Ethics Discussions 2

Protecting the Adolescents’ Right to Privacy

Adolescents are a critical group to deal with due to the variations in the consent age. Besides, their decision-making does not guarantee they will make the best medical decisions. Despite these factors, all minors who do not meet the majority age should be permitted to consent to their medical treatment. Doing so demonstrates respect for autonomy that all patients deserve. As healthcare providers extend this right to minors, they should ensure that they (minors) are adequately informed about the treatment and its outcomes. Minors also have a right to request their information not be shared with their parents. Besides acting in the minors’ best interest, not sharing information maximizes their right to privacy and confidentiality, which increases their trust in the healthcare system and providers (Pathak & Chou, 2019; United Nations, 2021). It should also be remembered that adherence to some medical practices, such as the use of contraceptives, and positive outcomes are best achieved when minors make some decisions independently. As a result, coding for juveniles is appropriate if parents must not know what transpired during the visit. A teen who does not want the parent to know what happened during the visit has a right to do so. However, they should be educated about parental engagement and its importance in terms of social support and health decisions.

Ethics Discussions 2 References

Pathak, P. R., & Chou, A. (2019). Confidential care for adolescents in the U.S. health care system. Journal of Patient-Centered Research and Reviews, 6(1), 46–50. https://doi.org/10.17294/2330-0698.1656

United Nations. (2021). Children ‘s right to privacy in the digital age must be improved. https://www.ohchr.org/en/stories/2021/07/childrens-right-privacy-digital-age-must-be-improved

All students will respond to EACH discussion in a professional manner with researched facts related to the topic. Please provide at least one source when you are responding to a discussion.

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Feminist Ethics and the Ethics of Care

Ethics has different meanings, and therefore distinction of the terminology is needed to understand better the purpose of the given ideal. In the professional field, ethics are sets of rules or standards that guide the actions of specialists working within their designated positions (Grace, 2023). Feminist ethics, by term, seems to reference women in an acquired role; however, it serves a broader population than females alone. According to Lepinard (2020), the feminist theory addresses the issue of power between genders or races and thus describes feminism: inequality due to limits placed on our individualism. In addition, according to Grace (2023), feminist ethics refers to oppression and domination that may occur in “race, class, disability, sexual orientation, and so forth” (p. 29).

Feminist theorists differ from the traditional masculine approach’s application of morality in healthcare (Johannson & Edwards, 2021). Feminist philosophers have been critical of other approaches over the past few decades. The feminist theory is set apart from others because it focuses more on care in relationships rather than applying abstract principles (Grace, 2023). Johansson and Edwards (2021) state that feminist ethics of care support caring through emotions and not by a set of rules. It allows care to be individualized instead of generalized. From the nursing perspective, one gives good nursing care by providing specific consideration for each individual and applying any complexity to focus on the entire patient (Grace, 2023). According to Johannson and Edwards (2021), the caring nurse should be understanding, accept uncertainty, and promote growth that will influence the patient’s future, in which innovation is prioritized over permanence.

In practice, are there imbalances in the power structures? If so, who benefits from keeping or maintaining a power balance? How can we modify the focus of power or uplift the one who should be the main focus?

Transparency Versus Withholding Information in Healthcare

Through the years, transparency has become an ethical foundation for medicine in America (Sisk et al., 2016). In healthcare today, physicians are obliged to provide information to patients regarding their health information. However, when looking back at historical medical practice we see that the intentional withholding of information was accepted and possibly even expected in healthcare (Sisk et al., 2016). This shift from withholding information to transparency in healthcare can partially be attributed to the development and progression of the patient-physician relationship over time. Certain driving ethical forces that focused on the physician’s obligation to provide the patient with their healthcare information also had a major affect on these changes in healthcare (Sisk et al., 2016).

In recent years, the healthcare world has faced new questions and challenges pertaining to the ethics of transparency (Collins et al., 2020). The COVID-19 pandemic has seemed to underline the benefits and importance of providing patients and the public with the information necessary to make an informed decision. The world was faced with a similar dilemma with the outbreak of the “Spanish influenza”. In this instance, the world saw what the withholding of healthcare information from the public could lead to (Collins et al., 2020). What we have seen with the COVID-19 pandemic in recent years reinforces the need for direct and honest lines of communication between public health officials and the public as well as between physicians and their patients. Transparency builds trust and this opens the door for patients to make informed choices regarding their healthcare behavior (Collins et al., 2020).

