Applying Principles of Bioethics - Term Paper Example

Running head: principles of bioethics Name xxxxxx Course xxxxxx Lecturer xxxxxx Date xxxxxx Abstract This paper applies the principles of bioethics to a case study where a registered nurse has research intentions with residents of an aged-care facility. It applies prima facie principles of beneficence, maleficence, and respect for autonomy, as well as the ANMC codes for nurses. The nurse’s activities are most unethical and unprofessional with regard to breaching the respect for autonomy and consent by using residents’ records without their knowledge. There are also concerns for the safety of the residents in the research activities. Legal and ethical care issues: applying principles of bioethics Introduction This paper evaluates cases in nursing research and practice relative to principles of biomedical ethics and the Australian Nursing and Midwifery Council code of professional conduct and code of ethics. Three principles are featured: autonomy, beneficence and maleficence. It is imperative that nursing practitioners, managers, researchers and students adhere to the principles and codes for professionalism and quality care. Kate’s cases are in the area of nursing research in which she intends to undertake in a facility for the aged. She can make reference to the principles of beneficence and maleficence in order to enhance her engagement. However, her conduct is unprofessional due to disregard of their autonomy and management of their records. Scenario 1 The principle of beneficence is embedded on the requirements of common morality that all moral agents should provide benefit to other agents at all times. It has two aspects: positive beneficence and utility. The former details the ideals of standard health care as it focus on active well-doing. The latter entrenches the expectation that health care providers should weigh the benefits of their actions against any possible risks with an intention of providing the best outcome for the patients (Kernani, 2008). As such, the implications are that the main focus of any medical activity should be the patient so that any action should be referenced to the patient’s benefits. This scenario presents Kate as intending to sample some aged-care facility patients prior to designing a research proposal. In her attempt, she intends to take the sampled subjects through physical stamina and memory tests. This scenario may be interpreted from two applications. Firstly, it may be that that the research is to eventually benefit the patients. Its results may be beneficial in positively influencing aged-care in facilities. This agrees with the requirements of this principle that any moral agent should direct any self-interest for others’ benefits (Kanniyakonil, 2007). Essentially, her intended actions on the subjects are to verify that her research concept will work even before she puts it on paper as a proposal. Whereas the intended research may be intended at the good of the patients with the results eventually influencing the kind of care offered, there are several concerns about the ethicality of her intentions. My evaluation of her intentions is that the memory and stamina tests she designs are not essentially designed to the benefits of the patients, at this stage of research, but to her interests. According to Lawrence (2007), beneficence principle asks that any moral agent provide benefit. In addition, there are indications that beneficence should be accompanied by that of autonomy. Determination of good is a personal discretion concern that requires prior knowledge of any intervention. In Kate’s pursuit, she makes no indication of having the subjects know what she is up to. As such, her intended actions will amount to defying this principle. Conclusively, the intentions of Kate’s research may be intended for the eventual good, thus agreeing to with the requirements of the principle of beneficence. However, it is her approach into the research that is apparently drawing to her personal gains. In addition, she does not make indication of an intention to notify the subjects. As such, I would recommend that she first develops her research concept independently, rather than exploiting the patients in the facility. Scenario 2 Kate’s identification of residents between 80-84 years and her intention to involve them in tests may have direct or indirect implications on the subjects. The activities chosen for the pre- and post- tests should be designed and conducted with a critical reference to the bioethical principle of nonmaleficence (Kanniyakonil, 2007; Dickenson et al., 2010). This principle requires that any moral agent should not inflict any harm on another. Essentially dictates an obligation to “first do no harm”. The emphasis laid by this principle is to encourage healthcare professionals to render good, but if for a reason or the other they cannot, it is required of them to at least do no harm (Butts & Rich, 2012). Essentially, this principle complements that of beneficence. However, nonmaleficence is more emphatic on intentional refrain from doing any harm or causing injury, than on delivering good to a health care consumer (Beauchamp & Childress, 2009). I may argue that Kate has a greater responsibility to do no harm than to deliver benefits to the respondents. This has been closely related in medical ethics to the Hippocratic Oath which charges all medical professional to first do no harm as derived from the ancient medical ethics maxim, primum non nocere. The Oath expresses: “I will use treatment to help the sick according to my ability and judgement, but I will never use it to injure or wrong them” (Dickenson et al., 2010: 195).It is also regarded by many healthcare givers a more binding duty than other biomedical principles. As such, it is imperative that she designs her tests for the research in a way that first considers the need to do no harm to the respondents. Her tests are both physical and mental. It would be expected of her to not only protect any harm from occurring, but to also refrain from injurious activities. This could be by designing protective mechanisms or first institute mechanisms that test the appropriateness of the tests to the respondents on the basis of health safety. For instance, the 300 meters walk distance and the weight lift may be injurious on respondents’ physique given the expected increasing weakness of their bones as well as heart capacities. As such, there should be a keen address of safety concerns. This is either by modifying the tests to fit the selected facility residents or by selecting residents whose engagement would be least harmful. According to Taylor (2006), nurses like Kates ought to pride herself in their being accountable and responsible. This involves caring for people, valuing relationships and human dignity, as well as delivering quality benefits. Scenario 3 Beneficence and non-maleficence principles have a common element which nurses and any other medical professional must make consideration of in