Category: Bioethics

Context

By any standards, the nursing profession has encountered many bioethical issues due to the nature of duties involved. Under the principle of beneficence, it is the duty of professional nurses to enhance goodness, kindness, quality care, and charity to all patients, their health status notwithstanding (Mosby Inc., 2002). In addition to abstaining from causing injury to patients, nurses must also help their clients to further their well-being by offering interventions that will remove them from danger. In this particular case, however, there is an intricate discrepancy between the demands of beneficence on the one hand and the demands of the health care facility and code of conduct on the other. According to the case, Mrs. Corrine Worthen’s actions of enhancing goodness and kindness to the patient by performing dialysis on him results in more harm. This is the bioethical issue

The factual information relevant in this case is the patient’s experiences and health status when a dialysis procedure is perfumed on him. The nurse has a duty not to inflict harm to patients, and must, under all circumstances, abstain from injuring clients (Mosby Inc., 2002). Yet the procedure that Mrs. Worthen is supposed to administer has, on the previous occasion, caused the patient to suffer cardiac arrest and haemorrhaging.

Stakeholders

The stakeholders in this particular case include the patient, family members, nurse, treating physician, and the trans-disciplinary team. The patient is guided by the personal value and belief that his well-being will be furthered, while the nurse is guided by the values of altruism, aesthetics, freedom, respect for human dignity, justice, and truth (Mosby Inc., 2002). The treating physician’s decisions about the patient may be guided by values towards paternalism, otherwise referred to as involuntary treatment. On their part, the trans-disciplinary team, led by the head nurse, is guided by the values of offering the greatest good to the patient, information disclosure, and an overriding desire to conform to the set Code of Professional Ethics. The family members have the values of decision-making and compulsion to protect their relatives (Konishi, 2003).

A terminal illness, more often than not, leaves stakeholders with very limited priorities to choose from. The patient, however, has the priority of self-regulating and self-directing himself instead of waiting for decisions to be made by relatives. In other words, he has the priority of self-determination based on the information received from caregivers (Konishi, 2003). The nurse has the priority of thinking autonomously beyond the Code of Professional Ethics for Nurses and other concerns related to authority and reverence, but basing her thinking on altruism and respect for human dignity. The nurse also has the priority of being well informed about the underlying consequences that her decisions or approach may attract (Johnstone, 2009). Family members have the priority of giving the terminally ill patient a chance to make his own decisions. Lastly, the medical professionals and trans-disciplinary team have the immediate priority of benevolent paternalism and enforcement of rules respectively.

Alternatives

Judging by the complexity of the matter, morally and professionally, the available alternatives may not have the capacity to please all stakeholders. One of the alternatives is to allow the patient, who is an adult, to make an informed decision on what he wants. Treating the patient for the simple reason of pleasing the family rather than ensuring the well-being of the patient is not ethically right. The other available alternative, of course, is to follow the family’s wishes and continue dialysis on the patient despite the fact that it has already proven counterproductive.

If the patient is left to make his own informed decision, the odds are that he will have the dialysis procedure stopped. This way, the family members will not continue to contribute to needless costs of medical care, especially with the full knowledge and understanding that the patient is suffering from a terminal illness. The nurse will stop worrying that she might be causing the premature demise of the patient by administering dialysis, not because of the well-being of the patient, but to comply with set rules and please the family members. Other stakeholders will be affected positively by these alternatives through reduced psychological anxieties. The opposite is true for the second alternative

Solution

The best solution is to let the patient take his own decision about treatment procedures based on objective and credible information provided by the attending nurse and the treating physician rather than going by the family’s wishes. The nurse, of course, does not want to live with the guilt of causing death to the patient prematurely by continuing to administer dialysis. The family members should be convinced on the basis of superfluous costs and anxieties raised. The treating physician should be convinced on the basis that benevolent paternalism, that is, involuntary treatment of patients, may indeed be considered morally wrong (Johnstone, 2009). The trans-disciplinary team should be convinced on the basis of utilitarianism, that is, individuals should always endeavour to do what is morally right despite the rules and institutions of authority.

