Ethics Of Forgoing Life Sustaining Treatment

Ethics Of Forgoing Life Sustaining Treatment

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Ethics Of Forgoing Life Sustaining Treatment

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Ethics Of Forgoing Life Sustaining Treatment

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Most nurses all over the world are struggling with ethical issues such as confidentiality and the ability to meet the patients’ needs. Nurses are obliged to uphold strict moral principles, virtues and duties in their profession. It is increasingly becoming difficulty for the nurses to uphold integrity in their professional practice due to increasing pressure and complex moral choices the nurses have to make (Ulrich et al. 2010). Ethical issues arise in the health care setting where moral questions on rightness and wrongness of health care practices underlie decisions making in the hospital concerning the patient. According to a research carried out by Ulrich and Grady (2009), most nurses claim that staffing inadequacies and protecting patients’ rights are the most stressful issues in the health care setting. Insufficient stuffing, systematic and organizational shortcomings make it difficult for nurses to meet the professional and ethical standards in their practice.
On daily bases, nurses make decisions on care delivery. In a correlational health care settings, different ethical principles arise. These include veracity, non-maleficence, beneficence, justice, fidelity and respect for others (NCCHC, 2011).
Code of ethics and code of professional conduct- These codes guide the nurses in making ethical decisions as nurses occasionally refer to these principles in as they make decisions. According to the NCCHC, a common ethical concern for the nurses is finding a balance between their attitudes of care, compassion and keeping safe boundaries (McElroy, 2012).
Nurses and midwives registered by the NMBA must adhere to the professional code of conduct. This code ensures that nurses respect, uphold and protect the fundamental rights of the Australians.
Justice is an ethical principle that involves the equitable allocation of health care services and fair treatment of patients
Rights- health officers have the right to practice nursing in accordance to their code of conduct. Patients have the right to make decisions in accordance to their treatment.
Continuing professional education opportunities- this is education made maintain knowledge, experience and skills gained as a nurse is working.
Beneficence- is an ethical practice whereby nurses do good to their clients as a moral obligation.
Nonmaleficence- this must be in balance with beneficence. Nurses should not inflict any harm so as to attain a good result
Code of practice- The code of ethics together with the code of practice offer a framework for responsibility and accountability in health care practices (Waubra foundation, 2015).
Children in work place- According to Scott (2010), a professor at the University of South Australia, there has been an urgent need standards for child protection in Australia due to the increased child abuse and neglect. She claims that child maltreatment is on the increase and has serious consequences on the child and long term effects on their mental and adult health. The health sector in partnership with the universities came up with a project aimed at equipping nurses and midwives with skills and knowledge to identify, respond and also prevent child neglect and abuse and even promote and enhance child wellbeing (Scott, 2010).
Discrimination- According to Lampert (2016), 561 cases were reported on racial discrimination, 740 on disability discrimination and 453 on sex discrimination between 2014 and 2015. This indicates the increased rates of discrimination in the health sector.
Stonewall Scotland (2018) describes direct discrimination as a situation whereby a person is treated unfavourably due to their gender, their sexual orientation or of their family member or any other person they are close with.
Indirect discrimination is a situation whereby the health care policies group people into a given gender or sexual orientation whereby they are disadvantaged as compared to another gender or sexual orientation (Royal College of Nursing, 2018). It is unlawful according to the Equity Act 2010 for any one including patients and health practitioners to be discriminated, be it direct or indirect.
Duty of care- Dowie (2017) thinks that nurses consider duty of care as a fundamental aspect in their nursing practice. It is a legal obligation that the nurses take to act within their competence and to the best interest of their patients (and everyone else) and avoid endangering their health and wellbeing (Young, 2009).
Equal employment opportunities- The WSLHD is working hard to come up with an environment which is a real reflection of the diversity in the society. This would be achieved through ensuring there is equity in employment as Australia in one of the socially, and culturally diverse nation. This would make the nurses and patients feel accepted and supported regardless of their culture, religion, gender, race, sexual orientation and physical abilities (NSW Government, 2018).
