Read the case study presented at the end of Chapter 8 (Guido, p.133) which begins, “The patient was hospitalized for extreme low back pain
- Was there informed consent for the initial medications given to the patient?
- How would you determine that informed consent had been given for the MRI and the medications needed for sedation for the test?
- Was the informed consent deficient to the degree that there was a lack of informed consent for the patient for the second dose of medications?
- How would you decide this case?
Read the case study presented
- What questions would you anticipate the judge to ask Jimmy to ascertain his level of maturity, understanding of the full consequences of his lack of action, and possible alternative reasons for requesting that he be allowed to make his own medical decisions?
- How should the judge evaluate the mother’s response to her son’s request?
- Does the state of residency factor into the judge’s decision?
- Are there additional issues that should be addressed prior to deciding the outcome of this case?
- How would you decide the case?
Jimmy Chang, a 20- year- old college student, is admitted for additional chemotherapy. Jimmy was diagnosed with leukemia 5 years earlier and has had several courses of chemotherapy. He is currently in an acute active phase of the disease, though he had enjoyed a 14- month remission phase prior to this admission.
His parents, who accompany him to the hospital, are divided as to the benefits of additional chemotherapy. His mother is adamant that she will sign the informed consent form for this course of therapy, and his father is equally adamant that he will refuse to sign the informed consent form because “Jimmy has suffered enough.”
You are his primary nurse and must assist in somehow resolving this impasse.
- What do you do about the informed consent form?
- Who signs and why?
- Using the MORAL model, decide the best course of action for Jimmy from an ethical perspective rather than a legal perspective.
- Now decide the best course of action based on a purely legal perspective.
- Did you come to the same conclusion using both an ethical and a legal approach?
Please combine all of these responses into a single Microsoft Word document for submission. Submit only completed assignments (not partial or “draft” assignments). Be thorough in your responses to adequately address all aspects of each question.
Submit only the assignments corresponding to the module in this section.
Assignment Expectations
Length: 1500 words; answers must thoroughly address the questions in a clear, concise manner.
Structure: Include a title page and reference page in APA style. These do not count towards the minimum word count for this assignment.
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M6 Assignment UMBO – 4
M6 Assignment PLG – 4, 6
M6 Assignment CLO – 1, 2, 3, 7
The case study for Chapter 8:
so intense that he could not be scheduled for a magnetic resonance imaging (MRI) until his fifth hospital day. His physician explained to him that the Dilaudid and Ativan he would receive the next day to numb his pain for the MRI could cause respiratory depression or arrest in patients like himself who were on high doses of opiates. The patient agreed to be given the medications. At 8:15 A.M. the next day, a nurse gave the patient the medications, but the MRI had to be postponed.
With the physician’s new orders and the patient’s verbal consent, the nurse gave a second dose of the same medications at 11:30 A.M. About 5:00 P.M., the patient became stuporous. Vital signs were taken, oxygen was initiated, and Narcan was prepared for injection. At 6:00 P.M., the critical care code team was called, as the patient was in full cardiopulmonary arrest. The patient was successfully resuscitated and was discharged the next day. The patient then sued, claiming residual psychologi-cal symptoms and failure to obtain valid informed consent for the second dosage of medications administered at 11:30 A.M.”
The case study for Chapter 9:
When his attending physicians discovered that he was no longer taking the prescribed medications, they instituted court proceedings against his mother for child endan-germent. Jimmy was readmitted to the hospital at the same time in an attempt to ensure that he restarted the immuno-suppressive mediations.A juvenile court judge held separate meetings with
Jimmy, his mother, and the health care team in an attempt to resolve the issue. His mother, at her meeting with the judge, expressed anguish as she felt that not taking the medications would hasten her son’s death, but she was also resolved to the fact that she felt he was mature enough to fully under-stand the consequences of his non-actions.
Jimmy assured the judge that he understood the consequences of his non-actions, but he was tired of taking medications that merely increased his pain and suffering and wanted, as stated in his final comment, “some time to be free of pain. I am go-ing to die anyway.” The health care team were unable to assure the judge that taking the medications would greatly increase Jimmy’s longevity.”
Required resources:
- Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Prentice Hall. ISBN: 9780134701233. Read Chapter 8 & 9.
