September, 2022

COURSE/SECTION: BSN 2B

2.1 APPLY YOURSELF

In The News

“Why I Hope to Die at 75”

The October 2014 issue of the Atlantic contained an article by Dr. Ezekiel Emanuel advocating ending the desperate medical quest for
continued life after the age of 75. He was not advocating euthanasia or suicide, but only that he would personally cease to take yearly
physicals, refuse vaccines , and all efforts to extend his life beyond that age. His opinion is important for several reasons to extend his life
beyond that age. His opinion is important for several reasons not the least of which is that he is one of the important architects of the
Affordable Care Act and is a chief medical advisor to the Obama administration.

His analysis is that essentially, if an individual were ever going to do anything useful, he or she would already have done it by 75 years of
age. He feels after age 75, the manic efforts to keep an individual alive are not leading to a high quality of life, but rather to a life of
continued enfeeblement of both mind and body. According to his view, not only is the effort to keep one alive extending the processes of
dying, but also gobbling up collective health resources that could be put to a better use.

1. Consider this in light of the right act that which creates the best outcome. If we decided to make his ideas the law, we could free up
additional money for vaccines, prenatal care and other important health initiatives. Is that the best outcome?

A. In my opinion, if this can be a law it will really benefit the human kind, there will be no shortage of vaccines, more benefits in prenatal
care and the government can save up the money that can be put on other things. By doing so, the government can focus more on the
problems in health care that requires more funding and attention.

2. If this make sense in regard to the elderly, why not the mentally infirmed perhaps the comatose?

A. The reason why mentally infirmed or comatose patients are not considered in this idea it is because it is their right to make their own
decision. We cannot take away their right and money just because they are not on their right mental state. They are not like those
people that have already done their role at the aged of 75. They are still human and it is their right to be treated with respect in their
decision.

3. If someone was willing to pay all additional medical cost after age 75, would that be acceptable, even if it only allowed the affluent
to extend their lives?

A. In my opinion it is not acceptable because it will be unfair to those who could not afford it. What is the essence of making it a law if
there will be no equality and there will be discrimination, because it will just shows that you need to have money in order for you to
extend your lives and if you have none then you need to accept that your life will end soon enough.

4. It is possible that Emanuel has taken a too limited view of the situation, and perhaps the best outcome comes from rejecting his
thesis altogether, and firmly insisting that a greater good comes from affirming that every person regardless of age or condition
possesses an intrinsic dignity, and worth by virtue of being human?

A. I agree that Emanuel had taken a too limited view of the situation because no one has the right to judge whether this person or that
person is not contributing to the community. Nobody has a right to choose or even think of deciding how others should or should not
live. So rejecting Dr. Ezekiel Emanuel thesis is the best thing to do.

CASE STUDY # 2

Act Of Utilitarianism: Calculating the Pleasures and Pain

Mr. Jimenez is a 78-year-old chronic pulmonary patient (emphysema) who has smoked two packs a day for 40 years. He takes a great
enjoyment and satisfaction in smoking and does not want to quit.
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In that his illness is exacerbated by smoking, his physician is demanding that he quit. Each time he tries to quit smoking, Mr. Jimenez
becomes irritable and unhappy. His wife and family hate it when he is not smoking because he becomes difficult to live with.

1. Consider this case from the position of act utilitarianism and create a pleasure-gained and pain-avoided list to see if you can
determine whether Mr. Jimenez should continue or Quit smoking.

If Mr. Jimenez Quit smoking the pain that he can avoided are heart disease, emphysema, diabetes, COPD or chronic obstructive pulmonary
disease, lung disease, heart disease and chronic bronchitis. These diseases are the pain-avoided list while if Mr. Jimenez do not quit
smoking the pleasure that he gained in smoking are it relieves his mental states such as depression, tension, irritability, and craving for
nicotine. That is why he takes great enjoyment and satisfaction in smoking because smoking can cause the nervous system to release a
happy hormone. On the other hand, each time Mr. Jimenez quit smoking he becomes irritable and unhappy making it difficult for his
family to handle him. If we consider this case from the position of act of utilitarianism, Mr. Jimenez should quit smoking because it will
benefit the majority in the family and as a nurse we should teach the family how to handle Mr. Jimenez temper so that he can adopt slowly
to the changes.

CASE STUDY # 3
Duty Oriented Reasoning: A matter of Principle

Juan and Joe are good friends. They both graduated from the same program and have gone work in the same radiography department. Part
of their duties is to be sure that the standby equipment is ready for service on the wards. Juan and Joe are working the night shift, and while
playing around, Juan inadvertently bumps the equipment, tips it over and breaks the standby instrument.

In that it was an accident, Juan ask you, as a friend, not to tell anyone it was his fault. “Accidents do happen”. The two of you switch out the
equipment, sending the broken piece down to maintenance, and put a working instrument on standby. In the morning your boss comes in
and notices that the equipment has been sent down to maintenance. He ask what happen, and Juan says, “I don’t know. Someone from out
of the department must have bumped it or something.” The boss looks at you and ask you the same question.