Reference List

Johnstone, M.J. (2009). Bioethics: A Nursing Perspective, 4^th Ed. Victoria Avenue, Chatswood: Elsevier. ISBN: 9780729538732.

Konishi, E. (2002). Physician Non-Disclosure & Paternalism in Terminal Care: Ethical Issues for Japanese Nurses. Eubious Journal of Asian & International Bioethics, Vol. 13, pp. 213-215. Web.

Mosby Inc. (2002). Ethical and Bioethical Issues in Nursing and Healthcare. Web.

Historical Background of Human Subject Protection

The human-subject system of protection currently being used has undergone serious development in the last six decades. The rules followed today while conducting human research were developed as the Nuremberg code used in the trial of the Nazi war criminals (Resnik, 2018). The three basic constituents of the code were consent that was informed, favorable risk and risk analysis, and the right to pull out from the research. The principles became the foundation and cornerstone for the research regulations and ethical codes that followed the Nuremberg code (Malgieri & Niklas, 2020)

After the Second World War, the world superpowers focused most of their attention on finding cures for some deadly diseases, and human subjects were needed for the success of the research. Between 1950 and 1973, countless research misconducts were reported in the United States, prompting congressional contemplation about human-subject research management. The National Research Act of the year 1974 was Congress’s first legislation move to safeguard the rights of those participating in their research (Artal & Rubenfeld, 2017). The legislation created a national commission that protected participants in Biomedical and behavioral research. The commission issued a report stating three fundamental principles in conducting human subject research. The three principles were respect for the persons participating in the human subject research, justice, and benefaction for those involved (Resnik, 2018).

Historical Incident of Human Subject Abuse and Human Rights Violated

The public health service, in collaboration with Tuskegee’s institute, began researching syphilis in 1932 in the hopes of justifying treatment for black men. A total of 600 people were interested in the study, all of whom were black; 399 had contracted syphilis, and 201 did not have the disease. (Dickert et al., 2017) The 600 men involved in the Tuskegee study were not given the benefit of the human subject’s informed consent as the researchers carrying out the research informed the subjects that they were testing for bad blood, a word they used to describe various diseases. The project was initially scheduled for six months, but it went on for forty years.

The Tuskegee study violated the bioethical code of respect and denied the participating human subjects the right to complete information to make sovereign decisions. The participants faced racial injustices as the researchers were only using human subjects from the African American community. The human subjects that were tricked into participating in the study were denied the right to receive good healthcare (Dickert et al., 2017). The participants’ treatment was withheld after it was identified as the best choice of treatment.

Steps Taken to Minimize Risks on Human Subject

Consent

Participants are the best judges as to what is the acceptable amount of risk. Providing the participants with consent that is accurate and communicates effectively about what the study entails helps them decide on what is best for them (Lentz et al., 2016). The participants must read and understand the consent form before signing.

Data Collection and Storage

Losing confidentiality always proves to be a risk to those participating. Therefore, the data collection and storage methods ought to be the practices recommended and compliant with the data storage protocols (Malgieri & Niklas, 2020). Research that collects its information anonymously means that the data about participants cannot be leaked, which is considered a minimal risk. The data must be appropriately stored and destroyed after analysis to protect the participants’ confidentiality (Artal & Rubenfeld 2017).

The Population Considered Vulnerable

Refugees and IDPs, children, and pregnant women are a vulnerable population. The International Rescue Committee has a policy that does not tolerate anyone’s abuse in the vulnerable population. Children are not to continue participating in research if the team notices they are experiencing guilt, fear, or obligation (Blades et al., 2018). Refugees may be in trouble if any breach of confidentiality occurs. Pregnant women, and those that are still nursing children, may encounter increased mental and physical risks from taking part in the research (Goodwin, 2016).