- Pozgar, G. D. (2020). Legal and ethical issues for health professionals (5th ed.). Jones and Bartlett. ISBN: 9781284144185. Read Chapters 12, 13, & 14.
Expert Answer and Explanation
Informed Consent
This paper will give an insight into various issues surrounding informed consent. Three case studies will be used to provide context on the subject under discussion.
Chapter 8 Case Study
Informed consent is a critical component when discussing ethics in care provision. Informed consent is a process that allows the patient to be informed about the benefits, risks, and alternatives to a given procedure, allowing them to make an informed decision without being forced by any secondary party (Guido, 2014). It is a way of ensuring that the patient has all the facts before deciding on how their care is to be provided. By getting valid informed consent, the health care worker is absolved of any known adverse outcomes that can occur from a therapy, which has been made known to the patient prior to the intervention.
Based on the merits of the case presented, there are two things that are to be assessed. The first being, whether oral consent is considered valid consent, and whether the patient was in the right state of mind to give the informed consent. As to whether the oral informed consent was valid, the answer is yes. Informed consent according to Guido (2014) can either be written or oral. Likewise, if it was proven that the patient was in the rights state of mind, (not under duress, in that case, extreme pain or under the effect of opiates), then the informed consent would be considered valid (Kalina, 2020)
To ascertain whether informed consent had been given, the following are some of the factors that need to be met. One is an explanation of the intervention, the name, and qualification of the person performing the procedure, an explanation of the benefits and risks of the procedure, and the right to refuse or stop the intervention even after being initiated (Guido, 2014). However, there are certain circumstances where informed consent becomes implied, especially when the procedure has low risk, for example, imaging procedures like MRIs and standard medication (Reeder et al., 2017). From the case, the patient also gave a second verbal consent for the procedures to be undertaken.
Having been explained the implications and risks attached to the medication given to the patient, then the informed consent could not be said to be lacking to the degree that no informed consent was given. However, the physician, to eliminate and benefit of doubt, should have reinformed the patient of the attached risks of the medication, and reiterate to the patient whether he intends to continue receiving the medication or not. Having done so would have absolved the hospital and the concerned parties from any liabilities that could occur thereafter.
Based on the merits of the case, it can be said that the patient gave oral consent on the procedures that were being undertaken. This was after being explained the risks attached to the procedure. While written consent would have been better evidence (Guido, 2014), oral consent is still considered valid before the court, so long as it is proven that it was given.
Chapter 9 Case Study
Using orthodox means, minors are not permitted to give consent on medical procedures on interventions to be prescribed by the health care provider. This is a mandate specifically meant for the parents and guardians of the minors, unless under special circumstances. However, a new concept of matured minors, borrowed from family law, has gained acceptance in many states. A matured minor can be termed as a teenager between 14 to 17 years who can make informed independent decisions after understanding the nature and consequences of those decisions (Guido, 2014).
Using the presented case, the judge is expected to ask Jimmy, whether he first understands the implications of the choice he is making, and whether those decisions are based on emotions or analysis of facts. The judge will also want to ask Jimmy whether it was common for him to make independent decisions without his mother’s input. Another question that the judge would likely ask Jimmy is the reason why he didn’t seek approval from his parents before making the decision.
From the mother’s response, there are two ways in which the judge can make his evaluation. The first approach is that the judge can look at Jimmy’s mother from the perspective that she is irresponsible and uncaring on the decisions made by her son. As such, the mother can be considered as having endangered Jimmy for lack of supervision when taking the prescribed medication, which could lead to a shorter lifespan for Jimmy.
Another way the judge could evaluate the response made by Jimmy’s mother is that she trusts her son is mature enough to make competent decisions on his own, maybe based on his previous decisions. As such, Jimmy can be considered a mature minor who can make independent decisions on his health without the input of his mother.
The state residency plays a major role in the judge’s decision. There are some states that do not recognize the aspect of matured minors (Guido, 2014). In case the judge is presiding the case in such a state, then Jimmy’s mother can be held culpable of endangering the wellbeing of her son and, as a result, charged by the court.
