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

537 Pages·2010·2.52 MB·English

by  Sara T. Fry

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
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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