Dementia Patients
Instructions:
- Create an ethical legal decision-making dilemma involving an advanced practice nurse in the field of education, informatics, administration, or a nurse practitioner. Apply relevant codes of conduct that apply to the practice of nursing and your chosen field.
- Include one ethical principle and one law that could be violated and whether the violation would constitute a civil or criminal act based on facts.
- Construct a decision that demonstrates integrity and that would prevent violation of the ethical principle and prevent the law from being violated.
- Describe the legal principles and laws that apply to the ethical dilemma.
- Support the legal issues with prior legal cases or state or federal statutes.
- Analyze the differences between ethical and legal reasoning and apply an ethical-legal reasoning model in the case study to create a basis for a solution to the ethical-legal dilemma.
- List three recommendations that will resolve advanced practice nurses’ moral distress in the dilemma you have presented.
- Based on the issue you presented and the rules of the law apply the laws to your case and come up with a conclusion.
Note:
This is a fact-based Assignment that will not include your opinion.
This will require research and support for what is written.
You will continue working on the topic you have chosen and submit the paper using the most recent version of APA format. A template is provided in the left navigation of the course room for the paper. The paper should have a minimum of seven citations and some of these should be case law or applicable statutes. The Kaplan Library has Westlaw Campus Research database where you can find case laws that relate to your topic. The APA Manual and the textbook have instructions on legal formatting.
Solution.
Surrogates Decision to Stop Enteral Nutrition in End Stage Dementia Patients
Nurse practitioners especially dementia professional nurses in the contemporary world face numerous ethical dilemmas that are more perplexing and treacherous compared to those who practiced medicine before. The complexity in the dilemmas is made prevalent by the advancements that are being made in medical technology. Medical technology is continuously being embraced because it has proved to prolong life (Friedrich, 2013). Even though there are philosophical and legal debates on how the application of technology prolongs life of a patient, new concerns are emerging on how nurse practitioners value patients’ autonomy, the quality of a patient’s life, and the general definition of death (Beauchamp & Childress, 2009). Advanced dementia or end stage dementia is a disease that affects the old aged patients. The patients experience feeding problems, characterized by difficulties in swallowing, and respiratory complications. This makes the patients to become incompetent of making informed decisions. As a result, care decisions become very complex leading to situations where the families of the patients and the dementia nurse practitioners have to decide whether enteral nutrition is likely to be beneficial to the patient.
Case Scenario
Mr. Smith is an 85-year-old white male who after the loss of his wife 27 years ago was diagnosed with dementia. The health conditions of Mr. Smith have since then been deteriorating and now the disease has reached its last stages. Mr. Smith’s family admitted him to a nursing home five years ago. Despite the regular visits by the family members, it has been hard for Mr. Smith to recognize any of the family members for the last two years. Mr. Smith is verbally non-communicative and over the last eighteen months, he has been using enteral nutrition to avoid malnutrition or aspiration. Two of the family members insist that the administration of the enteral nutrition as a feeding method to Mr. Smith is contrary to the previous wishes of the patient. The family is of the opinion that they can devise a plan to regularly prepare Mr. Smith’s favorite meals and coax him to feed himself orally. The care center administrator is concerned and opposes the idea because the facility may risk losing its license if found by the regulating authority having patients who are not properly fed. On the other hand, the administrator is concerned of the staffing constraints that the facility is facing while caring for patients with feeding tubes.
Ethical Principle
If Mr. Smith’s feeding tube is removed, the patient will have left the category of patients with acute cognitive impairments that need to be fed by use of tubes. On the contrary, the beneficence ethical principle will be violated. According to Kinsinger (2009), all health care personnel have to maximize the benefits of the patients while minimizing potential harm on behalf of the patient. As such, all end-of-life nurse practitioners are expected to offer nutrition and hydration therapy to the patients. By so doing, the health providers will have taken into account the overall benefits of the treatment to the patient, the quality of life, and the psychological or spiritual wellbeing of the patient.
While referring to the Barber V. Superior court of state of California, in the Calif report of 1983, the court of appeal reversed the court ruling acquitting the physicians all the murder charges. In the ruling, the judge indicated that removal of any life support equipment from a patient is an omission and therefore not a chargeable offense if a doctor had no legal obligation and duty to act (Liang & Lin, 2005). In the case of Mr. Smith, the nursing home administrator is well aware of the legal obligations that the nurse practitioners have making it a legal offense to withdraw the feeding tube.
