The National Council of State Boards of Nursings Professional Boundaries in Nursing Video

After reading Chapter 14 and reviewing the lecture powerpoint (located in lectures tab), please answer the following questions. Each question must have at least 3 paragraphs and you must use at 3 least references (APA) included in your post.

1. What signs might alert you to a potential professional boundary violation or crossing?

2. Contrast the terms terminal sedation , rational suicide, and physician-assisted suicide.

3. Identify at least 3 moral dilemmas that occur duEthical Issues in


Nursing Practice

Chapter 14

Relationships and

Professional Ethics

• Nurse–physician relationships

• Nurse–patient–family relationships

– Unavoidable trust

– Boundaries

– Dignity

– Patient advocacy

• Nurse–nurse relationships

The National Council of State Boards

of Nursing’s Professional Boundaries

in Nursing Video
Moral Rights and Autonomy (1 of 2)

• Moral rights are defined as rights to perform

certain activities

– Because they conform to accepted standards or

ideas of a community

– Because they will not harm, coerce, restrain, or

infringe on the interests of others

– Because there are good rational arguments in

support of the value of such activities

Moral Rights and Autonomy (2 of 2)

• Two types of moral rights

– Welfare rights

– Liberty rights

• Informed consent

• Patient Self-Determination Act

• Advance directives

– Living will

– Durable power of attorney

Social Justice

• Sicilian priest first used term in 1840; in 1848,

popularized by Antonio Rosmini-Serbati

• Center for Economic and Social Justice


• John Rawls’ concept of veil of ignorance

• Robert Nozick’s concepts of entitlement


Allocation and Rationing of

Healthcare Resources

• Does every person have a right to health care?

• How should resources be distributed so

everyone receives a fair and equitable share of

health care?

• Should healthcare rationing ever be considered

as an option in the face of scarce healthcare

resources? If so, how?

Organ Transplant Ethical Issues

• Moral acceptability of transplanting an

organ from one person to another

• Procurement of organs

• Allocation of organs

– Justice

– Medical utility

Balanced Caring and Fairness

Approach for Nurses (1 of 2)

• Encourage patients and families to express

their feelings and attitudes about ethical issues

involving end-of-life, organ donation, and

organ transplantation

• Support, listen, and maintain confidentiality

with patients and families

• Assist in monitoring patients for organ needs

Balanced Caring and Fairness

Approach for Nurses (2 of 2)

• Be continually mindful of inequalities and

injustices in the healthcare system and how the

nurse might help balance the care

• Assist in the care of patients undergoing surgery

for organ transplant and donation patients and

their families

• Provide educational programs for particular

target populations at a broader community level

Definitions of Death

• Uniform Determination of Death Act definition of

death: “An individual who has sustained either (1)

irreversible cessation of circulatory and respiratory

functions or (2) irreversible cessation of all functions

of the entire brain, including the brain stem is dead.

A determination of death must be made in

accordance with accepted medical standards.”

• Traditional, whole-brain, higher brain, personhood.


• Types of euthanasia:

– Active euthanasia

– Passive euthanasia

– Voluntary euthanasia

– Nonvoluntary euthanasia

• Blending of types may occur

• “Is there a moral difference between actively

killing and letting die?”

Rational Suicide

• Self-slaying

• Categorized as voluntary active euthanasia

• Person has made a reasoned choice of rational

suicide, which seems to make sense to others at

the time

– Realistic assessment of life circumstances

– Free from severe emotional distress

– Has motivation that would seem understandable to

most uninvolved people within the community

Palliative Care

• Approach that improves the quality of life of

patients associated with life-threatening illness,

through prevention and relief of suffering

• Do-not-resuscitate order:

– There is no medical benefit that can come from

cardiopulmonary resuscitation (CPR)

– The person has a very poor quality of life before CPR

– The person’s life after CPR is anticipated to be very


Rule of Double Effect

• Use of high doses of pain medication to lessen

the chronic and intractable pain of terminally

ill patients even if doing so hastens death

• Critical aspects of the rule:

– The act must be good or at lease morally neutral

– The agent must intend the good effect not the evil

– The evil effect must not be the means to the good


– There must be a proportionally grave reason to risk

the evil effect

Deciding for Others

• A surrogate, or proxy, is either chosen by

the patient, is court appointed, or has other

authority to make decisions

• Three types of surrogate decision makers:

– Standard of substituted judgment

– Pure autonomy standard

– Best interest standard

Withholding and Withdrawing

Treatment: 3 Cases

• Case 1: Karen Ann Quinlan

• Case 2: Nancy Cruzan

• Case 3: Terri Schiavo

Terminal Sedation

• “When a suffering patient is sedated to

unconsciousness…the patient then dies of

dehydration, starvation, or some other

intervening complication, as all other life-

sustaining interventions are withheld”

• Has been used in situations when patients

need relief of pain to the point of


Physician-Assisted Suicide

• Act of providing a lethal dose of medication for

the patient to self-administer

• Oregon Nurses Association special guidelines

related to the Death with Dignity Act

– Maintaining support, comfort, and confidentiality

– Discussing end-of-life options with patient and family

– Being present for patient’s self-administration of

medication and death

– Nurses may not administer the medication

– Nurses may not refuse care to the patient or breach


End-of-Life Decisions and Moral

Conflicts with the Nurse

• Communicating truthfully with patients about death due to

fear of destroying all hope

• Managing pain symptoms because of fear of hastening


• Feeling forced to collaborate relative to medical treatments

that in the nurses’ opinion are futile or too burdensome

• Feeling insecure and not adequately informed about

reasons for treatment

• Trying to maintain their own moral integrityring end-of life care and decision making.

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