NURSING ROLES AND RESPONSIBILITIES ON EUTHANASIA, ADVANCE DIRECTIVES AND DNR, ETHICAL DECISION-MAKING PROCESS

a discrepancy between the current situation and a desired state

Problem

Four Basic features of ethical decision making

- A problem must exist - Two alternative solutions - Action implies uncertainty - Implemented Decision

Nursing process steps

- Problem identification based on assessment of subjective and objective data - Development of Plan of care - Implementation of intervention - evaluation and outcome - revision of plan

Hallmarks of end-of-life care include:

- respect for patient self-determination - nonjudgmental support for patients' end-of life preferences and values - prevention and alleviation of suffering.

Arguments for medical aid in dying are based on?

- respect for patients' self-determination - a desire to prevent unnecessary suffering, - assurance that patients have access to the full range of care options at the end of life - consideration that medical aid in dying is a last act of autonomy.

ANA supports recommendations that nurses: a.Remain objective when discussing end-of-life options with patients who are exploring medical aid in dying b. Have an ethical duty to be knowledgeable about this evolving issue.. c. Be aware of their personal values regarding medical aid in dying and how these values might affect the patient-nurse relationship. d. Have the right to conscientiously object Never "abandon or refuse to provide comfort and safety measures to the patient" who has chosen medical aid in dying e. Protect the confidentiality of the patient who chooses medical aid in dying. f. Remain objective and protect the confidentiality of health care professionals who are present during the aid in dying process, as well as the confidentiality of those who choose not to be present. g. Be involved in end-of-life policy discussions and development (Ersek, 2004) on local, state, and national levels, including advocating for palliative and hospice care services.

ALL

Who recognizes that medical aid in dying is a controversial topic that encompasses a plurality of views.

ANA (American Nursing Association)

a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity

Advance directives

TRUE OR FALSE

An understanding of the ethical issues surrounding medical aid in dying is essential to support patients to make informed end-of-life decisions.

used in making nursing care decisions derive from areas such as knowledge of anatomy, physiology etc.

Criteria

This form specifies end-of-life wishes, s readily available to emergency personnel, and travels with the person to the hospital or other treatment facility.

DNR

persons with serious medical conditions keep a special medical order form documenting end-of life wishes posted in a prominent place at home. What do you call to that special medical order

DNR

pattern for most types of decision making includes recognizing a problem, gathering data, comparing options, using some criteria for weighing the merits of each option, and making a choice.

Decision making

Depending upon the situation, the ____________ ranges from a subconscious one used for minor routine problems to a sophisticated one based upon scientific principles.

Decision making process

occur when the agent believes that one or more moral norms exist to support one course of action, and one or more moral norms exist to support another course of action, and the two actions are mutually exclusive.

Dilemma

usually unplanned and often unexpected.

Problem

an essential attribute for those making ethical decisions. It creates positive action flowing from sensitivity, compassion, caring, and responsibility. - Sensitivity, Compassion and Caring - Responsibility - Empowerment - Patience and willingness to deliberate.

Empowerment

suggests that a person has selfconfidence that he or she can effect change - Sensitivity, Compassion and Caring - Responsibility - Empowerment - Patience and willingness to deliberate.

Empowerment

the capacity of people to be active participants in matters that affect them. - Sensitivity, Compassion and Caring - Responsibility - Empowerment - Patience and willingness to deliberate.

Empowerment

occurs when options include conflicting moral claims.

Ethical Dilemma

not as clear cut as decisions made in other areas of life.

Ethical decision making

it is related to nursing care in the ethical realm in the same way that the nursing process is related to nursing care in the physical realm.

Ethical decision making model

inconsistent with the core commitments of the nursing profession and profoundly violates public trust.

Euthanasia

not legal in the United States, occurs when someone other than the patient administers medication in any form with the intention of hastening the patient's death.

Euthanasia

TRUE OR FALSE Medical aid in dying occurs when a terminally ill, NOT mentally competent adult patient, who is likely to die within six months, takes prescribed medicines, which must be self-administered, to end suffering and achieve a peaceful death

FALSE

TRUE or FALSE As nurses, we DONT need to be familiar with our patients' directives for care, and ensure that care is consistent with the patient's wishes as expressed in the advance directives

FALSE

TRUE or FALSE If a patient or appropriate surrogate indicates to the nurse the desire not to be resuscitated and there is no order in the chart, the nurse should NOT document the request in the patient's chart

FALSE

TRUE or FALSE Patients expect nurses NOT to be able to discuss all end-of-life options

FALSE

TRUE or FALSE person with moral integrity WILL compromise beyond a certain point.

FALSE

not synonymous with euthanasia.