1. Solved the problem using Duty-Oriented or principal reasoning. Remember that in this from of reasoning, it is not the
consequences that are considered by rather the principles involves.

A. Juan and Joe are good friends and as a part of radiography program they need to fulfill their duties and that is to ensure that the
equipment’s to be use is ready for service in the ward but the problem is Juan bumps the equipment and it breaks. That is why Juan
Ask Joe that not to tell anyone about the accident. But because it is a duty-oriented ethics Joe need to tell the truth to their boss
because it is the right thing to and it is their duty to ensure the equipment.
2. What principles are involves in this case.
A. The principles involved in this case is Joe must tell the truth to the boss about why the equipment has been sent down to maintenance
or he must lie to the boss because it is your duty as his friend and also to escaped the situation.
3. Do any of the principles involved conflict with each other?
A. Yes, There is a conflict between the two principles because Joe has to choose, either he will betray his friend by telling the truth or he
will lie to save his friend that will result in breaking the code of ethics.
4. Do some principles have a higher value than others?
A. Yes, some principles have a higher value than others because some of the principles will be positively associated which has a higher
value than a negatively associated principles.

CASE STUDY #4

Think of this problem in light of the Ethics of Care:

1. If you were John, would you stay or leave? Explain your decision.

If I were John I will choose to leave with my wife from the hospital to the city because I’ve already stayed there and helped the staff and
patients for more than 10 hours which is the a lotted time given for level 1 and level 2 responders even though that I am a level 3
personnel. The hospital provided the medical and dietary needs of my wife for the last 10 hours but it cannot sustain my wife needs
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because her blood sugar is already out of control and could not rely on the food so it needs already a facility that can facilitate my wife. I
know that the nursing supervisor assured that my wife will be taken care of for me just to stay in my post but the resources is not enough to
sustain my wife’s condition so it is better for me to take her to the city.

2. List all the ethically sound options that john might considered.

1. John can leave together with his wife to the city but after his wife condition become stable, he can return to the hospital to continues
his duties as level 3 personnel.
2. He can ask his friend who is level 2 personnel to take his wife to the city, because it almost the end of his shift, so that he can still do
his duties as level 3 personnel.

3. Do you think the nursing supervisor’s decision was correct?

In my opinion, the supervisor’s decision of reporting John’s actions to the Louisana State Board of Nursing is wrong because even though
John is a level 3 personnel, he already done his job because he became a substitute for the level 1 and 2 personnel and his wife is also a
patient that needs urgent care so I don’t think that John have any violations.

4. If john leaves, should he receive a reprimand for his action? Potentially lose his license? Explain your answer.
If John leaves he should no be given a reprimand or lose his license because of his actions because he did not have any violations and
before he leaves he already done his duties to the hospital it just that he do his duties early and his wife is also a patient of the hospital so it
is natural for the hospital to provide what is best for the patient and that is better facility.

5. Regardless of whether John receive a reprimand, what should be done about the level 1 and level 2 nurses who failed to come to the
hospital to assume their roles?

As for the Level 1 and 2 nurses who failed to come to the hospital to assume their roles, they are the one who should be given public
reprimand because they have violations which is they fail to do their responsibilities as a nurse. It also can be neglect of duty, to be ground
for Dismissal under Article 282 of the Labor Code specifically gross negligence because of absence of care or they fail to do their
responsibilities.

2.2 REVIEW EXERCISES

1. What are some answers you could give” List five possibilities.
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- “Dr. Jones is a good surgeon but Dr. x is much better”
- “Dr. Jones is a very qualified and has been here for more than 10 years. We already handle many of his patients and
take very great care of them and all the so don’t be anxious it just a rumor”
- “Dr. Jones does most of the surgery in this hospital”
- "Are you feeling anxious about what will happen, now that you already done with your surgery?”
- "It is my first day on the job. I have no idea."
2. Which of the ethical system for decision making will you use in coming to answer – consequences, duty or virtue
ethics?
A. I will going to use virtue ethics in coming to an answer because
B. I will going to use duty ethics over virtue in coming to answer.

3. What answer will you give and why?

- The answer that I will give is "Are you feeling anxious about what will happen, now that you already done with your
surgery?” because it is bad to talk bad about other healthcare staff and also we can’t lie to the patient so it is better to
ask the patient how they feel to plan care needed.
- The answer that I will give is “Dr. Jones is a very qualified and has been here for more than 10 years. We already
handle many of his patients and take very great care of them so don’t be anxious its just a rumor” because I need to
lessen the anxiousness of the patient by letting her now that she is in good hands.

B. Review the following case thinking in terms of the Ethics of Care.

You and your sister are both physical therapist and are attending a professional conference. You’ve been asked by the
conference leaders to take one of the speakers to his hotel following his lecture. You are thrilled by this as Dr. Smith is a
noted medical scientist and a Nobel Prize winner. On the way to the hotel, the three of you are involved in a horrible car
accident that has resulted in a rapidly growing fire. You are fortunate enough to have been thrown out of the car and are
available to help. Unfortunately, you only have the time and strength to rescue one of the two victims, the noted physician or
your sister which will you choose?