Appropriate Ways of Recruiting Human Subjects

All research recruitment methods must be described following the International Rescue Committee protocol. The recruitment process materials have to be approved by the IRC (Kadam et al., 2016). Ways of recruiting people for human subjects include notices, advertisements, and the mainstream media. Furthermore, the UCIMC Clinical Trials Website can be utilized to post information related to the research study. The researcher should consider approaching the patients, students, and even employees in person (Lada, 2017).

Proper Ways of Obtaining Consent from Human Subjects

Any research that needs human subjects must be pre-emptively accepted by the participants after thoroughly briefing them on the whole exercise. Competent participants able to understand and comprehend the information related to the research topic can give proper consent (Goodwin, 2016). Giving the subject enough information about the study, giving them enough time to weigh all of their choices, and answering their questions accurately and honestly are all part of the informed consent process (Resnik, 2018).

Components of a Properly Written Consent

The study definition, threats, and any discomforts, benefits of the research to the subject and others, alternative procedures or therapies, confidentiality, human subject compensation, and any medical check-up or accident care, communications, and voluntary involvement are all included in a well-executed consent. All research-related information must be given so that participants can determine whether or not to be part of the study (Goodwin, 2016).

Committees Responsible for Monitoring Human Subjects Protection

Institutional Review Boards (IRBs) provides protection to human subject participating in research through the advanced and periodic reviews of the ethical acceptability of proposals presented by the researchers (Lada, 2017). IRBs play a significant role in the protection of human subjects from possible exploitation and harm.

References

Artal, R., & Rubenfeld, S. (2017). Ethical issues in research.Best Practice & Research Clinical Obstetrics & Gynaecology, 43, 107-114. Web.

Blades, C. A., Stritzke, W. G., Page, A. C., & Brown, J. D. (2018). The benefits and risks of asking research participants about suicide: A meta-analysis of the impact of exposure to suicide-related content. Clinical Psychology Review, 64, 1-12.

Dickert, N. W., Eyal, N., Goldkind, S. F., Grady, C., Joffe, S., Lo, B., Miller, F. G., Pentz, R. D., Silbergleit, R., Weinfurt, K. P., Wendler, D., & Kim, S. Y. (2017). Reframing consent for clinical research: A function-based approach.The American Journal of Bioethics, 17(12), 3-11. Web.

Goodwin, M. (2016). Vulnerable subjects: why does informed consent matter?.The Journal of Law, Medicine & Ethics, 44(3), 371-380. Web.

Kadam, R. A., Borde, S. U., Madas, S. A., Salvi, S. S., & Limaye, S. S. (2016). Challenges in recruitment and retention of clinical trial subjects.Perspectives in Clinical Research, 7(3), 137. Web.

Lada, F. (2017). Guidance for the management and administrative operations of Research Ethics Committees (REC). In Research ethics in the Arab Region (pp. 325-342). Springer.

Lentz, J., Kennett, M., Perlmutter, J., & Forrest, A. (2016). Paving the way to a more effective informed consent process: Recommendations from the Clinical Trials Transformation Initiative.Contemporary Clinical Trials, 49, 65-69. Web.

Malgieri, G., & Niklas, J. (2020). Vulnerable data subjects.Computer Law & Security Review, 37, 105415. Web.

Resnik, D. B. (2018). The ethics of research with human subjects: Protecting people, advancing science, promoting trust. Springer.

Bioethics is a rather specific field of ethical science which concerns itself with establishing universal moral principles and values that the development of biotechnologies and medicine should adhere to. As the existing tools and knowledge in biology, genetics, healthcare, and other related areas progress, it becomes incredibly important to review each aspect of existing and emerging ethical issues in an objective light. Thus, understanding the principles of bioethics and how to apply them to various parts of research and study is crucial for the healthcare field.

