1. What is the patient’s medical problem?

Consider the “Four Topics Approach” (or Four Box method) to ethical decision making on page 61, Table 2.1 in Butts (below). Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.

In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?
Your paper should be 1-2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.
Review the rubric for further information on how your assignment will be graded.
Due: Sunday, 11:59 p.m. (Pacific time)
Points: 60
TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases
Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

SAMPLE SOLUTION

Ethical Frameworks Essay

The four-box method is a framework used to sort through and focus on specific aspects of clinical cases. The technique helps health care professionals connect the different circumstances of a situation to associated ethical principles. An example of a situation that required the use of the four-box method approach was that of a patient diagnosed with cancer (Schuman & Alfandre, 2008). The patient desired to live out the remaining days in peace and without pain. Therefore, she did not want tubes inserted to help in the breathing and eating processes. However, the family did not agree with the patient’s decision and told the staff that once the patient cannot object to the tubes, they should be put in. In order to find an ethical and amicable solution …

Medical Conditions

The patient had chronic lymphocytic leukemia. The disease was in its advanced stages hence there was no hope for a cure or full recovery. The goal of the treatment was to make the patient as comfortable and humanly as possible in the hospice (Baliakas et al., 2016). The patient was going through a combination of chemotherapy, targeted drug therapy, and immunotherapy. However, the treatments administered were not making much impact in fighting off the disease. The patient could benefit from medical and nursing care by allowing the healthcare staff to do their best in prolonging life, despite the discomfort and pain. Harm can be avoided by encouraging the patient to go on with the treatment process and offering ways to decrease any pain …

Patient’s Preferences

The patient decided that he did not want to be artificially maintained, no matter what the family and friends thought was best. The staff ensured that he understood the implications of this decision before giving consent. The patient made a choice when mentally capable and legally competent, which made sure that the family could not overrule his decision when the patient was incapacitated. It was the hospital’s role and obligation to ensure that the patient’s preferences were adhered to and …

Quality of Life

The patient’s quality of life was one of comfort. Due to the chronic nature of his illness, the treatments provided could not lengthen his life; instead, they were used to help in managing pain (Kangasniemi, Pakkanen & Korhonen, 2015). Even when the patient could no longer express himself, the hospital made their treatment judgments based on the earlier stated preferences of the patient, which they followed to the letter. The quality of his life in the long-run was poor and hence, consistent with the decision not to be …

Contextual Features

The patient’s family members were devout Christians who believed that all life is sacrosanct, which stemmed from the belief that the patient’s life should be preserved at all costs. The health care officials, however, opted to stick to the patient’s requests, considering the nature of his illness (Grace, 2017). Another reason noted by the staff was the financial implication in keeping the patient on life support. They pointed out that the financial burden may be a strain on the family, mainly because there was no hope that the patient …

Conclusion

The four-box method helps health care officials understand how to accurately associate the principles of beneficence and nonmaleficence ….

References

Baliakas, P., Mattsson, M., Stamatopoulos, K., & Rosenquist, R. (2016). Prognostic indices in chronic lymphocytic leukaemia: Where do we stand how do we proceed?. Journal of Internal Medicine, 279(4), 347-357.

Grace, P. J. (Ed.). (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.

Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: An integrative review. Journal of Advanced Nursing, 71(8), 1744-1757.

Pollard, C. L. (2015). What is the right thing to do: Use of a relational ethic framework to guide clinical decision-making. International Journal of Caring Sciences, 8(2), 362-368.