Informed consent- Legally, informed consent is the right of the patient or the surrogate to know the risks, advantages and alternatives to the health care practice. Ethically, informed consent is the patients’ autonomy; the patients should be informed of their treatment details and freely agree to them. Health officers must respect an informed consent on a person’s care, provided the person is in a capacity to consent (Menendez, 2013).
Insurance requirement for enrolled nurses- It is a recommendation for every nurse to have Professional indemnity insurance so as to practice nursing. This insurance would help in paying for any damages and legal fees in case of any claim raised against them due to negligence of duty. (Express insurance, 2018). According to the Nurse Buff (2016), the steps to get a malpractice insurance are: get a carrier, get a quote then apply.
Health Practitioner Regulation National Law Act- this is a legislation in accordance to the nurse code of conduct and nurse principle code of conduct to regulate the nurse practice.
Death and life issues- In most cases, nurses are faced with ethical issues concerning legal mandates as thy care for dying patients. In cases of ethical dilemmas, the nurse could be knowing the right action to take but cannot approach it or the nurse is uncertain about the outcome. Research shows that end of life care ethical dilemmas are as a result of lack of right channels to discuss the family preferences concerning the person’s death (Hold, 2015). Family members’ interference and how to preserve the quality of life during the process of dying causes a unique headache to nurses.
Power of attorney- is a legal document that gives authority to a second party to make decisions on one’s behalf in case the first person is unable to do so due to illness or absence (Queensland Government, 2017).
Mandatory reporting- is a legislative duty given to certain people in the society to report to the government authorities any cases of child neglect and abuse (Matthews, Walsh and Fraser, 2006).
NMBA nursing practice guidelines- Enrolled nurse standards for practice are standards set to give a framework to assess registered nurses. The help the public know what they should expect from enrolled nurses. The NMBA and the courts use these standards to assess professional conduct of nurses (NMBA, 2017)
Professional boundaries- are borders are the minimum standards as dictated in the nurses profession code of standards that the health professions must uphold in their practice. These boundaries give a limit to patients’ vulnerability and clinicians’ powers. Crossing these boundaries could have consequences like termination of employment or disciplinary measures as it is a violation to the nurse practice.
Professional practice guidelines- Clinical practice guidelines are statements and principles set to health practitioners in decision making in given clinical circumstances. Nurses have a growing interest in using the guidelines as they help the nurses facilitate quality and evidence based health care practice Australian Nursing and Midwifery Federation, 2018).
Decision making framework -is set for nurses and clinical stakeholders to intervene if given roles and activities are acceptable as the competence and level of education of a nurse and if they meet the required standards for health care practice (Minnesota Board of Nursing, 2018).
Re-entry to practice- According to the NMBA (2018), there is a set of mandatory requirement for any nurse requiring to return to nurse practice. These requirements are based on nature, period, recency and extend of the previous health care practice and the nurse should meet then all. The re-entry to practice police holds to anyone seeking for registration after five or more years lapse in nursing practice, anyone who has not been practicing nursing for five or more years and is willing to start the practice again and anyone who has qualifications on mental health, disability and paediatric nursing but does not hold registration for the practice (NMBA, 2013).
Recency for practice according to the NMBA (2018) shows that a nurse or a midwife has observed and maintained what is required of them in their health care practice since registration.
Confidentiality is a professional obligation that ensures that patients’ records are held in confidence by any stakeholder with access to them. The law recognizes confidentiality as a communication between two parties (Prater, 2014).
Privacy, confidentiality and disclosure- Privacy in the health care setting requires that any information about the patient is held private. The patient has a legal right to privacy. Laws have been set to guide health officers in collecting and recording information on the patient’s health, how and when to share it (Victoria State Government, 2015). Health care practitioners are facing a big dilemma on the issue of disclosure. On exceptional circumstances like in cases where it is to protect the best interest of the patient, a health professional could overlook the principle of confidentiality to patients (Royal College of Nursing, 2018). The issues of confidentiality and disclosure could be unclear in most cases and the nurse should seek advice from the manager or senior colleague.
