HLTEN509B: Apply Legal & Ethical Parameters to Nursing Practice - Assessment Answers

Introduction

The major focus of the profession of nursing is to provide quality care, preventing any kind of harm, safeguarding the patient’s dignity and keeping the confidentiality of the patient. The nurses should work in order to defend the rights of the patients. There are eight major principles that must be focused in order to provide legal and ethical practice. These eight principles are autonomy, veracity, justice, beneficence, paternalism, nonmaleficence, fidelity and confidentiality. The nursing practice should be practiced by regulating with statutory law and administrative law.

At all the levels, nurses has to perform the specialization that should comply with strict guidelines related to legal and ethical perspective and nurses have to operate according to various regulatory and governmental rules. The interaction of the nursing practice with the legal and ethical laws is very complex. However, the professional nursing practices are based on the ethics, which are basically followed with the law and are considered to be legally defensible. Nurses have to face many legal and ethical dilemmas during the practice, in such case some of the nurses are not prepared that how they have to respond and end up with confusion regarding ethical practice. The paper, thus explores the legal and ethical parameters related to ethical dilemma in Palliative Sedation. The essay will discuss the ethical issues related to palliative sedation and will discuss sedation for physical distress and Psycho-Existential Suffering and will support it with relevant research.

Ethical Controversy and Palliative Sedation

Palliative Sedation in context to palliative care could be defined as the monitored use of palliative medication, which is induced to decrease consciousness. This is done so that patient could be relived from the intractable suffering, but could only be accepted if done in ethical manner, which is acceptable by patient, family and healthcare providers. In practicing palliative care, nurses have to face difficulty. There are many ethical dilemmas and issues that may occur in palliative sedation. It is very important nurses should have good understanding towards medical ethics.

Ethical dilemma is regarded as the complex situation, which involves mental conflict between two options and moral imperatives. The healthcare providers may have to choose from two options and both of them could be morally correct but are in conflict. The key value of the palliative medication is to offer relief to the patient from suffering. Sedation in palliative care is an accepted strategy to control suffering in patients. There have been different agreements regarding the use of sedation for the patients under palliative care. This is mainly used to relieve patient from uncontrolled psychosocial and existential suffering (Maltoni, et al, 2012).

The nurses often face dilemma, because the numerous challenges are created due to the patient close to end of life. Some of the challenges could be real but some of them are often perceived. The reason of ethical dilemmas could be that near to death patients are often vulnerable and receiving informed consent could be difficult (Schildmann, & Schildmann, 2014). Creating balance between clinical roles and research could be difficult, and also the benefits and risks associated with sedation are very difficult to access.

Palliative sedation is considered as the use of sedation in the patients, who are close to end-of-life. The sedation is administered in order to relieve the patients from unbearable and intractable suffering.

The decision making for sedation in palliative care should not be taken lightly. Although, it is considered as the last option, after all the other measures have been used. It is generally used in small number of patients, who mainly show intractable symptoms.Palliative sedation is administered, where the life expectancy of the patient is less than three weeks and the patient is under intolerable pain (Cherny, 2014). The aim of sedation in palliative care is always focused to ease the pain and let patient die in dignified manner. In the existential plan it is very difficult to state that the symptoms are refractory to the treatment.

In the patient with near to death, there is profound spiritual and psychosocial suffering occurs outside the coming death. It should be clear the sedation does not hasten the death, or even if the death is hastened, the good intention behind it is to relief the symptoms. The sufferings of existential pain and psychosocial reasons may be very dramatic; the standard treatment in the palliative care patients has low inherent morbidity and also there is no well established treatment for the same.

Legal Aspects Related to Palliative Sedation

Thus, the intent of palliative sedation is in most of the cases is to relieve the pain and not to hasten death. It is different from assisted suicide or euthanasia. The ethical dilemma with sedation is that the escalation of the sedative dose and analgesic are done to hasten the death. This distinction between palliative sedation and assisted suicide or euthanasia has been differentiated by the Supreme Court of United Sates in the year 1997, when the court gave decision on Vacco v. Quill and also in the case of Washington v. Glucksberg (Duffy, 2016). In these cases court stated that patients, who have been suffering from terminal illness and are experience unbearable pain has no legal barriers to receive medication that can alleviate the suffering, even to the extent where it unintentionally causing hastening of death or unconsciousness.

It is imperative that whenever sedation is given in palliative care, it is offered as the proper plan of care. The organizations have well established policies and procedures to administer the correct process. The palliative sedation involves the role of physicians and nurses, palliative care team and pain team.

Ethical Code of Conduct

The NMBA new Code of Ethics August 2008 in Australia is the definition of the commitment of the nursing profession towards providing respect, care, support, and promotes and protects the rights of the healthcare receiver and the healthcare providers. The impact of the Code of Conduct on the practice of the enrolled nurses is to offer quality care, taking proper actions with reasoning and analytical thinking and respecting the ethical value of the individuals. Understanding different languages and cultures is also beneficial in providing quality care to the individuals and groups (Chiarella, & McInnes, 2008).

