara T. Fry, Robert M. Veatch, Carol R. Taylor. — 4th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-7637-8031-9 (pbk.) 1. Nursing ethics—Case studies. I. Veatch, Robert M. II. Taylor, Carol, CSFN. III. Title. [DNLM: 1. Ethics, Nursing—Case Reports. 2. Bioethical Issues—Case Reports. WY 85 F947c 2011] RT85.V4 2011 174.2—dc22 2010017881 6048 Printed in the United States of America 14 13 12 11 10 10 9 8 7 6 5 4 3 2 1 Contents List of Cases ix Preface xiii Introduction xv Part I Ethics and Values in Nursing Chapter 1 Values in Health and Illness 3 Identifying Evaluations in Nursing 4 Identifying Ethical Conflicts 15 Benefit to the Patient vs Benefit to Others 15 The Rights of the Patient vs the Welfare of the Patient 19 Moral Rules and the Nurse’s Conscience 23 Limits on Rights and Rules 27 Chapter 2 The Nurse and Moral Authority 35 The Authority of the Profession 37 The Authority of the Physician 42 The Authority of the Institution 46 The Authority of the Health Insurer 50 The Authority of Society 52 The Authority of the Patient 56 iii iv Contents Chapter 3 Moral Integrity and Moral Distress 61 Why Does Moral Agency Matter? 63 Moral Distress 63 Creating and Sustaining Healthy and Ethical Work Environments 66 Ethics Environment Assessments 67 Resources for Establishing and Sustaining Healthy Environments 67 Change Theory Models 68 Part II Ethical Issues in Nursing Chapter 4 Benefiting the Patient and Others: The Duty to Produce Good and Avoid Harm 79 Benefit to the Patient 82 Uncertainty About What Is Actually Beneficial to a Patient 83 Health Benefits vs Overall Benefits 85 Benefiting vs Avoiding Harm 89 Act vs Rule Consequentialism 91 Benefit to the Institution 94 Benefit to Society 97 Benefit to Identified Nonclients 99 Benefit to the Profession 102 Benefit to Oneself and One’s Family 105 Chapter 5 Justice: The Allocation of Health Resources 109 The Ethics of Allocating Resources 111 Two Meanings of the Word Justice 111 Three Ways to Allocate Resources 111 Justice Among the Nurse’s Patients 114 Justice Between Patients and Others 122 Justice in Public Policy 126 Justice and Other Ethical Principles 131 Contents v Chapter 6 Respect 136 Ignoring a Person as a Person and Focusing Only on the Pathology or “Task” to Be Performed 139 Arrogant Decision Making 141 Humiliating Others 144 Chapter 7 The Principle of Autonomy 149 Internal Constraints on Autonomy 152 External Constraints on Autonomy 159 Overriding Autonomy 164 Paternalistic Overriding of Autonomy 164 Overriding Autonomy to Benefit Others 169 Chapter 8 Veracity 174 The Condition of Doubt 176 Duties and Consequences in Truth Telling 179 Lying and Patient Well-Being 179 Lying and the Well-Being of Others 184 Complications in Truth Telling 187 When the Patient Asks for Dishonesty 187 When the Family Asks Not to Tell 188 The Right to Health Records 192 Chapter 9 Fidelity 196 Promise Keeping 197 Explicit Promises 198 Implicit Promises and the Right of Access to Health Care 201 Confidentiality 203 When the Patient May Be Harmed 209 When Others May Be Harmed 215 When Required by Law 220 vi Contents Chapter 10 The Sanctity of Human Life 223 Actions and Omissions 225 Criteria for Justifiable Omission 229 Withholding and Withdrawing 233 Direct and Indirect Killing 238 Voluntary and Involuntary Killing 243 Is Withholding Food and Water Killing? 