Social media policy- The Nursing Council of New Zealand in 2012 came up with guidelines on how nurses and midwives should use the social media in relation to the nurse and midwives code of professional conduct. These guidelines explain the benefits and consequences of the social media in accordance to the standards and code of conduct for nurses (Nursing Council of New Zealand, 2013). Hughes (2017) thinks that use of social media is more on the personal purposes than professional, though it could be helpful in education and peer support.
human rights including access to healthcare- this is a legal obligation that ensures that every citizen can access affordable, timely and acceptable health care
Nursing and Midwifery Board of Australia nursing practice guidelines, standards- these are principles and guidelines set by NMBA to govern registered nurses and protect the health of the public
registration guidelines- these are standards set by the bodies governing nurses and health practitioners so that every health officer meets them before staring the health care practice
National safety and quality health service standards- The NSQHS standards are rules set such that hospitals and other health care facilities set up maintain a system whereby they minimize cases of patient harm and promote quality of health care delivery (Victoria State Government, 2018; Twigg et al. 2013).
Health legislation- Victoria State Government (2018) claim that drugs and poisons are beneficial to the society when used appropriately but cause harm to people when mishandled. It is for this reason the government has set laws to con control the manufacture, supply and use of these substances. Medicine and poison permits and licences guidelines are stated in the Drug, Poison and Controlled Substances Act 1981 andthe Drugs, Poisons and Controlled Substances Regulations 2017.
The mental health legislation- aims at providing a quality care, treatment and control to people with mental illness, people with mental disorders and any other related infections (NSW Government, 2018).
The Privacy Act 1988-gives guidelines on how personal information should be handled. This covers even collection, storing, use and disclosing the personal information. The Health Record Act 2012- contains a system of records with summaries of people’s health information. The record allows health care professionals to access health information of patients and also the patients are able to access their records (Australian Government, 2018). The Aged Care Act 1997- is a legislation that provided care for the elderly people in the nation. This Act was amended as part of the government’s strategy to improve care for the aging people (Australian Government, 2017).
The Carers Recognition Legislation- explains the role of carers in the society. It also discusses the principles and relationship of carers with the community and the obligation of government authorities in the care for its citizens (Australian Government, 2011).
working with children legislation- this legislation  protects children from any kind of abuse by ensuring that people working with them are caring
Ethical decision making model-this are models use to evaluate and choose the best alternative according to the nurse code of conduct
role of the Nursing and Midwifery Board of Australia in regulating the nursing profession- the NMBA supports nurses and midwives by providing professional advice and policies helpful in the nurse and midwifery practice
The Disability Discrimination Act 1992-protects the disabled from any kind of discrimination based on their physical status (Australian Human Rights Commission, 2018). Children and young people legislation- The commonwealth, states and territories in Australia altogether in 2009 agreed that children and the young people were important and therefore the need to protect them. This was stated in the Children and Young People Legislation.
The Workplace health and safety legislation- is a national policy set to ensure and uphold health and safety of workers in the workplace. It also aims to improve workers’ compensation (Australian Government, 2018).
Autonomy in the health care setting is a right of an individual (mostly adults) to make decisions relating their medical care. Autonomy underlies the need to seek for consent before the patient is treated.
Veracity is related to autonomy and is based on a trust between the patient and health professional. It requires that every party be honest and tell the truth (Hill, 2003).
Ethical principles- Borhani et al. (2010) claim that the importance of ethics is not just to teach nurses mental skills but also to promote spiritual, moral and good communication among the stakeholders.

Ethics help nurses to show commitment, responsibility and offer a high quality health care. Moral theorists claim that ethical principles install in nurses the ability to handle ethical issues in their working environment. In the health care setting, ethics is a set of moral standards and principles that call for application of values in the health care practice. Bioethics- explains on matters concerning human values such as right to live and the right to health (Gabel, 2010).
Ethical issues in abortion: abortion is among the controversial issues in medical ethics. Many nations have accepted abortion in cases when the mother’s life is at stake though other nations still hold abortion as unethical (Patil et al. 2014). Those against abortion think that a foetus is alive and killing it would just be like killing a human being.