The principle of autonomy refers to the equality of the health professional and the patient, stating that they both should have control over decisions made during research or treatment. For example, in research, adhering to this principle would mean that the researcher obtains informed consent from the patient. They would need to explain to the patient all aspects of the study and lead them through the entire process of it before the patient can give their consent to participate. Another example is that if the patient decides to drop out of the study and asks the researcher to withdraw all data related to them, their decision must be respected and followed through on. Finally, the third example outlines that the researcher should never try to dictate to the patient on what decisions to make, as well as to influence them to accept or refuse specific offers.

Beneficence principle in bioethics emphasizes that a healthcare worker’s actions should always strive to benefit the patient. The first example of that is that a medical/biology student should constantly continue their education, improving and growing their knowledge and skills in order to provide the best outcomes for patients. Another example is that the research they conduct must be aimed towards learning about and/or resolving issues that people meet with their health, and should provide new theories to consider and explore. Thirdly, if, during a study, a group of patients is administered a placebo, this fact should never be revealed to them until at least the end of the research, as it would diminish healing benefits and violate the results.

The next bioethical principle is non-maleficence which means that a healthcare worker should not bring any harm to the patients unless it is ultimately necessary for their healing. There are many aspects to that claim, as the definition of harm can be ambiguous in different situations. However, this principle states that is should never be a healthcare professional’s intention to purposely violate patients’ well-being. The first example of that is that during a study, the researcher must never provide patients’ data to third parties unless it is necessary and agreed upon with the patients. Secondly, the researcher should always consider the effects the study they wish to conduct would have on the patients and ensure that it will not harm them in any way. Event unintentional, a violation of anyone’s health is still a threat, and the researcher must avoid that in their studies. Finally, when obtaining consent to participate in a study, the researcher must never alter or conceal vital information from the patient. They should provide participants with an honest review of the research, its potential consequences, adverse effects, and possible dangers.

The last principle of bioethics is justice, and it refers to the claim that every human being should have equal rights when obtaining medical help, and must receive the full scope of it. In research, an example of that principle can be that the researcher should never discriminate between races, genders, sexualities, or other characteristics when considering participants for their study. This is applicable unless the specifics of the research require only certain groups of population to be studied. A second example could be that the researcher must always strive to prioritize patients’ health when deciding on research topic, and not let financial or scientific interest overshadow it. Thirdly, when conducting a study, the researcher should take strong measures to protect patients’ data and their identities, and refrain from continuing with their research if that information is in any way compromised.

Ethics is a concept that outlines what is anticipated in regards to what is proper and accurate and what is incorrect or erroneous in terms of attitude. All areas of nursing care incorporate standards and moral conduct. Utilitarian theory and deontological ethics are the two basic categories of ethical standards and ethical theory. The distribution of restricted resources and end-of-life difficulties are two of the most prominent ethical dilemmas and issues in medicine (Fowler, 2017). This work was written with the aim of studying and analyzing the ethical theory of nursing.

Bioethics is a theory concerned with ethical decisions and good behavior in the biological sciences. Nursing ethics is a component of bioethics, which has grown into an umbrella word encompassing the ethics of the many disciplines of medicine (Jaimes, 2022). As a result of four societal pressures, bioethics combines ethical guidelines, nursing principles, public health moral standards, and other practically oriented ethics into a unified topic (Johnstone, 2019). The fast advancement in life science and healthcare technologies during the last century was the first cause for the birth of bioethics.

Bioethics arose as a result of media reporting on human research violations. The press solicited comments on medical technology developments from physicians, nurses, attorneys, theologians, philosophers, and other experts concerned with ethical concerns in the biological sciences. Patients sought the authority to make their own healthcare decisions. Patients and families demanded to discover the condition’s predictive value. Instead of just being a topic of healthcare coverage, they desired to collaborate with health care providers in determining treatment, improvement, and quality.

