In an inpatient clinical setting, a patient refuses surgical intervention in favor of medical management for coronary artery disease.
Prompt:
In an inpatient clinical setting, a patient refuses surgical intervention in favor of medical management for coronary artery disease. The health care delivery team and the patient’s family favor surgical intervention. Can this dilemma be resolved solely on the theories of deontology and teleology? Why or why not? How would you resolve the issue? When discussing resolutions, focus on the following ethical principles: autonomy, beneficence, nonmaleficence, veracity, fidelity, paternalism justice, and respect for others.
Template 1
Healthcare providers have inherent professional duties and ethical obligations in using appropriate interventions to optimize the health and well-being of others (American Nurses Association, 2015). However, there are instances when ethics may not guide practice, and ethical dilemmas may arise in clinical practice making it challenging to determine action choices through a clear definition of a good or bad course. Deontology is an ethical theory that does not focus on personal emotion and individual control over actions. In this case, personal feelings do not matter; actions are judged based on moral right or wrong, irrespective of consequences (Barrow &Khandhar, 2021). On the hand, the theory of teleology explains human intention and the consequences of the action. It entails the why, why not, functional traits, and benefits an action confers to the bearer (Kampourakis, 2020).
To explain the place of theories of teleology and deontology in resolving the ethical dilemma behind a patient who opted for medical management in place of coronary bypass surgery may be reasonable to ensure this patient receives the best available evidence-based treatment that prolongs health and improves function. Conversely, seeking a reference point that guides treatment (the so-called policies and procedures) may not be compatible with patient goals, preferences, and goals of care. This will involve categorizing the patient’s choices as right or wrong, diverting moral principles or human emotions. In other ways, the effect of the patient’s feelings regarding the choice of medical treatment that will impact overall physical, social, physiological, moral, and psychological performance might not be considered. Although one might visualize that bypass surgery might improve the patient’s overall physiological function, that might not be the patient’s ultimate goal of care.
Clinically, resolving this dilemma would involve applying the paradigm (4 boxes) that offers decision-making tools. This allows providers to consider the medical indications, benefit versus risk, and impact on goals of care while considering the patient’s values, preferences, and effect on his quality of life, financial, legal implications, and hospital policy (University of Washington Medicine, n.d.). Beauchamp & Childress (2019) explain the need to prioritize moral values and virtues that define patients’ preferences for medical care, choices of healthcare services, and biological interventions. These individual moral values are rooted in ethical principles of respect for autonomy, nonmaleficence, beneficence, veracity, fidelity, paternalism, justice, and respect for all, essential in offering moral judgment and considerations in practice. Ethical principles correlate with fundamental human rights and establish what is ethically acceptable in societies, creating a balance in individual values, professional practice, and society and cultural context (Beauchamp & Childress, 2019).
Respect for autonomy will offer this patient the choice of medical treatment that improves the quality of life based on a clear definition of what quality of life means, individual preferences, and the meaning of treatment to goals of care. This patient may require a psychiatric consult for capacity assessment to understand the severity, gravity, and consequences of refusing surgical intervention. Consulting an advance care planning specialist will ensure that patient has a clear definition of value and preferences for goals of care goals. Aligning patients’ preferences for medical treatment over surgical intervention will guide the treatment team in weighing the futility of care and the medical reality of benefit versus harm. The providers must implement the principle of veracity by offering a clear explanation of each treatment option, including the harm versus benefit, relevant facts to allow the patient to gain knowledge of treatment options, and time to process and make informed consent. Explanation of treatment options should reflect the healthcare team’s primary commitment to the patient (fidelity), offering choices, helping, and advocating for best treatment options (Paternalism).
Suppose this patient has the capacity to precisely define and outline care goals that will improve quality of life. In that case, the ethical principle of respect for autonomy will protect personal freedom, informed decisions, and acceptance of the use of limited aggressive medical treatment. The ethical principle of the beneficence for offering care that promotes the good in others will protect healthcare providers’ obligations to advocate for patients’ choices of less aggressive medical care, thereby enhancing the ethical principle of a “Do No Harm” in a desire to relieve pain and suffering per patient’s individual choice (Guido, (2020, p. 36). The principle of justice allows patients to weigh the benefit versus the burden and ensures that patient is treated with fairness and dignity irrespective of personal preferences and available resources (Guido, 2020).
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.
Barrow, J. M, &Khandhar, P. B. (2021) Deontology. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls. (2022). https://www.ncbi.nlm.nih.gov/books/NBK459296/
Beauchamp, T., Childress, J., (2019). Principles of Biomedical Ethics: Marking Its Fortieth
Anniversary. American Journal of Bioethics. 19(11), 9-12. doi: 10.1080/15265161.2019.1665402.
Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Pearson
Kampourakis, K. (2020). Students’ “teleological misconceptions” in evolution education: why
the underlying design stance, not teleology per se, is the problem. Evo Edu Outreach 13(1) https://doi.org/10.1186/s12052-019-0116-z
University of Washington Medicine (n.d.). Bioethics tools.
Template 2
A strong sense of ethics helps people understand the reasons behind human behavior, which explains a great deal about human behavior (Baumane-Vitolina et al., 2016). The patient in the scenario presented has the right to refuse the surgical intervention in favor of medical management for coronary artery disease, despite the health care team and the patient’s family advocating the surgical procedure. This dilemma has a great deal of complexity, and it cannot be resolved solely based on the theories of deontology and teleology. The patient is acting on autonomy.
The concepts of teleology have been used in economic analysis to provide a framework to explain the choices consumers make as they go about their daily lives (Baumane-Vitolina et al., 2016). It is generally accepted that teleological ethics theories assume that a decision that is taken behind certain conduct should be based on an assessment of whether it is likely to lead to an ideal outcome (Baumane-Vitolina et al., 2016). Conversely, deontologists place a high value on the dignity of human beings, the obligation to fulfill one’s responsibilities to one’s fellow man, and the importance of respecting our various rights (Baumane-Vitolina et al., 2016).
The notion of autonomy refers to the ability of a person to act based on his or her values and interests (Guido, 2020). A person with autonomy has characteristics of a sense of self-worth, self-respect, and self-knowledge. For a person to develop these capabilities and attitudes, he or she must have the chance to consider viable options that include both opportunities for action and ways of thinking about the issues at hand.
The matter of deciding the fate of a patient based on their medical condition and the fact that the patient has the right to choose what happens to him or her is a complex one, with many factors to consider. I agree that the patient has the right to refuse surgical intervention. The patient was not deemed incompetent to refuse treatment, so whether the health care team or the patient’s family agrees or disagrees with the choice of treatment is up to the individual.
References
Baumane-Vitolina, I., Cals, I., &Sumilo, E. (2016). Is ethics rational? teleological, deontological and virtue ethics theories reconciled in the context of traditional economic decision making. Procedia Economics and Finance, 39, 108–114. https://doi.org/10.1016/s2212-5671(16)30249-0
Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Pearson.
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