Tissue transplant- is among the medical advancements in the recent centuries and is perceived as a means of giving a gift of life to a patient with vital organ failure.
Organ donation- Donation of organs must involve the participation of the donating individual, the one to which the organ is being donated and also the society (Tonti-Filippini, 2012).
Reproductive technology- Different governments have enacted laws to limit and regulate the use of reproductive technologies though they have left some issues unsolved. Issues like the disposal of embryo after conclusion of the medical process, pregnancy and multiple implantation have not been tackled exhaustively (OBOS infertility contributors, 2011).
Mandatory reporting- is the act of reporting to the government agencies any suspected case of child abuse. Mandatory reporting in the US is not new and they have developed model acts for the concerned authorities to use in enacting the policy (Brashler et al. 2016). Conscientious objection- though in the rise in health care setting mostly due to the controversy arising in abortion and emergency contraception, it is believed to be ubiquitous in women care and reproductive medicine. According to Savulescu (2006) conscientious objection leads to inefficiency, inequality and inconsistency.
Artificially prolonging life- requires the consent of the patient or the family. Though many nurses are aware of the consequences of using life sustaining intervention on patients, they claim that it is safer provide the treatment (Welie and ten Have, 2014).
Refusal and withdrawal of treatment- It is legally and ethically justified that withdrawing treatment overweighs the benefits to the patient.
Stem cell research- it offers hope to treatment of diseases like spinal cord injury and diabetes. However, human stem cell research has faces ethical controversies as it deprives embryos and oocytes pluripotent stem cell lines. Other ethical dilemmas arise on the consent to donate stem cells required for the research (Lo and Parham, 2009).
Euthanasia- this is an intentional act to cause dealth.

Contemporary ethical issues are situations that needs one to choose between what is right and what is unethical.
Qn4. According to the Australian department of health (2005), restraint should not be used on a patient unless it is within the approved procedure of mental health and it is the only way to protect the patient from harm. Instances of patient restraint must be recorded in the patient’s medical record. A restrained patient should be kept under close and regular care and supervision of qualified health care professionals. The use of restraint has been related to adverse events like dehydration, loss of strength in the muscles, mobility, skin problems, chocking, mechanical and physical restraint, pressure sores and circulatory complications. It is also associated with other problems such as lack of good clinical practice, inappropriate use of intervention, poor skills and knowledge on safer use of restraint or alternative ways and violence triggered by using restraint (NSW Government, 2018).
Qn5. According to Marshal (2015), medical profession discourages disclosure of medical errors or atoning for their actions. In the recent years this has changed, doing away with the culture of secrecy and upholding transparency which is of benefit to health care providers and the patients. Marshal (2015) thinks that disclosure is the right thing to do as the patient and his family have the right to know what happened and also know what the causes of the mistake were. He also thinks that disclosure is ethical for nurses to disclose their errors to the patient. Mental Health Act 2014 requires only in specific conditions that health information should be disclosed for patients with mental illness to get quality care and treatment. Patient’s health information should be disclosed during when there is a threat on the safety, health or even life of the patient and the public (Victoria State Government, 2018).
Australian Government. 2018. WHS/OH&S acts, regulations and codes of practice, retrieved from:
Australian Human Rights commission. 2018. Human Rights Act – Children and young people. Retrieved from:
Australian Government (Department of Social Service). 2015. Children and Young People. Retrieved from:
Australian Human Rights Commission. 2018. A brief guide to the Disability Discrimination Act. Retrieved from:
Australian Government (Department of Health). 2015. Ageing and Aged Care. Retrieved from:
Australian Government (Office of the Australian Information Commissioner). 2018. My Health Record. Retrieved from:
Brashler, R., Finestone, H. M., Nevison, C, Marshall, S. C, Deng, G., Bismark, M. and Mukherjee, D. 2015. Time to Make a Call? The Ethics of Mandatory Reporting. The PM&R, Vol. 8, No. 1, pp. 69-74. DOI:
Borhani, F., Alhani, F., Mohammadi, E., & Abbaszadeh, A. 2010. Professional Ethical Competence in nursing: the role of nursing instructors. Journal of Medical Ethics and History of Medicine, 3, 3.
