Week 2 Ethical Frameworks Essay
Consider the “Four Topics Approach” (or Four Box method) to ethical decision making on page 61, Table 2.1 in Butts (below). Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.
In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?
Your paper should be 1-2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.
Review the rubric for further information on how your assignment will be graded.
Optional: You may download this pdf, complete it using correct grammar and APA, and submit it as your assignment in lieu of writing a paper. *You will need Adobe Acrobat in order to utilize this fillable .pdf form.
Points: 60
TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases
Medical Indications: The Principles of Beneficence and Nonmaleficence |
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal? 2. What are the goals of treatment? 3. In what circumstances are medical treatments not indicated? 4. What are the probabilities of success of various treatment options? 5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided? |
Patient Preferences: The Principle of Respect for Autonomy |
1. Has the patient been informed of benefits and risks, understood this information, and given consent? 2. Is the patient mentally capable and legally competent, and is there evidence of incapacity? 3. If mentally capable, what preferences about treatment is the patient stating? 4. If incapacitated, has the patient expressed prior preferences? 5. Who is the appropriate surrogate to make decisions for the incapacitated patient? 6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why? |
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy |
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds? 2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment? 3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life? 4. What ethical issues arise concerning improving or enhancing a patient’s quality of life? 5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment? 6. What are plans and rationale to forgo life-sustaining treatment? 7. What is the legal and ethical status of suicide? |
Contextual Features: The Principles of Justice and Fairness |
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients? 2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions? 3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties? 4. Are there financial factors that create conflicts of interest in clinical decisions? 5. Are there problems of allocation of scarce health resources that might affect clinical decisions? 6. Are there religious issues that might influence clinical decisions? 7. What are the legal issues that might affect clinical decisions? 8. Are there considerations of clinical research and education that might affect clinical decisions? 9. Are there issues of public health and safety that affect clinical decisions? 10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare? |
Expert Solution Preview
Introduction:
The “Four Topics Approach” is a widely used method for ethical decision making in the healthcare field. This approach aims to address the medical indications, patient preferences, quality of life, and contextual features of a patient case. In this answer, we will apply this model to a challenging situation in the nursing career, analyze each topic area and discuss the impact of the Four Topics process.
Answer:
In my nursing career, I encountered a patient who suffered from chronic kidney disease and required dialysis. The patient was suffering from depression and anxiety due to the illness, and the family was concerned about the high cost of treatment and insurance coverage. Applying the Four Topics Approach, we can analyze the case as follows:
Medical Indications: Our primary goal was to manage the patient’s acute and chronic health issues and prevent further complications. The patient had a critical medical problem, which was reversible with treatment. The goal of treatment was to alleviate symptoms and improve the quality of life. Further, we evaluated various treatment options and considered the probabilities of success to benefit the patient with minimal harm.
Patient Preferences: We informed the patient and family about the benefits and risks of treatment and obtained their informed consent. We assessed the patient’s capacity to make decisions and respected their autonomy to choose the course of treatment. We also involved a surrogate decision-maker as per the patient’s prior preferences and wishes.
Quality of Life: We evaluated the prospects of a return to normal life with or without treatment and considered the patient’s physical, mental, and social well-being. We avoided any biases that could affect the patient’s quality of life evaluation and considered ethical issues concerning the improvement of the patient’s quality of life. We also discussed the possibility of forgoing life-sustaining treatment, and the patient and family agreed to the rationale and plan.
Contextual Features: We addressed conflicts of interest that may affect clinical decisions and considered the legitimate interests of third parties. We respected patient confidentiality and privacy while complying with the legal requirements. We evaluated financial factors that affect clinical decisions and ensured that it did not impact the patient’s care. We also discussed the ethical issues concerning clinical research and education, as well as the issues of public health and safety that affect clinical decisions.
In conclusion, the Four Topics Approach was a valuable method to address the ethical dimensions of the patient case, and it helped shape my decision-making process. It provided a systematic and comprehensive framework to evaluate the case from all angles, including medical, social, psychological, and ethical considerations. The process allowed us to identify and resolve any conflicts of interest and involve all stakeholders in the decision-making process. Overall, this approach seems like a valid process for healthcare professionals to apply in their practice and to provide the best possible care to their patients.