Bioethics concerns the interaction of healthcare, legislation, government policy, theology, and science. Each profession brings valuable ideas, resources, and approaches, and attempts to consider or reform behaviors and regulations that raise ethical issues are frequently most effective when they rely on resources from many disciplines (Martins et al., 2020). Organ transplantation and donation, comparative genomics, dealing with death, and environmental issues are some of the long-standing topics of bioethics. New scientific and technological advancements have an intense focus on problems such as assisted reproduction and nanoelectronics.

The importance of debate and exposition in bioethics is a crucial premise. There are several conversation bioethics organizations at campuses around the United States that advocate for precisely such aims. Many bioethicists, particularly medical researchers, place the highest value on independence (Veatch and Guidry-Grimes, 2019). They think that each patient should decide whatever course of action is best consistent with their values. In other words, the patients should always be able to select their own therapy.

Medical sociology has investigated the practice of bioethics in clinical treatment. Ethicists frequently place essential choices in the hands of doctors rather than individuals. Communication tactics advocated by ethicists reduce patients’ dignity. Instances entail physicians reviewing treatment alternatives with one another before speaking with patients or their families in order to portray a united front, limiting patients’ dignity and concealing professional doubt (Lamb and Pesut, 2021). Decisions regarding broad treatment goals were reframed as technical issues that excluded patients and family members.

Biological sciences, biotechnology, healthcare, pharmacy, government policy, legislation, philosophy, and religion are some of the disciplines of study that frequently intersect in bioethical problems. They emerge in medical, academic, and governmental settings, typically as a result of developments in biology, health care, and technologies, notably biotechnology. Although it originated as a heterogeneous field of knowledge, bioethics is today a full-fledged subject in its own right. As technology improves, bioethics will grow and become increasingly relevant.

References

Fowler, M. D. (2017). Why the history of nursing ethics matters. Nursing Ethics, 24(3), 292-304.

Jaimes, S. D. P. (2022). Role of ethics and bioethics in nursing. Revista Ciencia y Cuidado, 19(1), 5-8.

Johnstone, M. J. (2019). Bioethics: a nursing perspective. Elsevier Health Sciences.

Lamb, C., & Pesut, B. (2021). Conscience and conscientious objection in nursing: A personalist bioethics approach. Nursing Ethics, 0969733021996037.

Martins, V., Santos, C., & Duarte, I. (2020). Bioethics education and the development of nursing students’ moral competence. Nurse Education Today, 95, 104601.

Veatch, R. M., & Guidry-Grimes, L. K. (2019). The basics of bioethics. Routledge.

Introduction

The main principles of bioethics in the United States are beneficence, non-maleficence, autonomy, and justice. According to the concept of beneficence, a medical professional has a duty to act in the patient’s best interest rather than their own. This idea asks to weigh the advantages of obtaining therapies against their potential costs and hazards (Devettere, 2016, p. 14). In the non-maleficence, the patient should not suffer any damage. According to the non-maleficence principle, any activity that could in any way hurt a patient must be avoided at all costs. Additionally, this concept argues that the damage should not be excessive compared to the treatment’s benefits because “many therapies include some degree of pain” (Devettere, 2016, p. 18). These two principles might best represent patients’ interests, while the other two serve the healthcare workers more than patients.

Discussion

The patient’s liberty implies that each patient has the right to accept or refuse therapy. This concept mandates that a healthcare provider perceive the patients’ beliefs and judgments regarding certain treatments (Devettere, 2016, p.19). Justice entails allocating limited medical resources by deciding who receives what sort of care, when, and in what manner. When a patient is unable to make an educated choice on their treatment, this principle applies. The idea permits surrogates to be discovered acting in the patient’s place, in which case justice must be applied to find the appropriate individual (Devettere, 2016, p. 90).

Which of the bioethics principles listed above should be given precedence may not be clear and is still up for discussion and interpretation. In my position, though, I would first take into account the non-maleficence principle, which indicates that there ought to be no damage done to the patient, or at the very least, only to a minimal extent that is not excessive compared to the advantages of the therapy. Anyone seeking treatment frequently prioritizes getting better through better care which hence increases the weight of this principle relative to the other three.

