Method for Analysis of Clinical Ethics Cases

Apply this model (table 2-1) to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.

In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?

  1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
  2. What are the goals of treatment?
  3. In what circumstances are medical treatments not indicated?
  4. What are the probabilities of success of various treatment options?
  5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?

Patient Preferences: The Principle of Respect for Autonomy

  1. Has the patient been informed of benefits and risks, understood this information, and given consent?
  2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
  3. If mentally capable, what preferences about treatment is the patient stating?
  4. If incapacitated, has the patient expressed prior preferences?
  5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
  6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy

  1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
  2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
  3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
  4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
  5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
  6. What are plans and rationale to forgo life-sustaining treatment?
  7. What is the legal and ethical status of suicide?

Contextual Features: The Principles of Justice and Fairness

  1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
  2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
  3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
  4. Are there financial factors that create conflicts of interest in clinical decisions?

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Sample Answer




The patient’s medical problem can be classified as acute, chronic, critical, reversible, emergent, or terminal.

  • Acute: An acute medical problem is one that comes on suddenly and is of short duration. Examples of acute medical problems include heart attack, stroke, and appendicitis.
  • Chronic: A chronic medical problem is one that is long-lasting and may not have a cure. Examples of chronic medical problems include diabetes, hypertension, and asthma.

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  • Critical: A critical medical problem is one that is life-threatening and requires immediate medical attention. Examples of critical medical problems include cardiac arrest, respiratory arrest, and sepsis.
  • Reversible: A reversible medical problem is one that can be cured or improved with treatment. Examples of reversible medical problems include pneumonia, heart failure, and cancer.
  • Emergent: An emergent medical problem is one that requires medical attention within a short period of time, but is not life-threatening. Examples of emergent medical problems include broken bones, severe bleeding, and poisoning.
  • Terminal: A terminal medical problem is one that is expected to result in death within a short period of time. Examples of terminal medical problems include advanced cancer, end-stage heart disease, and advanced lung disease.

The specific medical problem that the patient is experiencing will determine the classification of the problem. For example, a patient who is experiencing a heart attack is experiencing an acute, critical, and potentially reversible medical problem. A patient who is experiencing diabetes is experiencing a chronic, reversible medical problem.

It is important to accurately classify the patient’s medical problem so that the appropriate treatment can be given. In some cases, the classification of the medical problem may change over time. For example, a patient who is initially diagnosed with a chronic medical problem may develop a critical medical problem if the condition is not properly managed.

The patient’s medical problem should be discussed with the patient’s doctor or other healthcare provider to determine the appropriate classification and treatment.

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