Before the court makes a decision, various issues must be addressed. The first issue is a show of proof from the medical experts that continuing with the prescribed immunosuppressive medications has a positive impact on the longevity of the patient. Likewise, the court has to assess the relationship between Jimmy and his mother to understand the motive behind the mother’s response. From there, a more informed decision can be made.
For the case, I would base my decisions based on the laws of the state, specifically laws concerning matured minors. Similarly, I would also base my decision on whether Jimmy was mature enough to make the decision he made. Otherwise, if found that he was not mature enough, then his mother would be found culpable of endangering her son.
Case study for Jimmy Chang
Getting informed consent from the concerned parties can end up being complicated. For example, in the provided case, where both parents have a conflicting opinion on the best method to deal with their child’s care.
After assessing the facts presented, the wisest decision would be to hold on to the patient’s consent form to give time for either parent to amicably come to an agreement. Likewise, in case the parents fail to agree on the issue, it would be prudent to also seek the input of Jimmy on what action he wants to take, given that he can be considered to be an adult capable of making his own decisions (Guido, 2014).
The choice of who signs the documents is dependent on the decision made by the patient. The reason for this is because Jimmy’s age considers him mature enough unless proven otherwise, to make competent decisions about his healthcare. Another consideration is what the best interests of the patient are from a clinical perspective.
Therefore, if chemotherapy is considered to be helpful to Jimmy in the long term, then his father will be allowed to sign the consent. According to Lang and Paquette,(2018), the right to refuse consent or to ignore non-consent can be made after a court order has been taken to indicate that the decision made can injure the health of the patient.
The MORAL model is a decision-making tool that can be applied in the context of the case to make ethical decisions. The first course of action that can be taken is to massage the dilemma (M). This involves the identification of issues surrounding the case from the various stakeholders, including both parents, in this case, Jimmy, and health care providers.
Using the collected information, an outline of options (O) can be made. This involves the identification of options based on the facts presented, including conflicting options (Ramos et al., 2016). At this stage, it is wise to list the pros and cons of each option. The third step in the model is to resolve the dilemma (R). this is done by using the basic ethical guidelines when assessing the available options and deciding the best option to take in resolving the dilemma (Guido, 2014).
The next step is the act of applying the chosen option (A) which involves implementing the decision made, whether it is to continue or desist from taking the therapy. The last stage is looking back and evaluating (L) whether the decisions made were to the benefit of Jimmy or not. Engaging Jimmy and his parents during the evaluation process is important. In case the first option failed to improve his health outcomes, then the alternative options will be implemented, taking the same approach again.
Based on a purely legal perspective, subjecting Jimmy to chemotherapy, in case he consents would be the best course of action. The legal standpoint indicates that the intervention to improve the health outcomes of the patient should be given priority and that court orders can nullify lack of consent if it is deemed to endanger the life of the patient.
Both ethical and legal approaches led to the same conclusion, which is to try and help Jimmy using chemotherapy to increase his longevity. However, for both approaches, his decision will be regarded as a primary factor using the ethical principle of autonomy and by law.
Conclusion
This paper has discussed various aspects of informed consent and some of the ways in which issues concerning informed consent can occur in the health care setting. Some of the pertinent issues that have been discussed include seeking consent from matured minors and application of legal and ethical principles in the event of a dilemma.
References
Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ: Prentice Hall.
Kalina, P. (2020). Ethical and Legal Manifestations of Informed Consent. Technium Social Sciences Journal, 8, 753-758.
Lang, A., & Paquette, E. T. (2018). Involving minors in medical decision making: understanding ethical issues in assent and refusal of care by minors. In Seminars in neurology (Vol. 38, No. 05, pp. 533-538). Thieme Medical Publishers.