The ethics of care hold compassion, discernment, trustworthiness, integrity, and conscientiousness as guiding virtues in
decisions. A consequentialist might have selected the scientist in the basis of the greater good. A duty-oriented ethicist might
have held each victim as equal and used a criterion that allowed for a just decision between equals.

1. Would the fact you are physical therapist have any effects on your decision?
A. No, being a physical therapist doesn’t have any effects on my decision because as a professional I have a
responsibility on both person so I have a to rescue both of them no matter what.

2. Certainly, rescuing your sister Is the natural thing to do and an understandable choice, but is it the “right
choice”?
A. Yes, because as a health care professional and a duty-oriented ethicist, it is my duty to also save my sister because
even though we are related to each other she is still a patient, but it depends on the situation because if my sister is
less injured and conscious, I might rescue Dr. Smith first.

3. In reality, even if you were a consequentialist, a thought the scientist might in the future do something great,
would that really stop you from rescuing your sister? Would saving your sister feel like the natural thing to do? is
naturalness considered a strength of the ethics of care with its focus in responsibility?

A. No, because I don’t have reasons any why I should stop rescuing my sister. As part of a family, it is a natural thing to do
and as a professional it is my responsibility to also rescue my sister. Naturalness is considered a strength of the ethics of
care because in care ethics, special relationship is morally relevant.

4. One of the criticisms of the Ethics of Care is that it threatened to devolve into tribalism. There’s my group and I
take care of them. As for the rest of you, you’re in your groups and in charge of yourselves. This isn’t “every man
for himself,” but it comes close to “every social group for itself” do you think tribalism represents a potential
problem with the ethics of care?

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A. In my opinion tribalism is a potential problem with the ethics of care because tribalism poses several challenges
such as competition, exclusion, shunning, discrimination, elitism and the possibilities of either ethnocentrism or
racism are all noticeable results of bad tribalistic behavior. Morality (the acceptable conduct of a group), in contrast
with ethics, can follow destructive patterns, such as discrimination on the basis of gender, race, status or place of
birth

C. A competent Erdely patient tells, “I want to go home.” You respond with “we won’t let you go home; you’re not
capable of taking care of yourself.” You may have just created the elements for what tort?
A. The elements of tort present in this scenario is intentional tort which violates a patient’s rights. A specific type of
intentional tort present in this scenario is false imprisonment because the nurse is keeping the patient against their will
even thought the patient is already competent.

D. The patient tells you, “I don’t want the treatment” you respond with, “your doctor ordered the treatment and told me
to make sure you take it, even if I have to hold you down”. You have just created the elements of what tort?

A. The elements of tort present in this scenario is intentional tort where in it is a willful act that violates a patient’s rights. A
specific type of intentional tort present in this scenario is assault because there is a threat made against the patient that
makes them fearful.

E. Following her return home from the hospital, the patient became aware that the respiratory therapy technician on the
day she checked out had given her a treatment that was meant for the patient in the next bed. The technician had not
checked the wristband on the patient before giving the treatment. This was a deep-breathing treatment designed to
make her cough and clear her lungs. Would the scenario produce a viable negligence action? If so, which type of best
fit? If not, what element is missing? Defend your answer

A. Yes, this scenario produces a viable negligence action. Medical negligence does not always result in injury to the patient.
The type of negligence best fit for this is negligence acts of commission because the respiratory therapy technician
administered wrong medication to a wrong patient and it is also a negligent of action of not checking the wrist band of
the patient that led her to be given a wrong medication.

F. Would a surgical nurse with strong pro-life values be correct in refusing to take part in a therapeutic abortion?

A: No, but even though a nurse is a pro-life when it comes to abortion, it is the responsibility of nurses to respect the patient
rights. Nurses should respect the choices of the mother for as long as abortion is legal under the law. But if abortion is against
the personal moral, ethical and religious values of the nurse, the nurse has a right to refuse to participate in therapeutic
abortion, except in an emergency situation, where the patient's needs do not allow for substitution and should not be ubjected
to coercion, censure or discipline for reasons of such refusal. The nurse should be competent, supportive and nonjudgmental.

G. Following his return from the hospital after abdominal surgery, the patient continued to have a pain and discomfort.
Returning to the hospital for a check up an X-ray was taken that showed a clamp had been left within the abdominal
cavity during the surgery.

If the patient decides to sue, do you think res ipsa loquitur would be a consideration? Explain why?
A. Yes res ipsa loquitur would be a consideration because there is absence of evidence that the injury complained was the
consequences of any other cause and the injury complained as well as the left clamp within the abdominal cavity would
not have happened if, proper care and due diligence were exercised and there was no negligence. In conclusion the
doctor who conducted the abdominal surgery is liable for negligently leaving a clamp in the patient’s body.

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