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Ethical Decision Making in Nursing and Health Care the Symphonological Approach James H 4EDITION Ethical Decision Making in Nursing and Health Care The Symphonological Approach James H. Husted is an independent scholar. He is a member of the American Philosophical Association and the North American Spinoza Society.He has been a member of the high IQ societies, Mensa and Intertel. He was the philosophy expert for Dial-An-M for Mensa, as well as the philosophy editor of Integra, the journal of Intertel. He guest lectures on bioethics at Duquesne University in the BSN, MSN, and PhD programs. He writes and presents workshops in the area of bioethics. Gladys L. Husted, RN, MSN, PhD, CNE, is a professor emeritus of nursing at Duquesne University,Pittsburgh, Pennsylvania. She received a master’s in nurs- ing education from the University of Pittsburgh, where she also completed her PhD in curriculum and supervision. She was awarded the title of School of Nurs- ing Distinguished Professor in 1998. She has retired from full-time employment at Duquesne University but continues to teach part-time in the MSN and PhD programs. Her main area of expertise is in bioethics, where she writes, presents workshops, consults, and does research. Her other areas of expertise are in cur- riculum design, instructional strategies, and theory development. Dr. Husted’s Web site can be accessed at www.nursing.duq.edu/faculty/husted/index.html. 4EDITION Ethical Decision Making in Nursing and Health Care The Symphonological Approach James H. Husted ■ Gladys L. Husted Copyright © 2008 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Allan Graubard Production Editor: Tenea Johnson Cover design: Joanne E. Honigman Composition: Aptara Inc. 07080910/54321 Library of Congress Cataloging-in-Publication Data Husted, James H. Ethical decision making in nursing and health care : the symphonological approach / by James H. Husted, Gladys L. Husted.—4th ed. p. ; cm. Gladys L. Husted’s name appears first on the previous edition. Includes bibliographical references and index. ISBN 978-0-8261-1512-6 (pbk.) 1. Nursing ethics. 2. Nursing—Decision making. I. Husted, Gladys L. II. Title. [DNLM: 1. Ethics, Nursing—Case Reports. 2. Ethics, Nursing—Nurses’ Instruction. 3. Decision Making—Case Reports. 4. Decision Making—Nurses’ Instruction. 5. Models, Theoretical—Case Reports. 6. Models, Theoretical—Nurses’ Instruction. WY 85 H972e 2008] RT85.H87 2008 174.2—dc22 2007029676 Printed in the United States of America by Bang Printing. Contents List of Case Study Dilemmas ..........................................................vii List of Figures ......................................................................xi List of Tables ......................................................................xiii Preface ...........................................................................xv Acknowledgments ..................................................................xix Section I: The Basics of Bioethical Decision Making Chapter1 Overview ...........................................................3 Chapter2 The Ethical Journey ...............................................15 Chapter3 The Nurse—Patient Agreement ....................................33 Chapter4 The Bioethical Standards and Their Role as Preconditions of the Agreement ..................................................55 Chapter5 The Nature of the Ethical Context ..................................81 Chapter6 Practice-Based Ethics and the Bioethical Standards as Lenses .......105 Chapter7 The Power of Analysis Through Extremes ..........................123 Chapter8 Apparent Conflicts Among the Bioethical Standards ................139 Chapter9 Elements of Human Autonomy ....................................157 Section II: Beyond the Basics—An Extended Perspective Chapter10 Giants: The Classic Tradition ......................................191 v vi Contents Chapter11 Contemporary Ethical Systems ....................................207 Chapter12 Virtues as Resources .............................................227 Chapter13 Advanced Concepts in Symphonological Theory ....................245 Section III: Case Study Analyses Analyses of Dilemmas ..............................................................259 Glossary .........................................................................311 Index ............................................................................325 List of Case Study Dilemmas (See section 3 for Analyses of Dilemmas) 3.1 What to do about a woman who says she wants to quit going to dialysis, but continues to get on the bus? .........................35 3.2 Is the use of “deception” to protect a patient’s pride justified? ...............................................................40 3.3 What is the nurse’s obligation to herself in this difficult situation? ..............................................................44 3.4 Should a patient in a persistent vegetative state be allowed to die? .................................................................47 3.5 Can the agreement be broken for a once in a lifetime opportunity? ...........................................................51 4.1 What should the health professional do when a patient delays life-saving treatment to protect the life of her unborn child? ..................................................................60 4.2 Should a dying patient remain “full code” because of his family’s optimism? ......................................................62 4.3 Should a nurse be held to her promise of secrecy? ........................64 4.4 Should a dietitian provide TPN to a dying man against her better judgment because it is what the physician wants? ...................65 4.5 As the agent of the patient, what could the nurse have done? ..............67 4.6 Is it ever right to tell lies from benevolent motives? .......................71 4.7 Should heroic measures be used to keep a dying patient who is in excruciating pain alive? ........................................74 5.1 Are there circumstances under which a nurse is justified in discontinuing home visits? ............................................82 5.2 What is the relative importance of protocol versus patients? ...............83 vii viii List of Case Study Dilemmas 5.3 Should homeless men without relatives be considered organ donors? ................................................................92 5.4 Should a physician order beneficial surgery against a patient’s wishes? ........................................................93 5.5 What are the rights of a gay couple? ......................................94 5.6 Should a person be forced to do what is in her own best interest? ...............................................................97 5.7 In the case of an in-vitro fertilization and subsequent divorce, who owns the embryos? ........................................100 6.1 Should a young girl be told she is dying despite what the mother wants?.........................................................114 6.2 Should the wishes of a daughter to be an organ donor be honored now that she is dead? ..........................................117 6.3 Should a young girl be informed that her physician has discovered the condition of testicular feminization? ......................117 6.4 Does a terminally ill patient have a right to expect something from a nurse that might be injurious to his health? .......................120 8.1 Should an individual with dementia be medicated against his will to make him “easier to handle”? .................................141 8.2 Is a health care professional right in attempting to compel a patient to make decisions regarding his treatment? .....................142 8.3 Should a dying patient be told of his condition if the information will terrify him?............................................143 8.4 What is to be done when intrafamily coercion is suspected? ..............144 8.5 Should a comatose Jehovah’s Witness be given a blood transfusion? ...........................................................146 8.6 How does a nurse deal with a patient who makes demands on her that interfere with her attention to other patients? ................147 8.7 Does a parent’s right to know override the right of a child to have his parents not know? ..........................................147 8.8 Should a nurse give out information on the phone if this information might help or might harm her patient’s best interest? ..............................................................149 8.9 Should a feeble and elderly patient be let out of restraints to freely walk around? .................................................149 List of Case Study Dilemmas ix 8.10 Should a nurse interfere with a patient’s activities if these activities threaten his well-being? ......................................150 8.11 Should a nurse give sensitive information to a family member before she has discussed this with her patient? ..................151 8.12 Should a nurse tell a patient’s wife that a symbolic agreement the patient and family member had was not realized? ....................152 8.13 What should be done about a conflict between what a family needs to know and what a patient does not want
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