Case Study Balancing Autonomy and Beneficence

Amelia Roses (UNC2021-5678) Bachelor of Science in Nursing CASE STUDY BALANCING AUTONOMY AND BENEFICENCE You are a registered nurse (RN) working in the intensive care unit (ICU) at a major hospital in the United States. You are assigned to care for Mr. Jones, a 72-year-old man diagnosed with end-stage lung cancer. Mr. Jones' condition has worsened significantly in recent days. He is currently on mechanical ventilation, which is assisting his breathing. Mr. Jones' wife and adult children are at his bedside. During rounds, Mr. Jones expresses his desire to be taken off the ventilator and allowed to die peacefully. He states that he is tired of fighting the disease and wants to spend his remaining time with his family. However, the attending physician, Dr. Lee, believes that there is still a chance for Mr. Jones to recover if he remains on ventilation. Dr. Lee recommends continuing aggressive treatment, including additional rounds of chemotherapy. This situation presents a classic ethical conflict between the principles of autonomy and beneficence in nursing ethics. Mr. Jones' right to autonomy, or the right to make his own healthcare decisions, clashes with the beneficent principle, which compels healthcare professionals to act in the patient's best interest. In this case, Mr. Jones' best interest according to Dr. Lee is to continue treatment with the hope of recovery. However, Mr. Jones prioritizes his autonomy and wishes to forgo life-sustaining treatment. The United States healthcare system recognizes a patient's right to selfdetermination. This right is supported by legal precedents and professional codes of ethics, including the American Nurses Association (ANA) Code of Ethics for Nurses. The ANA code emphasizes respecting patient autonomy and informed consent. Questions for Consideration: 1. As the nurse, it's crucial to assess Mr. Jones' decision-making capacity. Is he mentally competent to understand his condition, treatment options, and potential consequences? 2. Have all potential treatment options, including palliative care focused on comfort and symptom management, been discussed with Mr. Jones and his family? 3. Has Mr. Jones' family been involved in the decision-making process? Is there consensus among family members regarding his wishes? 4. Considering the complexity of the situation, involving an ethics committee or a bioethicist for consultation may be beneficial. Breakdown of the questions and possible considerations: 1. Assess Mr. Jones' mental competence to make informed decisions about his care. Evaluate his ability to understand his condition, treatment options, and potential consequences. Honor Mr. Jones' decision to forgo life-sustaining treatment, even if it differs from medical recommendations. 2. Comprehensive Discussion: Discuss all potential treatment options, including palliative care, with Mr. Jones and his family. Ensure they understand the benefits, risks, and goals of each option. Provide comprehensive palliative care to manage symptoms, improve comfort, and support Mr. Jones' emotional and spiritual well-being. 3. Facilitate a family meeting to discuss Mr. Jones' wishes and ensure everyone is on the same page. Encourage open communication and respect for diverse perspectives. Maintain open and honest communication with Mr. Jones, his family, and the healthcare team throughout the process. 4. Consider involving an ethics committee or a bioethicist for consultation. Their expertise can provide valuable insights and support in navigating this complex situation. Encourage shared decision-making, involving Mr. Jones and his family in discussions about his care, even if their preferences differ from medical advice.