Markenzie Jean-baptiste

11/18/2018

Ethics Paper 2

Consult Note: Should Mr. S wear the Wander Guard?

There are two ethical issues that need to be considered in this case. The first deals with denying Mr. S’s right to refuse treatment. This is an ethically significant issue because having Mr. S wear the wander guard appears to help decrease his fall risk. However, this decision would also oppose his clearly stated wishes against wearing the wander guard while denying him the right in exercising a greater freedom in this situation, which is the ability to urinate on his own( Kirk, 202).

The second ethical issue regarding this case involves the hospital’s insufficient staffing. Having more nurses to monitor Mr. S would also decrease his fall risk and accommodate his preference against wearing the wander guard. However, the insufficient staffing is limiting the hospital’s options in monitoring his safety. In so, Mr. S would be accommodating the capacity of the nursing staff to monitor him by wearing the wander guard while consequently rejecting his own preference. (Kirk, pg 203). This is ethically significant because accommodating Mr. S’s values and preferences, as well as accommodating the concerns of the nursing team regarding his safety are both important to consider( Kirk, pg 203).

Based off these ethical issues, three ethical principles can guide the course of action to address Mr.S’s fall risk. The first principle is Autonomy. Autonomy as free action is not being forced to do what one does not want to do (Yeo, 93). Autonomy is a good principle for guiding the decision in this case because having Mr. S wear the ankle wander guard violates his free action since it opposes his preference. Autonomy can also be related to effective deliberation, which is having the ability to rationalize thoughts regarding a decision (Yeo, 94). Since Mr.S has limited decision-making capacity, he has decreased ability to effectively deliberate his decision. This questions his competency and capability of making an autonomous decision and affects how much authority he should be allowed regarding his own welfare (Yeo, 97).

Dignity is the second ethical principle that should be considered. Dignity is concerned with how people feel, think and behave in relation to the value of themselves (Baillie et al, pg 9). It is important to consider the harm to Mr. S’s dignity by him wearing the ankle guard. It is important to also consider any identifiable dignity deficits in the care of Mr. S that could result in embarrassment, distress and harm to him( Baillie, pg 8). In so, the course of action should aim to preserve the dignity of Mr. S while promoting beneficence, keeping in mind any dignity deficits in care.

The third principle is beneficence, which incorporates promoting someone else’s good or welfare as well as removing or preventing harm (Yeo, 103). This is a good source for guiding the decision in this case because beneficence has always been valued in health care and is closely linked in meaning with caring( Yeo,104).Therefore, the decision to have Mr. S wear the wander guard can be an act of beneficence if it decreases his risk of falling as well as incorporate his own preferences and values.

Based off the ethical issues and principles presented, I recommend not having Mr. S wear the wander guard. The team should instead partner with Mr. S to reduce his fall risk by setting up more times to call and check on him at night. The hospital should make changes within the care team to be more observant regarding Mr. S, even having other medical team members, clerks, clinicians, volunteers or security guards alerted of the situation and help the nurses with the task of observing him and assisting him to the bathroom.

This course of action is supported by the principles of autonomy and dignity. Subjecting Mr. S to wearing the ankle wanderer guard would violate his autonomy as free action. Even though he has limited decision-making capacity, he was still able to communicate his choice regarding the wander guard. In so, his sister should make the medical choice that Mr. S would have made if he had full decision-making capacity since surrogate decision-making remains the best method of safeguarding prospective autonomy (Pope, pr 1079). It is also clear that she as well as the medical team do not want to attach the guard to him against his will.

Regarding dignity, Mr S. has repeatedly stated that he does not wish to wear the wander guard and it makes him feel like an animal with a shock collar. Even though he lacks full decision-making capacity, dignity applies equally to those who have capacity and those who lack it (Baillie, 9). Therefore, the hospital should follow my course of action since the lack of staffing is an identifiable dignity deficit in care. It is not Mr. S’s fault that the hospital is not adequately staffed with nurses. Therefore, he should not be penalized and have to wear the wander guard since it will cause him distress and harm to his dignity.

The course of action is challenged by the principle of beneficence. Having Mr. S wear the wander guard seems to remove harm if a nurse is able to help him get to the bathroom and reduce his fall risk. However, if a nurse isn’t available to help him in a timely matter due to insufficient staffing, the wander guard would not reduce harm to him and would not be an act of beneficence.

The greatest act of beneficence to Mr. S would be to respect his autonomy and dignity, which outweighs the possible beneficence with wearing the wander guard. This can be done if the clinical team partners with him and follow my proposed course of action. Health care is a team oriented field and this problem can be resolved if all health care team members in the hospital work together. Doing so would accommodate both the values and preferences of Mr. S and the care team. Subsequently, it would demonstrate respect for the dignity of the nursing staff knowing that they are understaffed( Baillie et al, pg 8).

 

 

Sources

• Kirk, Timothy W..” Staying at Home: Risk, Accomodation, and Ethics in Hospice Care.” Journal of Hospice and Palliative Nursing, 16, no. 4 2014;200-205
• ) Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116
• Yeo, M et al. (2010). Autonomy [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.
• Baillie et al. (2008)Defending Dignity- Challenges and opportunities for Nursing. Royal College of Nursing.