Medical aid in dying

It binds all of a person's moral virtues into a coherent package—it creates a wholeness and stability of character that leads to trustworthiness

Moral Integrity

a "soundness, reliability, wholeness, and integration of moral character"

Moral Integrity

coherent integration of aspects of the self— emotions, aspirations, knowledge and so on—so that each complements the others"

Moral Integrity

Complex Problem

Moral problems

occurs when we sense that there is a moral problem, but are not sure of the morally correct action;

Moral uncertainty

we are unsure which moral principles or values apply; or when we are unable to define the moral problems

Moral uncertainty

a deliberate activity that provides a systematic method for nursing practice.

Nursing Process

The process is systematic and involves both logical thinking and intuitive knowing.

Nursing process or Ethical decision making model

informing other health team members of the presence and content of advance directives. What advocacy role is this?

Nursing's advocacy role

nurse must listen and be patient and able to live with vagueness, confusion, uncertainty, and paradox - Sensitivity, Compassion and Caring - Responsibility - Empowerment - Patience and willingness to deliberate

Patience and willingness to deliberate

shared responsibility of professional nursing organizations to speak for nurses collectively in shaping health care

Recommendation

a sense of duty to the patient, an obligation to do whatever is necessary, within reason, to care for the patient or solve a problem. - Sensitivity, Compassion and Caring - Responsibility - Empowerment - Patience and willingness to deliberate.

Responsibility

includes a duty to understand ethics in a way that informs consistent and fair application of ethics at the bedside - Sensitivity, Compassion and Caring - Responsibility - Empowerment - Patience and willingness to deliberate.

Responsibility

Type of problem involve how or when to do something, which item to choose, whom to assign to a task, and so forth.

Routine problems

Nurses hear what patients say and understand the meaning. - Sensitivity, Compassion and Caring - Responsibility - Empowerment - Patience and willingness to deliberate.

Sensitivity, Compassion and Caring

Nurses intimately know about suffering—from touch, sight, smell, and sound. Interests of patients become their own. - Sensitivity, Compassion and Caring - Responsibility - Empowerment - Patience and willingness to deliberate.

Sensitivity, Compassion and Caring

TRUE OR FALSE Nurses need to know which patients under their care have DNR orders

TRUE

TRUE OR FALSE Nurses are often the bridge between patient and physician.

TRUE

TRUE or FALSE All persons involved in the care of the patient need to know about the orders. (dnr)

TRUE

TRUE or FALSE Before you can begin to solve a problem, you must be able to identify and categorize it

TRUE

TRUE or FALSE In everyday situations nurses may not have a conscious awareness of our thought process, but nurses have an innate sense of knowing what to do

TRUE

TRUE or FALSE Nurses are ethically prohibited from administering medical aid in dying medication.

TRUE

TRUE or FALSE Since attitudes affect one's approach to others, nurses need to reflect on their own attitudes toward decisions regarding withholding of interventions, both in general and in particular patient situations.

TRUE

TRUE or FALSE moral integrity is integral to effective ethical decision making.

TRUE

TRUE or FALSE nurses have a key role and responsibility in ensuring that patients have an opportunity to complete advance directives

TRUE

TRUE or FALSE nurses make a decisions about routine matters such as patient care management and institutional policy.

TRUE

TRUE or FALSE nurses who are informed, courageous, and involved in ethical decision making are more likely to be satisfied with their work and thus stay at the bedside.

TRUE

TRUE or FALSE person with moral integrity does not hold stubbornly to one position, but rather encourages a climate of mutual respect and reasoned discourse.

TRUE

True or False Laws that allow medical aid in dying permit an adult patient with a terminal illness and the capacity for medical decision-making to self-administer oral or enteral medication when certain criteria are met

TRUE

Arguments against medical aid in dying are what? a. sacredness of life b. potential conflict with professional core values c. fears of a "slippery slope," d. prevent unnecessary suffering

a,b,c

ADVANTAGES OF ADVANCE DIRECTIVES a. Unnecessarily prolonged painful hospitalization b. Prevents unnecessary prolonged comatose or vegetative state c. Prevents burden of rising medical costs d. Releases responsibility of love ones of difficult decisions e. Family or loved ones may disagree with your medical decisions. f. Difficulty in predicting what treatments will be available and preferred in a "future" crisis

a,b,c,d,

DISADVANTAGES OF ADVANCE DIRECTIVE a. Family or loved ones may disagree with your medical decisions. b. Prevents burden of rising medical costs c. Difficulty in predicting what treatments will be available and preferred in a "future" crisis. d. Uncertainty over who can/should be a health care agent, especially for individuals without available (or willing) family.

a,c,d

Information concerning advance directives is often provided to patients on: a. Admission b. Referral c. Discharge

a. admission

can be experienced when there is evidence to indicate that a certain act is morally right and evidence to indicate that the act is morally wrong, but no evidence is conclusive.

conflict

a problem that requires a choice between two options that are equally unfavorable and mutually exclusive.

dilemma