247 Part III S pecial Problem Areas in Nursing Practice Chapter 11 Abortion, Contraception, and Sterilization 259 Abortion 260 Contraception 270 Sterilization 274 Chapter 12 Genetics, Birth, and the Biologic Revolution 278 Genetic Counseling 280 Genetic Screening 289 In Vitro Fertilization and Artificial Insemination 294 Genetic Engineering 306 Chapter 13 Psychiatry and the Control of Human Behavior 313 Psychotherapy 317 The Concept of Mental Health 317 Mental Illness and Autonomous Behavior 320 Mental Illness and Third-Party Interests 324 Other Behavior-Controlling Therapies 329 Contents vii Chapter 14 HIV/AIDS Care 333 Conflicts Between Rights and Duties 335 Screening/Testing for HIV 335 Balancing Confidentiality Protection and the Duty to Warn 339 The Rights of HIV-Infected Individuals 345 Conflicts Involving the Cost of Treatment and Allocation of Resources 349 Research on HIV 357 Chapter 15 Experimentation on Human Beings 364 Calculating Risks and Benefits 370 Protecting Privacy 377 Equity in Research 380 Informed Consent in Research 383 Chapter 16 Consent and the Right to Refuse Treatment 396 The Right to Refuse Treatment 401 The Elements and Standards of Disclosure 405 Comprehension and Voluntariness 413 Consent for Patients Who Lack Decision Capacity 418 Chapter 17 Death and Dying 426 The Definition of Death 429 Competent and Formerly Competent Patients 433 Treating Against the Wishes of the Patient 433 The Patient in Conflict with the Physician and the Family 436 The Problem of the Ambivalent Patient 438 Never-Competent Patients and Those Who Have Never Expressed Their Wishes 441 How Much Discretion Should Family Have? 443 Nonfamily Surrogates 448 Divisions Within the Family 451 Futile Care 458 Limits Based on the Interests of Other Parties 464 viii Contents Appendix 473 Glossary 479 Index 487 List of Cases Case 1-1: The Patient Who Needed Help Getting Out of Bed 4 Case 1-2: The Nurse–Midwife and Crisis in a Home Delivery 9 Case 1-3: The Nurse and Cost Containment: The Duty to Society 16 Case 1-4: When Promoting the Patient’s Well-Being Infringes on Basic Human Rights 19 Case 1-5: The Nurse Asked to Assist in an Abortion 24 Case 1-6: The Visiting Nurse and the Obstinate Patient: Limits on the Right to Nursing Care 28 Case 2-1: The Nurse Who Thought the ANA Code of Ethics for Nurses Was Wrong 37 Case 2-2: Following the Physician’s Orders: The Nurse as Moral Spectator 43 Case 2-3: The Nurse Covering the Maternity Unit 47 Case 2-4: When Health Insurers Put Newborns at Risk 50 Case 2-5: Medications by Unlicensed Technicians 52 Case 2-6: The Patient Who Refused to Be Tested for a Genetic Disease 57 Case 3-1: The Nurse Expected to Go Along with the Doctor’s Deception 65 Case 3-2: Nurses Caught Between a Rock and a Hard Place 70 Case 4-1: Is the “Ashley Treatment” Beneficial? 83 Case 4-2: The Patient Who Did Not Want to Be Clean 85 Case 4-3: Is Leaving the Nursing Home Beneficial? 86 Case 4-4: When “Doing Good” May Harm the Patient 89 Case 4-5: Do Patients Always Have to Be Turned? 91 Case 4-6: Cost Cutting for the Indigent Patient 95 Case 4-7: When Providing Benefit Might Be Costly 97 Case 4-8: When Benefit to the Client Is Constrained 100 Case 4-9: Institutionalizing a Disabled Child: Benefit or Harm? 101 Case 4-10: The Duty to Participate in Collective Action 103 Case 4-11: Is There a Limit to Benefiting the Patient? 105 Case 5-1: Allocating Nursing Time According to Patient Benefit 114 Case 5-2: Choosing Between Two Infants with Multiple Handicaps 116 Case 5-3: The Psychiatric Patient with Special Nursing Care Needs 119 Case 5-4: The Elderly Patient Who Was Transferred 123 Case 5-5: The Noncompliant, Alcoholic Patient in the ER 123 Case 5-6: Problems of Justice in Policy Decisions 127 Case 5-7: Screening School Girls for Urinary Tract Infections 128 Case 5-8: When It Is Hard to Keep Promises 131 Case 5-9: Allocating Mechanical Ventilators During a Severe Influenza Pandemic 133 Case 6-1: Humanity Lost in the Bed 139 Case 6-2: The Heel Wound in the ER Bed 140 ix

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