The code of Ethic in nursing practice developed in Australia are considered to be relevant to all the areas of nursing such as clinical, nursing management, and researching fields. The code of Conduct 2008 is framed by the standards and principles “set forth in the United Nations’ Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights and International Covenant on Civil and Political Rights; the World Health Organization’s Constitution and publicationseries entitled Health and Human Rights; and the United Nations Development Programme Human Development Report2004: Cultural liberty in today’s diverse world” (Nursing, A., & Council, M, 2008)

The code of Ethics helps to understand the different cultures and languages and influence the healthcare and nursing practices. It also demonstrates the capability to provide the service rightfully and reasonably depending upon the needs of the patients, their race, age, gender, ethnicity, income level and social standings. The codes of ethics are meant to support culture, which is meant for safety of everyone (Productivity Commission, 2006). It is meant for the enrolled and registered nurses to document all the information related to the patient in the proper way, the treatment should be non-judgmental, and should practice confidentiality. The legal and ethical parameters for the nursing practice are meant to provide support to the patients as well as their families (Chiarella, & McInnes, 2008).

The relationship of honesty and support should be maintained to provide comfort to patients and families. It implies reducing the harmful effects of social, economical and environmental effects on individuals and groups. Trust and respect should be promoted and maintained between the healthcare receiver and nursing practitioners. Every duty should be performed ethically (Schluter, et al, 2008).

The main purpose of the NMBA new code of Professional Conduct August 2008 is to “specify a base to consumer, regulatory, employing and professional bodies for evaluating professional conduct of nurses Form a set of minimum national standards of conduct, nurses are supposed to support Inform the community of standards of professional conduct, it can sustain nurses in Australia” (Chiarella, & McInnes, 2008).

It is very important to understand the Code of Ethics for Nurses in Australia and the Code of Professional Conduct for Nurses in Australia are designed for the multiple service providers and receivers. It includes nurses; nursing students; people receiving nursing care; the community generally; regulatory authorities, employers of the nurses’ consumer protection agencies etc. employers of nurses; nursing regulatory authorities; and consumer protection agencies (Nursing, & Council, 2008). It is also important to understand that the concept of ‘morality’ and ‘ethics’ is considered as same in the Australian Code of Ethics and it is used interchangeably in the code.

Five Steps for Moral Decision Making

Ethics is the set of principles that helps to understand the moral decision making of a person in different situations. Ethics is not a thought or a feeling, but it may be derived from feelings of right and wrong. Five simple steps can help nurses in making a moral and ethical decision.

Gathering Facts: For making an ethical and lawful decision, it is very important to know all the facts. The nurses should behave neutral, while understanding and narrating the facts related to the condition of the patients under palliative care. It should be clear in mind that no information should be distorted for the benefit of one’s own self. Facts gathered, should not be stretched for own benefit, as this could lead to an unethical decision (Craft, 2013).

Predicting Future: It is important step for the nurses to predict the future outcomes of the given treatment. The prediction of the future health outcomes are based on the gathered facts. If the facts are properly noted, it would be easy to predict the outcome. The desired future results could also be achieved through proper prediction (Craft, 2013).

Understanding Personal Feelings: Personal feelings of a person are very important in making an ethical decision. Some of the people have highly developed ability to feel right and wrong. Nurses are close to the patients, they often understand, what is right for patient or not. Palliative sedation must be given to a patient only if the nurse thinks that it will not give any harm to the patient and will only relieve them from unbearable suffering (Craft, 2013).

Justice and Fairness: Aristotle has given the idea that everybody must be treated as equal. While, taking ethical decisions, it is very important that every person should be considered as equal. No discrimination should be made on the basis of age, race, gender or ethnicity. The nurses in palliative care should treat all patients equally (Craft, 2013).

Proper Reasoning: While taking ethical decisions, it is important have essential reasons behind the decision. The person should be able to explain the reasons to others. The decision of palliative sedation should be taken by considered all the facts. There should be a proper reason behind giving sedation to end to life patients (Craft, 2013).

Conclusion

The paper discussed the legal and Ethical parameters for the Nursing practice in Australia. There are many situations, where the nursing professional found themselves stuck in legal orr ethical dilemmas. Some situations are voluntary, while others are involuntary. In some cases the practice applied could be legally right but ethically wrong; and other the practice could be ethically right but legally wrong. To overcome such issues, there are state level legislations, which are meant to provide the legal framework for the nursing practice. The code of Ethics in Nursing Practice in Australia has the eight goals behinds its application. These goals include, providing quality care, working with respect and kindness, valuing diversity, access to quality care for all people, informed decision making, ethical nursing management and valuing social, economical and ecologically sustainable environment. It is also important to find the reasons that why in some cases nurses are unable to provide quality care and involves in legal issues. A detailed study on the topic can help to understand the subject completely.