Dowie, I. 2017. Legal, ethical and professional aspects of duty of care for nurses. The Nursing Standard, Vol. 32, No. 16-19, pp. 47-52. Doi: 10.7748/ns.2017.e10959
Express insurance. 20118. Nurses insurance. Retrieved from:
Gabel, S. 2011. Ethics and Values in Clinical Practice: Whom Do They Help? Mayo Clinic Proceedings, 86(5), 421–424.
Hill, J. 2003. Veracity in medicine. The Lancet. DOI:
Hughes, Z. 2017. Nursing, Privacy and the Risks of Social Media. Retrieved from:
Lo, B., & Parham, L. 2009. Ethical Issues in Stem Cell Research. Endocrine Reviews, 30(3), 204–213.
Marshall, D. 2015. Why Disclosure is Important for Healthcare. Retrieved from:
Minnesota Board of Nursing. 2018, Scope of Nursing Practice Decision-Making Framework. Retrieved from:
Matthewa, B., Walsh, K and Fraser, J. A. 2006. Mandatory reporting by nurses of child abuse and neglect.. The NCBI, Vol. 13, NO. 4, pp. 505-517.
NSW Government. 2018. Equal employment opportunities. Retrieved from:
Menendez, J. B. 2013. Informed consent: essential legal and ethical principles for nurses. The NCBI, Vol. 15, No. 4, pp. 140-144. Doi: 10.1097/NHL.0000000000000015.
Nurse Buff. 2016. Steps on How to Get Malpractice Insurance for Nurses. Retrieved from:
Nursing and Midwifery Board of Australia. 2013. Re-entry to Practice Policy. Retrieved from:
NCSBN. 2018. Professional Boundaries. Retrieved from:
Nursing Council of New Zealand. 2013. New guidelines for nurses on social media. Retrieved from:
Nursing and Midwifery Board of Australia. 2018. Fact sheet: Recency of practice. Retrieved from:
Nursing and Midwifery Board of Australia. 2018. Re-entry to Practice. Retrieved from:
NSW Government. 2018. Review of seclusion, restraint and observation of consumers with a mental illness in NSW Health facilities. Retrieved from:
OBOS Infertility contributors, 2008. The Ethics of Assisted Reproductive Technologies. Retrieved from:
Patil, A. B, Dode, P and Ahirroa, A. 2014. Medical ethics in abortion. Indian Journal of Clinical Practice, Vol. 25, No. 6, pp. 540-550.
Queensland Government, 2017. Power of attorney. Retrieved from:
Royal College of Nursing, 2018. Disclosure or confidentiality. Retrieved from:
Savulescu, J. 2006. Conscientious objection in medicine. BMJ?: British Medical Journal, 332(7536), 294–297.
OBOS Infertility contributors, 2008. The Ethics of Assisted Reproductive Technologies. Retrieved from:
Twigg, D. E, Duffield, C. and Evans, G. 2013. The critical role of nurses to the successful implementation of the National Safety and Quality Health Service Standards. The NCBI, Vol. 37, NO. 4, pp. 541-546. Doi: 10.1071/AH12013
The Department of Health. 2005. Reducing use of, and where possible eliminating, restraint and seclusion. Retrieved from:
Victorian State Government 2018. Disclosure of Health Information. Retrieved from:
Welie, J. V., & ten Have, H. A. 2014. The ethics of forgoing life-sustaining treatment: theoretical considerations and clinical decision making. Multidisciplinary Respiratory Medicine, 9(1), 14.
Victorian State Government. 2018. Medicines and poisons regulations. Retrieved from:
Wolf ZR, Hughes RG. 2008. Error Reporting and Disclosure. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US). Available from:
Young, A. 2009. Review: the legal duty of care for nurses and other health professionals. The NCBI, Vol. 18, No. 22, pp. 3071-3078. Doi: 10.1111/j.1365-2702.2009.02855.x.

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