Ramos, F. R. S., Barlem, E. L. D., Brito, M. J. M., Vargas, M. A., Schneider, D. G., & Brehmer, L. C. D. F. (2016). Conceptual framework for the study of moral distress in nurses. Texto & Contexto-Enfermagem, 25(2). https://doi.org/10.1590/0104-07072016004460015
Reeder, S. B., Kimbrell, V., Owman, T., Steckner, M., & Calamante, F. (2017). Guidelines for documentation and consent for nonclinical, nonresearch MRI in human subjects. Journal of magnetic resonance imaging: JMRI, 45(1), 36–41. https://doi.org/10.1002/jmri.25333
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FAQs
Deciphering the Moral Model of Addiction: Unveiling its Significance and Implications
In the realm of understanding addiction, various perspectives and models have emerged to shed light on the intricate nature of this complex phenomenon. One such perspective is the Moral Model of Addiction, which offers a unique lens through which we can view the behavior of individuals struggling with addiction. In this comprehensive exploration, we delve into the depths of the Moral Model of Addiction, dissecting its definition, historical context, implications, and its place in contemporary discussions surrounding substance abuse and dependence.
Defining the Moral Model of Addiction: A Moral Judgment Perspective
The Moral Model of Addiction posits that substance abuse and addictive behaviors are primarily a result of moral failings or deficiencies within the individual. According to this perspective, addiction is viewed as a conscious choice, driven by the individual’s lack of self-control, weak moral character, or an inherent lack of willpower. Proponents of this model often emphasize personal responsibility and accountability, framing addiction as a moral failing rather than a disease or medical condition.
Historical Context and Evolution
The roots of the Moral Model of Addiction can be traced back to ancient times when behaviors considered excessive or indulgent were often attributed to moral weaknesses. Over the centuries, this perspective evolved alongside societal beliefs about morality, willpower, and individual agency. During certain periods, addiction was stigmatized and seen as a reflection of one’s flawed character rather than a medical concern.
Implications of the Moral Model: Stigma and Responsibility
While the Moral Model of Addiction seeks to offer an explanation for addictive behaviors, it carries profound implications for individuals grappling with addiction and society at large.
Stigmatization and Self-Blame
One of the most notable consequences of the Moral Model is the stigmatization of individuals struggling with addiction. Viewing addiction as a moral failing can lead to societal judgment, shame, and isolation. Individuals may internalize this stigma, leading to decreased self-esteem and hindering their willingness to seek help.
Impact on Treatment and Support
The Moral Model’s emphasis on personal responsibility can influence how addiction treatment is approached. Some may argue that providing assistance to individuals viewed as morally responsible for their addiction enables their behavior. Consequently, this perspective could hinder the development of empathetic and supportive treatment approaches.
Critiques and Challenges
While the Moral Model of Addiction offers a distinctive lens for understanding addictive behaviors, it is not without its critiques and challenges.
Simplistic View of a Complex Issue
Critics argue that the Moral Model oversimplifies the complex nature of addiction. Substance abuse involves intricate interactions between biological, psychological, and environmental factors, which are not adequately captured by solely attributing it to moral failings.
Neglecting Medical and Psychological Realities
This perspective overlooks the well-established medical and psychological components of addiction. Neuroscientific research has demonstrated the impact of substances on the brain’s reward system and decision-making processes, indicating that addiction is rooted in physiological changes.
The Moral Model in Contemporary Discourse
In contemporary discussions surrounding addiction, the Moral Model has evolved alongside scientific advancements and changing societal attitudes.
A Nuanced Approach
While the Moral Model’s stigmatizing implications are concerning, some experts propose a more nuanced interpretation. They acknowledge the role of personal responsibility but emphasize the importance of considering addiction as a multidimensional issue that involves biological, psychological, and social factors.
Shifting Toward Compassion and Understanding
As society becomes more informed about addiction’s complexities, there is a growing movement toward compassion and understanding. Viewing addiction through a holistic lens that considers both individual agency and external influences allows for more comprehensive and effective approaches to prevention and treatment.
Conclusion
The Moral Model of Addiction, rooted in historical perceptions of morality and self-control, provides a distinctive perspective on addictive behaviors. While it offers insights into how society has historically viewed addiction, its stigmatizing implications and oversimplification of a complex issue have prompted critiques. As contemporary discourse embraces scientific understanding and empathy, the Moral Model finds itself evolving to accommodate the multifaceted nature of addiction. Ultimately, a balanced approach that acknowledges both personal agency and external influences is crucial for fostering a society that supports individuals on their journey toward recovery.