Alternative Approach
All healthcare providers are expected to guide the patients and the surrogates on the risks and other medical interventions that enteral nutrition has to end stage Dementia patients. According to Glaucia, Paulo, and Rodrigo (2012), enteral nutrition is not a risk free medical intervention but ensures that a patient is well fed for sustenance and increase or prolonging life. As such, the family members shall be made to understand that severely demented patients like Mr. Smith are not in a position to make judgment on whether it is right to eat or not. This will subject the patient to hunger or thirst. As a medical facility, it is the obligation of every medical practitioner and nurse practitioners not to starve any patient (Friedrich, 2013). The nurse practitioners will respond appropriately to safeguard life of the patient.
Legal Principles and Laws That Apply To Beneficence
Justice is usually achieved when both parties have respected the legal principles and the pertinent law. As a result, procedural principles of administering justice shall guide the prevalence of beneficence ethical principle and all nursing professionals are obliged to do the right thing (Kinsinger, 2009). It is illegal for any nurse practitioner to act with inhumanity while administering any form of assistance to a patient. Other laws like the revised Arizona law, statute section 36-3231, states that no surrogate unless the patient’s agent or guardian shall make decisions to withdraw artificial health administration of liquids and food to a patient (Kirk, 2010).
As indicated by Bankhead et al. (2009), the code of ethics for all nurse practitioners provides guidance to all patient handlers who are or may be confronted with end-of-life scenarios during duty. End-of-life nursing professionals should always try to provide supportive care to alleviate suffering in patients. Another way of remaining supportive to the patients is to respect the patient’s lifestyle, religion, and values. Effective counseling by the medical practitioners can help terminally ill patients prepare themselves to death and minimize unwarranted suffering.
Nurse practitioners, especially end-of-life nurse professionals administering care to end stage dementia patients are faced with numerous dilemmas especially when deciding to administer or withdraw enteral nutrition. End stage dementia affects old aged patients making them experience feeding difficulties and respiratory complications. The patients become incompetent of making informed decisions. As such, a nurse practitioner is expected to offer nutrition support to the patient considering the patient’s wishes, prognosis, and the nurse practitioners’ therapy goals. Various ethical principles may be applied by the nurse practitioners helping them to make decisions that are in the best interest of prolonging the patient’s life and avoid infringing on the rights of the patient even when faced by pressure from the surrogates. Efficient communication between the patient, family members, and the health care providers in charge of the patient facilitate decisions that are in the interest of the patient. The patient’s autonomy should always remain the driving force when making informed decisions. Throughout the therapy process, it is important for the nurse practitioner to keep a constant evaluation of the therapy benefits against the burdens to avoid infringing on the patients right.
References
Bankhead, R., Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B.,
Metheny, N., Mueller, C., Robbins, S., Wessel, J. & ASPEN (2009). Enteral nutrition practice recommendations. Journal of Parenteral and Enteral Nutrition 33(2), 122-167.
Beauchamp, T., & Childress, J. (2009). Principles of biomedical ethics 6th ed. New York, NY:
Oxford University Press
Friedrich, L. (2013). End-of-life nutrition: is tube feeding the solution? Annals of Long-Term
Care: Clinical Care and Aging. 21(10) 30-33.
Glaucia, A., Paulo, H., & Rodrigo, R. (2012). Nutrition in severe dementia. Current Gerontology
and Geriatrics Research. 1-7.
Kinsinger, F. S. (2009). Beneficence and the professional’s moral imperative. Journal of
Chiropractic Humanities, 16(1), 44–46.
Kirk, S. (2010). Artificial nutrition and hydration. Retrieved from: http://www.azbioethicsnetwork.org/resources/encyclopedia/artificial-nutrition-and-hydration
Liang, B., & Lin, L. (2005). Barber V. Superior court: Quality of life Matters. American Medical
Association Journal of Ethics, 7(2).
Palmer, A. (2010). Dilemma for nurses: Physician-assisted suicide. The Journal of Advanced
Practice Nursing. Retrieved from: http://www.asrn.org/journal-advanced-practice-nursing/768-dilemma-for-nurses-physician-assisted-suicide.html.