Conclusion

Christian worldview shapes the background of each person in accordance with Jesus’s teachings and hence affects the order of bioethics principles for every specialist. Since Christianity values human life, the most, because it is God’s best creation, it is essential to let humans have their full rights, liberty, or in other words autonomy (Meilaender, 2020, p. 15). The next principle is beneficence because every medical worker has to serve society selflessly (Van der Merwe, 2020, p. 1). Other principles of bioethics in the Christian worldview would be ranked in order of justice and then non-maleficence.

References

Devettere, R. (2016). Practical Decision Making in Health Care Ethics (4th ed.). Georgetown University Press. Web.

Van der Merwe, D. G. (2020). The Christian spirituality of the love of god: Conceptual and experiential perspectives emanating from the gospel of John. Verbum Et Ecclesia, 41(1). Web.

Meilaender, G. (2020). Bioethics: A primer for Christians. Wm. B. Eerdmans Publishing.

Introduction

A person must have specific moral values that express the ethical orientation and valuable meaning of human behavior. Human beliefs gain sense through implementation in life circumstances and reflect the importance of ethics for a person and society. Modern achievements of science, such as abortions, designer babies, and stem cell research, are directly related to the ethics of the human worldview. Controversial bioethical issues can be challenging for a person within the framework of one’s permanent beliefs.

Discussion

A human is central to the moral values system and perceives ethical norms subjectively. Medical phenomena, such as abortion, are meant to help humanity but often cause controversy. For example, representatives of the pro-life movement are convinced that abortion is unethical and equate it to murder. However, many women who dare to take this step have good reasons and need scientifically based methods of solving the problem (Faundes et al., 2020, p.3). Since the well-being and health of a person is the most valuable thing in life, and abortion is designed to help a woman, the issue of life and health comes before any controversy.

Speaking of ethically debatable phenomena, it is worth mentioning the issue of designer babies, roughly speaking, children with characteristics ordered by parents. At this stage of development, editing the genome is considered morally unacceptable if it is a question of changing the color of eyes or hair. However, such technology could save the embryo from genetic diseases (Dickenson & Darnovsky, 2019, p.2). Similarly, the procedure of introducing stem cells aims to treat those diseases that were considered incurable before the invention of the technology. They are removed from the umbilical cord or placenta, which does not contradict moral and ethical standards. Therefore, the introduction of new, in some people’s opinion, contradictory technologies requires the use of measures to educate the public (Moradi et al., 2019, p.2). I am convinced that if medical interventions aim to treat or save a life, they unquestionably value the person and put one first.

Conclusion

After all, people in the community do not perceive bioethical values to the same extent. They often form their own, leading to consciousness and practical significance contradictions. Therefore, ethical norms often only go beyond simple ideas and become an obstacle to realizing the practical value of scientific progress. A person undoubtedly occupies the first position in the value system of life, and the means to help humanity cannot be contradictory.

References

Dickenson, D., & Darnovsky, M. (2019). Did a permissive scientific culture encourage the ‘CRISPR babies’ experiment?Nature Biotechnology, 37(4), 355-357. Web.

Faundes, A., Comendant, R., Dilbaz, B., Jaldesa, G., Leke, R., & Mukherjee, B. (2020). Preventing unsafe abortion: Achievements and challenges of a global FIGO initiative. Best Practice & Research Clinical Obstetrics & Gynaecology, 62, 101-112. Web.

Moradi, S., Mahdizadeh, H., Šarić, T., Kim, J., Harati, J., Shahsavarani, H., & Moore, J. B. (2019). Research and therapy with induced pluripotent stem cells (iPSCs): Social, legal, and ethical considerations. Stem Cell Research & Therapy, 10(1), 1-13. Web.