Nurses have a variety of responsibilities when providing care for their patients. In particular, one such responsibility is advocating for the patient if a need to do so arises. In this paper, a hypothetical situation in which a patient is threatened will be identified; the bioethical decision-making model will be applied to analyze the case and formulate a process that will allow for pursing the chosen decision; and conclusions about nursing advocacy, in general, will be made.
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The hypothetical situation that will be considered in the current paper is that of a girl aged 16 who got pregnant but then was diagnosed with pre-eclampsia (Mol et al., 2016). The condition is rather dangerous, and there is a significant risk that she will not survive the child delivery, and a somewhat lower risk that the child will die anyway (Mol et al., 2016). Therefore, medics advise that she should undergo an abortion. However, to do that, it is legally required that her parents provide their consent, which they refuse to do due to their religious views, despite the medical personnel’s efforts to convince them.
Applying the Bioethical Decision Making Model
The dilemma that the nurse faces is whether to go against the parents and take the case to the court; or not to go against the parents, for they are legally entitled to the right not to permit the abortion, in which case both the patient and her child will likely die.
The medical facts include the diagnosis, that is, pre-eclampsia (Mol et al., 2016). They also include the prognosis of the outcome of an uninterrupted pregnancy, that is, a significant probability (more than 60%) that the patient will die if she does not undergo an abortion, and a slightly lower, but still high probability (more than 50%) that her child will die even if she does not undergo an abortion.
Both the diagnosis and the prognosis are described in the previous subsection.
The non-medical facts include those about the patient’s parents, who do not desire to provide their consent due to their religious views. They also include the legal status of the patient (she is a minor). It should also be noted that the patient is afraid and is not sure what to do. On the one hand, she fears death and does not want to die, so she would prefer to undergo an abortion. On the other hand, she does not wish to go against her parents.
The external influence includes the state laws, which make it obligatory that the parents provide their consent that their minor daughter can undergo an abortion, and they do not make an exception for circumstances when pregnancy is dangerous and can lead to a lethal outcome for the patient. Simultaneously, the code of ethics of the American Nurses Association states that the interests of the patients are primal and nurses should strive to provide care for patients and preserve their life and health (American Nurses Association [ANA], 2015).
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It is apparent that in this case, steps 2 and 3 only contain the description of facts. It would not be correct to consider the prognosis of the probability of the lethal outcome an assumption, for this is not a statement that was based on somebody’s personal opinion, but rather a statement that was based on the diagnosis, on the condition of the patient, and the available evidence about similar medical cases.
For the current case, it might be needed to further clarify the reasons for parents’ refusing to provide their consent. It might be possible that even though the health care facility personnel have already made considerable efforts to convince them, they still do not clearly understand that their daughter faces a significant risk of death and that in case she does not have an abortion, her child will probably die anyway.
The patient is a minor, so, according to the state’s legislation, she is not permitted to make the abortion decision herself. Nevertheless, she is 16, which means that she can have a say in the matter. This also makes it pivotal that the nurse advocates for the patient and her rights.
The principle of beneficence applies to the current case because it is pivotal that the patient preserves her life in the end (Grace, 2017). The principle of non-maleficence applies because the risks for the patient’s life should be minimized. The principle of veracity does not directly apply to this case because no information is being concealed from any party. The principle of fidelity applies to this case because a nurse should be dedicated to their patients and advocate their rights and interests. The principle of autonomy also applies to this case because even though the patient is a minor, she is being denied an opportunity to make her own decision, even if this denial is based on the legislation. The principle of justice applies to this case because it is unfair that the patient is not provided with the right to decide if she lives or probably dies (Grace, 2017).
A possible course of action is taking the case to the court so that the latter permits the patient to have an abortion. However, a potential route is to make further attempts to convince the parents that abortion would be a preferable option from multiple points of view. It might be possible to involve some other relatives of the patient, such as her grandparents, to help persuade the parents to provide their consent.
The process that will be used for the chosen alternative consists of obtaining contacts of the patient’s grandparents and possibly involving them in convincing the parents to provide their consent for an abortion. If that does not help, it is possible to take the case to the court, if the patient desires to do so.
On the whole, it should be stressed that one of the most important roles that a nurse has to play while providing care for their patients is that of an advocate. Patients may not be in a condition that would allow them to advocate for their rights. They might also be impaired by their current disease, which landed them in the clinical setting that they are currently in, and may prevent them from taking appropriate action. They might simply not know the strengths that they have in their situation, or not know the weaknesses in their current state.
As a patient advocate, a nurse needs to be able not only to provide care for their patients but also to be capable of defending their rights if a need for this arises. Nurses may need to work as the voice of their clients when representing the latter to doctors, insurance agencies, or other parties whose actions may have a considerable impact on the patient.
American Nurses Association. (2015). Code of ethics for nurses: With interpretive statements. Silver Spring, MD: American Nurses Association.
Grace, P. J. (Ed.). (2017). Nursing ethics and professional responsibility in advanced practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Mol, B. W. J., Roberts, C. T., Thangaratinam, S., Magee, L. A., De Groot, C. J. M., & Hofmeyr, G. J. (2016). Pre-eclampsia. The Lancet, 387(10022), 999-1011.