Case Studies in Nursing Ethics - uswr.ac.ir

1 case Studies IN. Nursing . Ethics . FOURTH EDITION. Sara T. Fry, PhD, RN. Brewster, Massachusetts Robert M. Veatch, PhD. Georgetown University Kennedy Institute of Ethics Washington, DC. Carol Taylor, PhD, RN. Georgetown University Center for Clinical Bioethics Washington, DC. 1 6/24/10 3:31 PM. World Headquarters Jones & Bartlett Learning Jones & Bartlett Learning Jones & Bartlett Learning 40 Tall Pine Drive Canada International Sudbury, MA 01776 6339 Ormindale Way Barb House, Barb Mews 978-443-5000 Mississauga, Ontario L5V 1J2 London W6 7PA. Canada United Kingdom Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations.

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3 Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product.

4 This is especially important in the case of drugs that are new or seldom used. Production Credits , Manufacturing and Inventory Control: Publisher: Kevin Sullivan Therese Connell Acquisitions Editor: Amy Sibley Composition: DataStream Content Solutions, Associate Editor: Patricia Donnelly LLC, Absolute Service Inc. Editorial Assistant: Rachel Shuster Cover Design: Scott Moden Associate Production Editor: Katie Spiegel Printing and Binding: Malloy, Inc. Associate Marketing Manager: Katie Hennessy Cover Printing: Malloy, Inc. Library of Congress Cataloging-in-Publication Data Fry, Sara T. case Studies in Nursing Ethics / Sara T. Fry, Robert M. Veatch, Carol R. Taylor. 4th ed. p. ; cm.

5 Includes bibliographical references and index. ISBN 978-0-7637-8031-9 (pbk.). 1. Nursing Ethics case Studies . I. Veatch, Robert M. II. Taylor, Carol, CSFN. III. Title. [DNLM: 1. Ethics , Nursing case Reports. 2. Bioethical Issues case Reports. WY 85 F947c 2011]. 2011. dc22. 2010017881. 6048. Printed in the United States of America 14 13 12 11 10 10 9 8 7 6 5 4 3 2 1. Conte n t s List of Cases ix Preface xiii Introduction xv Part I Ethics and Values in Nursing Chapter 1. Values in Health and Illness 3. Identifying Evaluations in Nursing 4. Identifying Ethical Conflicts 15. Benefit to the Patient vs Benefit to Others 15. The Rights of the Patient vs the Welfare of the Patient 19. Moral Rules and the Nurse's Conscience 23.

6 Limits on Rights and Rules 27. Chapter 2. The Nurse and Moral Authority 35. The Authority of the Profession 37. The Authority of the Physician 42. The Authority of the Institution 46. The Authority of the Health Insurer 50. The Authority of Society 52. The Authority of the Patient 56. iii iv Contents Contents . Chapter 3. Moral Integrity and Moral Distress 61. Why Does Moral Agency Matter? 63. Moral Distress 63. Creating and Sustaining Healthy and Ethical Work Environments 66. Ethics Environment Assessments 67. Resources for Establishing and Sustaining Healthy Environments 67. Change Theory Models 68. Part II Ethical Issues in Nursing Chapter 4. Benefiting the Patient and Others: The Duty to Produce Good and Avoid Harm 79.

7 Benefit to the Patient 82. Uncertainty About What Is Actually Beneficial to a Patient 83. Health Benefits vs Overall Benefits 85. Benefiting vs Avoiding Harm 89. Act vs Rule Consequentialism 91. Benefit to the Institution 94. Benefit to Society 97. Benefit to Identified Nonclients 99. Benefit to the Profession 102. Benefit to Oneself and One's Family 105. Chapter 5. Justice: The Allocation of Health Resources 109. The Ethics of Allocating Resources 111. Two Meanings of the Word Justice 111. Three Ways to Allocate Resources 111. Justice Among the Nurse's Patients 114. Justice Between Patients and Others 122. Justice in Public Policy 126. Justice and Other Ethical Principles 131. Contents v Chapter 6.

8 Respect 136. Ignoring a Person as a Person and Focusing Only on the Pathology or Task . to Be Performed 139. Arrogant Decision Making 141. Humiliating Others 144. Chapter 7. The Principle of Autonomy 149. Internal Constraints on Autonomy 152. External Constraints on Autonomy 159. Overriding Autonomy 164. Paternalistic Overriding of Autonomy 164. Overriding Autonomy to Benefit Others 169. Chapter 8. Veracity 174. The Condition of Doubt 176. Duties and Consequences in Truth Telling 179. Lying and Patient Well-Being 179. Lying and the Well-Being of Others 184. Complications in Truth Telling 187. When the Patient Asks for Dishonesty 187. When the Family Asks Not to Tell 188. The Right to Health Records 192.

9 Chapter 9. Fidelity 196. Promise Keeping 197. Explicit Promises 198. Implicit Promises and the Right of Access to Health Care 201. Confidentiality 203. When the Patient May Be Harmed 209. When Others May Be Harmed 215. When Required by Law 220. vi Contents Contents . Chapter 10. The Sanctity of Human Life 223. Actions and Omissions 225. Criteria for Justifiable Omission 229. Withholding and Withdrawing 233. Direct and Indirect Killing 238. Voluntary and Involuntary Killing 243. Is Withholding Food and Water Killing? 247. Part III Special Problem Areas in Nursing Practice Chapter 11. Abortion, Contraception, and Sterilization 259. Abortion 260. Contraception 270. Sterilization 274. Chapter 12.

10 Genetics, Birth, and the Biologic Revolution 278. Genetic Counseling 280. Genetic Screening 289. In Vitro Fertilization and Artificial Insemination 294. Genetic Engineering 306. Chapter 13. Psychiatry and the Control of Human Behavior 313. Psychotherapy 317. The Concept of Mental Health 317. Mental Illness and Autonomous Behavior 320. Mental Illness and Third-Party Interests 324. Other Behavior-Controlling Therapies 329. Contents vii Chapter 14. HIV/AIDS Care 333. Conflicts Between Rights and Duties 335. Screening/Testing for HIV 335. Balancing Confidentiality Protection and the Duty to Warn 339. The Rights of HIV-Infected Individuals 345. Conflicts Involving the Cost of Treatment and Allocation of Resources 349.