any engagement: personal autonomy. Autonomy is the ability and freedom to act in a way that is self-determined (Butts & Rich, 2012). By the principle of autonomy, any competent moral person has a right to decide and determine what treatment he/she receives relative to own system of values, beliefs and culture. Autonomy is the central concept of any informed consent (Albright et al., 2007). This right holds even when there are disagreements between the subject individual and a professional (Kernani, 2008). Kate’s use of clients’ records in her research without their knowledge intention and subsequent approval amounts to an unethical action. It breaches the bioethical principle of autonomy. Essentially, autonomy is has several inherent determinant factors. Firstly, the individuals must have information of what is happening and the choices available, and should be in a position to make a judgement based on an understanding of the potential outcomes of their choices. The individuals must also be facilitated to communicate their wishes. With regard to research, any involvement should be based on the subject’s consent. Additionally, this consent should be factored by freeness and prior full information. The consent must not be forced or acquired improperly (National Health and Medical Research Council, 2007). Given such requirements of this principle, it is clear that Kate has infringed the rights of clients by using their records in her study without their consent. In addition, her actions amount to dishonesty as she pretends to give them extra attention and stimulation whereas her main focus is not to assist them, but rather to get research information. Essentially, it is expected that all nurses respect the “inherent worth, dignity and human rights of every individual” (Mauk, 2011: 60). In any secular pluralistic society, personal permission is required for authority to involve them in any activity (Beauchamp & Childress, 2001). By using the client’s records, she is liable for not only dishonouring their dignity, but also disregarding it. They should have been notified of the intention to be involved in the research study and given a chance to give their personal consent. Using their records in the research without their consent may also imply that the research may be implicated as being without credibility. In addition, it implies that the entitlement to professional handling of personal information for any moral being has been breached. Scenario 4 The Australian Nursing & Midwifery Council (ANMC) specifies the codes of ethics for the nursing profession. This code not only guides ethical decision making, but also sets fundamentals of ethical standards of rights and service delivery. Essentially, these codes are expressed in eight distinct and precise value statements. Nurses are required to value quality care access and delivery, people diversity, respect for self and others, informed decision making, safety culture, ethics of information management and a sustainably health care enabling environment. It is expected of practicing nurses and nursing students to uphold the values as well the code of professional conduct. As such, Kate’s plans and actions for her research should be weighed in this regard especially with reference to her relationships with the health consumer- aged-care facility respondents. Regarding her actions, there are several value statements that are central: value for informed decision making, culture of safety, and value for ethical management of information. Kate’s selection of residents in scenario 2 for the pre-and post-tests is ethical to the extent that she has factored the residents’ safety from injury. The professional code require safety and competency considerations in nursing care whereas the values make reference to risk management, value for low-risk environments, and open disclosure of events described as adverse. As such, the residents’ safety extent determines Kate’s professionalism level. In scenario 3, the question lies in the management of health care consumers’ records, autonomy and value of decision making. Kate decides to use the residents’ health records in her research without prior authority, knowledge and consent of the residents. Value statement 5 requires nurses to value people’s decisions and their freeness. It implies that nurses ought to give an opportunity for the consumers to have full knowledge verify its value and subsequent implications of consent. This is the moral right of health consumers about which nurses are obliged to enable its establishment. Professional conduct statement 4 requires respect for the dignity and values of health care consumers. These are inherent in any free decision making. As such, Kate’s actions reflect unprofessional conduct. In addition, values and professional conduct statements 7 and 5 respectively address the requirement for nurses to be ethical in the way they handle and manage consumer’s information obtained in professional capacity confidentially and ethically. Her plans to use health records without consent of the residents’ amounts to misconduct due imminent divulgence of information. In addition, it is apparent that she intends to use inappropriate means of getting the information. Value statement 7 expounded implies that all moral beings are entitled to legal and professional safeguards as regarding their personal information. In conclusion, this write-up has explored three scenarios involving Kate’s actions in her research with reference to the principles of biomedical ethics and the codes of professionalism and ethics. In my opinion, Kate has a problem with regard to obtaining informed consent from research subjects as well as using their medical records. This is unprofessional and unethical. With reference to ensuring that she adheres to the principles of beneficence and maleficence, this paper has recommended that her actions are undertakes relative to a certain quality standard. References Albright, A., Pollack, I., & Adelson, P. (2007). Principles and practice of pediatric neurosurgery (2nd Ed). New York: Thieme. Beauchamp, T., & Childress, J. (2009). Principles of biomedical ethics (6th Ed.). New York: Oxford University Press. Beauchamp, T., & Childress, J. (2001). Principles of biomedical ethics (5th Ed). New York City: Oxford University Press. Butts, J., & Rich, K. (2012). Nursing ethics : across the curriculum and into practice (3rd Ed). Burlington: Jones & Bartlett Learning. Dickenson, D., Huxtable, R., & Parker, M. (2010). The Cambridge medical ethics workbook (2nd Ed). New York: Cambridge. Kanniyakonil, S. (2007). The fundamentals of bioethics : legal perspectives and ethical approaches. Kottayam: Oriental Institute of Religious Studies. Kernani, N. (2008, January). Bioethics: Applying the Basic Principles to Resolve an Ethical Dilemma. Northeast Florida Medicine Supplement , pp. 1-5. Lawrence, D. (2007). The four principles of biomedical ethics: A foundation for current bioethical debate. 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