Myra

Cabus
Ray
Velasco

Asherly
Silva

Ethics
Grace
Kim

Clarissa
Pak

NURS 211
Dr. Paulette Williams

Ethical Dilemma
Case 3
A 45-year-old woman makes an
informed refusal about life-preserving
treatment against the advice of her
clinical team

Ethical Principles
Autonomy

Beneficence

patient

nurse

Autonomy

Beneficence

-right to self-determination
-treat patient with value,
dignity and respect

-obligation to do good
-promote welfare and
best interest of patient

Giddens, J. F. (2013). Concepts for nursing practice. St. Louis: Mosby Elsevier.

Autonomy
(Patients Perspective)
Patient autonomy refers to the capability and
right of patients to control the course of their own
medical treatment and participate in the treatment
decision-making process. Today, case law and
the courts define the legal limits of patient
autonomy, usually framed under the rubric of
informed consent.
- www.ascensionhealth.org

Autonomy
(Patient Self-Determination
Act of 1990)
A federal statute that was established to support
individuals in expressing their preferences about
medical treatment and making decisions about
end-of-life care
- Cherry & Jacob, p. 146

Nurses Perspective
Beneficence- an ethical principle stating that one should do good and prevent
or avoid doing harm.

Nonmaleficence- an ethical principle stating the duty not to inflict harm

Advance Health Care Directives

allow people to specify aspects of care they wish
to receive should they become unable to make or
communicate their preferences

1. Living Will: provides specific instructions about what

medical treatment the client chooses to omit or refuse

2. Health Care Proxy (Durable power of attorney): a

notarized or witnessed statement appointing someone
else to manage health care treatment decisions

McGowan, C. M. (2011). Legal Issues. Legal Aspects of End-of-Life Care. Critical Care Nurse, 31(5), 64-69.
doi:http://dx.doi.org.ezproxy.library.kapiolani.hawaii.edu:8080/10.4037/ccn2011550

Retrieved from http://studyprof.com/blog/wp-content/uploads/2010/06/tv-dumb1.jpg

Retrieved from http://www.dilbert.com/dyn/str_strip/000000000/00000000/0000000/100000/20000/0000/600/120631/120631.strip.zoom.g

Common Arguments Against

Advanced Directives
Change of mind
Patients LOC is altered
Decisions and competence
New information

Issues of informed consent

Mitchell, M. (2012). An analysis of commo arguments against advance directives. Nursing Ethics, 19(2), 245.
Retrieved from http://connection.ebscohost.com/c/articles/73902131/analysis-common-arguments-against-advancedirectives

Ethical Dilemmas
Real life issues are complex,
and not easily solved by applying our textbook concepts.