The autonomy of the patient is one of the most important ethical principles that are needed to be considered by healthcare professionals. However, it also causes ethical challenges while working with the diseased individual. Paternalism in medical field pertains to the opposite meaning of autonomy. Medical paternalism refers to the decision making by the physician or any healthcare worker in which they feel that their decision is good for the health status of the patient even if the diseased individual can make the decision for himself (Murgic et al., 2015). Therefore, paternalism motivates the attitude of the healthcare professionals that they know much more than the patient. Because of this, the relationship between the healthcare professional and patient suffers the most and thus receive a lot of criticism. In other cases, sometimes the patient themselves asks healthcare professionals to practice paternalism. Hence, this all makes the situation difficult for the professional as there are conflicting attitudes (Murgic et al., 2015). Medical paternalism also gives priority to the decision of the healthcare workers and the decisions of the patient are disregarded. In addition to that, medical paternalism also helps in increasing the health status of the patient thus it could also be considered under beneficence (Davoudi et al., 2017). In the case study that has been provided, it can see that Joi Anderson was not able to make her own decisions. Her grandmother, Sharyn was taking decisions on her behalf. Even after the suggestion of the doctor, Sharyn refuses for blood transfusion for Joi because of cultural beliefs and financial issues. Therefore, in this case, the doctor could disregard Sharyn's decision as a blood transfusion for Joi's condition was very important so that major complications due to her condition can be avoided.
Informed consent in healthcare practices involves the autonomy concept. Taking consent from patients ensure them that no malpractice will happen which could harm them physically emotionally or culturally. Also, taking consent make sure that the patient is provided with complete information so that she can make decisions for his health. Informed consent involves full disclosure of facts and information with the patient so that the correct decision could be made by him (Katz, Webb & Committee on Bioethics, 2016). In this case study, informed consent will be obtained from Joi by stating all the information about her health to her. With that, knowledge about the procedure and its related advantages and complications should also be known to Joi. The registered nurse could maintain patient autonomy by giving patients the freedom to make a decision or choice. They could promote independent decision-making and thus regard their decision in the healthcare process (Arrieta Valero, 2019). It is also important for the nurse to preserve the privacy and confidentiality of the patient as it is crucial to protect the well-being of the diseased individual. This would help in maintaining the therapeutic relationship between the nurse and the patient. The registered nurse could take care of privacy and confidentiality by being more aware of the sensitive information of the patient for example the cultural beliefs and values of the patient. The nurse with that should pay extra attention to the factors which lead to confidentiality breaches in order to eliminate them in the case (Beltran-Aroca et al., 2016). The nurse, in this case, could make sure that Joi's personal health decision does not get out which could create problems for her. With that, the nurse could ensure to involve less number of members in the procedure so that information would not breach.
Beneficence is an ethical principle which discusses the goal of the nurse to work for the benefit of the patient. This practice in nursing improves the quality of life of the patient and thus promotes healing in them. It also enables preserving, respecting and protecting the life of the patient. The impact of beneficence on the patient-nurse relationship is very positive as both the individuals form a strong bond of trust due to regular and intense interactions. The relationship which formed involves genuine caring and respect for each other. The ethical principle ensures that both the parties would be faithful to each other (Pesut et al., 2020). In the case study, when beneficence would be applied here, then positive health outcomes would be attained for Joi. Her health would improve and thus a strong relationship will be formed between her and the nurse. Whereas the principle of non-maleficence suggests that no harm will be done to the patient knowingly or unknowingly by the nurse. By taking this principle in consideration the nurse and patient relationship are positively impacted. There will be respectful communication between the people (Ong-Flaherty DNP et al., 2016). In this case also, if the nurse would follow the principle of non-maleficence then the relationship between her and Joi would be therapeutic as the nurse would work for her profit only so that her health could be impacted in a positive manner.
Arrieta Valero I. (2019). Autonomies in interaction: Dimensions of patient autonomy and non-adherence to treatment. Frontiers in Psychology, 10, 1857. https://doi.org/10.3389/fpsyg.2019.01857
Beltran-Aroca, C. M., Girela-Lopez, E., Collazo-Chao, E., Montero-Pérez-Barquero, M., & Muñoz-Villanueva, M. C. (2016). Confidentiality breaches in clinical practice: What happens in hospitals?. BMC Medical Ethics, 17(1), 52. https://doi.org/10.1186/s12910-016-0136-y
Davoudi, N., Nayeri, N. D., Zokaei, M. S., &Fazeli, N. (2017). Challenges of obtaining informed consent in emergency ward: A qualitative study in one Iranian hospital. The Open Nursing Journal, 11, 263–276. https://doi.org/10.2174/1874434601711010263
Katz, A. L., Webb, S. A., & Committee on Bioethics (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2), e20161485. https://doi.org/10.1542/peds.2016-1485
Murgic, L., Hébert, P. C., Sovic, S., &Pavlekovic, G. (2015). Paternalism and autonomy: Views of patients and providers in a transitional (post-communist) country. BMC Medical Ethics, 16(1), 65.https://doi.org/10.1186/s12910-015-0059-z
Ong-Flaherty DNP, C., Banks PhD, A., Doyle MSN, M., &Sharifi, C. O. (2016). The meaning of evidence and non-maleficence: Cases from nursing. Online Journal of Health Ethics, 12(2), 2. http://dx.doi.org/ 10.18785/ojhe.1202.02
Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., Chambaere, K., &Janke, R. (2020). Nursing and euthanasia: A narrative review of the nursing ethics literature. Nursing Ethics, 27(1), 152–167.https://doi.org/10.1177/0969733019845127
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