Question

Nurse Travers, now employed by a local community hospital, has been an RN for over 25 years. She is shocked by how routinely physicians and nurses are lately will ing to participate in the death of patients. She strongly rejects abortion, withdrawing life-sustaining ventilators, and hastening death through pain medication. He beliefs are supported by her minister and her religious congregation. Supervisors a the hospital know about her views and frequently make arrangements so that Nurse Travers is not forced to violate her conscience. On a holiday, Nurse Travers's assigned floor was understaffed. Mr. Stoer, a patient with lung cancer and multiple organ failures, was in extreme pain because the cancer had spread near to his spinal column. The pain, which had only recently developed, was excruciating. Nurse Travers quietly prayed for him whenever she could. The patient's wife insisted on stronger pain medication, which a physician ordered. Nurse Travers believed that administration of the medication would hasten his death, due to his breathing problems. She refused to comply with the order, claiming it violated her conscience. On the phone, she explained to the physician that she was perfectly willing to give a more routine medication. The doctor aggressively insisted that she give the prescribed dose. Failure to do so, he insisted, would have serious consequences for Nurse Travers. She steadfastly refused. The result was that Mr. Stoer did not get the pain medication for five hours, the time it took to make alternative arrangements. He died soon after administration of the medication.

Explain virtual care ethics and principlism theory and why it is the appropriate ones to apply to the case with supporting reasoning.

Answer 1

The Nurse Travers case illustrates the conflict between virtue care ethics, which emphasizes moral character, and principlism theory, which applies four bioethical principles to medical decisions. While Nurse Travers acted out of a sense of moral virtue, the principles of autonomy, beneficence, non-maleficence, and justice highlight the complexity of the ethical dilemma faced when her personal beliefs conflicted with her professional obligations to relieve patient suffering.

Step-by-step explanation:

In the case of Nurse Travers and Mr. Stoer, the discussion revolves around the application of virtue care ethics and principlism theory. Virtue care ethics focuses on the moral character and virtues of the individual healthcare provider, emphasizing the empathetic, caring aspects of the patient-provider relationship, which Nurse Travers practiced through her care and prayer for Mr. Stoer. Principlism theory, on the other hand, deals with four main bioethical principles: autonomy, beneficence, non-maleficence, and justice. These principles help to navigate complex ethical dilemmas where clear-cut answers are not readily available.

Applying principlism to this case, autonomy respects a patient's right to make decisions about their medical treatment, such as requesting stronger pain medication. Beneficence and non-maleficence weigh the caring act of relieving suffering against the harm of potentially hastening death. Finally, justice considers the fair distribution of healthcare resources and access to care. There is a tension here as Nurse Travers's personal beliefs potentially conflict with the ethical obligation of acting in the patient's best interests as understood within a medical context.

The physician's insistence on administering medication reflects an interpretation of beneficence and non-maleficence prioritizing the immediate relief of extreme suffering. Meanwhile, Nurse Travers seems to prioritize the wrongness of killing and her personal definition of the physician's role, which she feels should not involve hastening death. Furthermore, her concerns reflect the deeper issue of the potential slippery slope that could arise from the broader acceptance of acts like euthanasia.

While virtue ethics would support the character-based decision-making that Nurse Travers exemplifies, it must be balanced with principlism not to deny care prioritized by the ethical principles guiding medical practice. Overall, the debate highlighted in this scenario is emblematic of the complex ethical issues faced in modern medicine, especially regarding end-of-life care and the physician's role in relieving suffering while respecting life.

Answer 2

Applying virtual care ethics and principlism theory to Nurse Travers's case is appropriate because these frameworks emphasize the importance of respecting individuals' values, autonomy, and moral principles in healthcare decision-making. Virtual care ethics acknowledges the impact of technology on healthcare relationships, ensuring that ethical considerations are addressed even in remote interactions. Principlism, with its core principles of autonomy, beneficence, non-maleficence, and justice, provides a systematic approach to evaluating conflicting values and ethical dilemmas, guiding decision-making in complex healthcare situations.

Step-by-step explanation:

Virtual care ethics recognizes the evolving nature of healthcare interactions, especially in the context of technological advancements. In Nurse Travers's case, the virtual component comes into play through communication with the physician over the phone. Virtual care ethics underscores the importance of maintaining ethical standards even in remote interactions, ensuring that Nurse Travers's refusal to administer the prescribed pain medication is rooted in ethical considerations.

Principlism theory, with its four core principles, provides a robust framework for evaluating the ethical dimensions of Nurse Travers's actions. Autonomy is evident in Nurse Travers's insistence on upholding her conscience and moral beliefs. Non-maleficence is considered as she refrains from administering the medication she believes may hasten Mr. Stoer's death. Beneficence is addressed through her commitment to praying for the patient and her willingness to administer a more routine medication. Justice is reflected in the efforts made by supervisors to accommodate Nurse Travers's conscientious objections.

By applying virtual care ethics and principlism theory, we ensure a comprehensive examination of the ethical dimensions of Nurse Travers's actions, taking into account her values, the patient's needs, and the principles guiding healthcare decision-making. These frameworks provide a balanced approach that respects autonomy, promotes beneficence, avoids harm, and upholds justice in the complex landscape of healthcare ethics.