Nursing: Ethical Situation - Essay Example

Barriers to Pain Relief: In this 40-year-old lady with metastatic breast cancer to the bone, a new regimen of chemotherapy has been scheduled. The nurse performs a pain assessment, and finds a mildly tender spot in the lumbar region, with pain and burning sensation in other areas of the body. This pain is crippling in the sense that this limits her mobility, and manipulation enhances the pain. There is paresis of both the legs with the right being more with sensory losses. The ethical issue here creates a double effect. By the principle of autonomy, the patient has a right to choose her medications, but the principle of beneficence promotes the nurse to give her some medications for her pain, which might have arisen from the lumbar metastasis and possible quadriplegia in the near future. This pain is throbbing and aching limiting her abilities to move. So her pain intensity needs some medications. As per the patient's reports in many cases, the pain becomes so excruciating that the conventional over-the-counter medications prove fruitless, and she has to take Vicodin that contains narcotic codeine. Her nuclear family comprises of her husband and two teenage children, although apparently supportive, her husband, do not like her to take pills, and her choice is against narcotic medication. When patient comfort is the nurse's priority, the nurse could offer her pain medication, and this being cancer pain, the choice would be a narcotic. The Doctrine or Principle of Double Effect arises from the application of moral theory to some difficult moral problems. According to the ethical principles, whatever the nurse does, it has both good and bad effects. From the same action of the two different options, two different effects would generate, a good or desirable effect which the agent intends, and a bad or undesirable effect which the agent foresees but does not intend. It is frequently invoked, for example, in distinguishing the permissible use of opioids in palliative care of the terminally ill for the purpose of pain relief, where this also has the effect of hastening a patient’s death, as opposed to active euthanasia for which the patient’s death would be the intended outcome. This is the ethical situation here. On the other hand, if the nurse follows the ethical principle of paying the highest regards to the patient's autonomy and withholds the drug, she is again ethically wrong, since she is violating the principle of beneficence. If she gives it, she is violating her autonomy and choice of the family, and since is in palliative care, she is hastening her death with narcotic against her wishes, thereby violating principles of nonmaleficence. Apart from ethical barriers, the other barriers are cultural barriers and barriers of belief (Benjamin and Curtis, 1992).

Types of Pain and Underlying Etiologies: Her final diagnosis should be advanced metastatic breast cancer to the lumbar vertebrae being treated with palliative chemotherapy, with a poor prognosis. Diana is experiencing pain in the lumbar region due to metastasis of breast cancer, metastasized to the lumbar region. Her metastases had earlier been documented in other regions. These metastases are causing compression on the lumbar nerves causing moderate to severe pain. The current examination reveals that she perhaps has a compressive metastasis leading to pain, difficulty in mobility, and the onset of paresis and paresthesias. Moreover, paresthesia may be caused by chemotherapeutic agents. (Snyder and Gauthier, 2008).

Questions to be asked: Given her advanced condition, the nurse should ask about her options about the care setting, her nutritional status and other health conditions, her coping with the grief of disease and suffering, her family support, and status of coping with her family members, her social network and how she socializes, and her end of life care and advanced directives of any. The choices and options of treatment of her pain need to be questioned, and pain assessment should be done in an elaborate manner. The patient’s options are limited, and she seems to be tolerating these discomforts. Her choice of pain relief is to be moderate with occasional narcotics. The nurse should explain the effect of the narcotics, so the patient can have a chance of an informed choice. The nurse should ask the patient whether she has divulged her disease condition to them or whether she wants to continue the treatment in this fashion from home (Johnson and Gross, 1998).

Evert attempts would be made so she understands her condition, prognosis, therapeutic choices available for her, and her regimens. These will be accomplished by a discussion with Diana about her own impression of the disease, and she will be encouraged to share her thoughts and feelings in an open environment. The client will be provided assurance that she is not alone or rejected, and she will be treated with dignity. She will be provided with consistent and accurate information regarding her diagnosis and prognosis with freedom for her to express emotions, and the recommended and available treatments will be explained to her in line with their purpose and potential side effects. Depending on her coping status, the coping mechanism will be strengthened further with all measures taken to prevent depression. She will be encouraged to develop support systems and encounter with her support systems. Despite ethical issues, she must be on pain medications, and she will be asked not to strain given her lumbar metastasis (Johnson and Gross, 1998).