Unlocking the Power of Moral Models: A Comprehensive Guide
In the ever-evolving landscape of ethics and decision-making, moral models stand as beacons of guidance. These models provide individuals and societies with structured approaches to navigating complex moral dilemmas. At their core, moral models serve as cognitive tools that help us dissect ethical problems, comprehend different perspectives, and arrive at well-considered conclusions. In this comprehensive guide, we delve into the essence of moral models, explore their applications across various fields, and highlight their significance in shaping a more conscientious world.
Understanding Moral Models: Deciphering the Ethical Labyrinth
Moral models are frameworks that offer systematic pathways to analyze ethical predicaments. They assist in unraveling intricate moral knots by breaking down situations into manageable components. The utilization of moral models ensures that decisions are not solely driven by emotions or biases but are instead based on logical and principled considerations.
The Utilitarian Paradigm: Pursuit of the Greater Good
The utilitarian moral model revolves around the principle of maximizing overall happiness or utility. This model advocates for decisions that lead to the greatest benefit for the majority. By quantifying happiness and weighing it against potential harm, the utilitarian approach encourages outcomes that generate the highest net positive impact.
Deontology: Upholding Moral Duties and Rights
Deontological ethics, in contrast, places emphasis on moral duties and rights. Adherents of this model believe that actions should be guided by principles and rules, irrespective of the consequences. Immanuel Kant’s categorical imperative is a hallmark of deontological thinking, urging individuals to act only according to principles that could be universally adopted.
Virtue Ethics: Cultivating Moral Excellence
Virtue ethics shifts the focus from specific actions to the development of virtuous character traits. This model underscores the importance of cultivating qualities such as honesty, courage, and compassion. Proponents of virtue ethics argue that making morally sound decisions becomes natural when one possesses a virtuous disposition.
Ethics of Care: Nurturing Interpersonal Relationships
The ethics of care model centers on relationships and compassion. It asserts that ethical decisions should prioritize the well-being of individuals within personal and communal contexts. This approach is often critiqued for its potential to overlook broader societal considerations, but its emphasis on empathy remains pivotal.
Applications of Moral Models: From Boardrooms to Classrooms
Moral models transcend theoretical discussions; they find practical utility in various arenas. From professional settings to educational institutions, the application of these models enhances decision-making and fosters ethical awareness.
Business and Leadership
In the corporate realm, ethical dilemmas are a constant. Moral models aid executives in navigating complex choices, ensuring that business strategies align with both profitability and moral integrity. Whether it’s weighing the environmental impact of a product or considering employee welfare, moral models provide a systematic approach to decision-making.
Healthcare and Medicine
Healthcare professionals grapple with life-and-death decisions daily. The application of moral models assists in making treatment choices that prioritize patient well-being while respecting their autonomy. These models guide doctors through the intricate balance between beneficence and patient choice.
Education and Character Building
Educators play a crucial role in shaping the ethical perspectives of future generations. Moral models offer a framework for discussing values and principles in classrooms. By engaging students in ethical reasoning using these models, educators nurture critical thinking and responsible citizenship.
The Significance of Moral Models: Shaping a Better Tomorrow
The relevance of moral models goes beyond immediate decision-making. These frameworks contribute to the collective evolution of societal norms and values.
Cultivating a Thoughtful Society
As individuals engage with moral models, they develop the capacity for nuanced ethical deliberation. This, in turn, fosters a society capable of addressing multifaceted challenges with wisdom and empathy. The widespread understanding of diverse moral models encourages open dialogue and collaboration.
Inspiring Ethical Leadership
Ethical leadership stems from the consistent application of moral principles. Leaders who integrate moral models into their decision-making inspire trust and establish a culture of integrity. This ripple effect extends to their teams, creating an environment where ethical conduct becomes the norm.
Global Implications
In an interconnected world, ethical decisions reverberate globally. Moral models provide a common language for discussing ethical issues across cultures and borders. By embracing these models, international dialogues on pressing matters such as environmental conservation, human rights, and social justice gain clarity and depth.
Conclusion
Moral models are the compasses that guide us through the intricate labyrinth of ethical decision-making. From personal choices to societal considerations, these frameworks equip us with the tools to dissect complex issues, respect diverse viewpoints, and contribute to a more principled world. By integrating moral models into various facets of life, we elevate our ability to not only make sound decisions but also to collectively shape a better future.