In healthcare today, standards of care include a distinct focus on disclosure of information and communication skills (Sisk et al., 2016). While there are some areas in healthcare in which communication and transparency may still be lacking, it is evident that major improvements have been made on this forefront over the past century. It seems that a common issue for many in healthcare is knowing what exactly the patient should know and how to best disclose this information to the patient. The ethical dilemma that is transparency versus withholding information in healthcare is a topic that will continue to evolve (Sisk et al., 2016).

In what ways do you feel that healthcare can continue to improve on with the disclosure of healthcare information? Have you ever been in a situation where disclosing information was difficult and what ethical dilemmas did you face during this situation? Has the COVID-19 pandemic altered you perspective on healthcare transparency in any way?

Ethical Issues Related to Providing Care to Difficult Patients and Families

Understanding the perception or danger of labeling patients or their families as “difficult” is something all healthcare workers should be aware of. No matter the reason, advanced practice registered nurses are responsible for trying to meet the needs of their patients (Amari-Vaught et al., 2023). Nurses may develop dislike towards patients or family members with their new perceptions. There are several reasons that patients may be or seem to be difficult. The same could be said for their respected family members who are a part of their progression of care. Reasons for possible labeling or developed dislike could be due to any of the following: age, prognosis, medical condition, personality, or any other factors (Fowler, 2020). Patients’ behaviors such as violence and abuse could also serve a role for possible labeling. Other patients or family members may question the knowledge or expertise of the nurse (Amari-Vaught et al., 2023). Providers may become angry, frustrated, or even punish patients when boundaries in the client-patient relationship are broken (UW Medicine, 2018).

Obligations

Maintaining a professional supportive environment is essential to treat individuals with dignity and respect (Amari-Vaught et al., 2023). As future advanced practice registered nurses, we have ethical and professional obligations to care for our patients and maintain clinician-patient relationships (UW Medicine 2018). Attempting to establish therapeutic relationships with patients may not be achievable but should be sought after. Transferring patients to other providers may be necessary if circumstances are necessary (UW Medicine, 2018).

Triggers

In a perfect world, all healthcare workers, patients, and family members would always get along. This unfortunately is not the case. Any divergence from this ideal world in healthcare can trigger any of the following: poor communication, anxiety, anger, or frustration (Fowler, 2020). Some of these triggers are out of our control but can be eased by better communication, training, and proper staffing (Fowler, 2020).

Strategies

There are several different ways to try to maintain therapeutic relationships with patients and family members. These strategies are done to keep our professional and ethical obligations. Using teamwork, patient allocation, and recognition of nurses’ strengths and weaknesses can help us care for difficult patients (Fowler, 2020). Setting clear expectations, boundaries, and ground rules will also help strengthen and maintain therapeutic relationships with patients (UW Medicine, 2018). Using awareness and understanding that negative emotions and attitudes displayed toward you are often misplaced may also help. Attempting to remove personal emotional reactions in difficult patient interactions can help with an overall objective reflection of the visit or situation (UW Medicine, 2018). Finding trusted colleges to assist with interactions will help to remove bias and maintain therapeutic clinician-patient relationships (UW Medicine, 2018).

Personal Views

The difficult patients or family members are a real population that healthcare workers deal with each day. Some places may be more difficult to work in and this population may be seen more. Physical and verbal abuse is most common in acute mental health and emergency departments that are often sparked by fear, alcohol, or frustration. (Fowler, 2020). For me, the only areas of health care I have worked in have been the emergency department and critical care units. The shifts that lack difficult patients are far and few in between. Personally, the diamond in the rough or angel patients and family members is what keeps me in healthcare. I have found it more difficult to come back to work in the intensive care unit when working seven days in a row. It is much easier to deal with a handful of perceived difficult patients in an emergency room and not have to deal with the same patient or family member the next shift. Knowing that the same difficulties will be there for the remainder of your stretch is one of the hardest pills to swallow for me as a nurse. Proper allocation of nurses based on acuity as well as difficulty can help ease burnout in these critical care units from my experience. As an advanced practice registered nurse, I can only hope to continue to have patience, kindness, and respect toward all populations that I come across.

Healthcare provider conscience

Conscience is defined as a cognitive process that provokes one’s emotions and decision-making based on the individual’s moral beliefs (Merriam-Webster, n.d.). One’s conscience is the “inner voice” that guides their decisions of right and wrong. Usually, these decisions are guided by religious or cultural beliefs. In healthcare, a provider’s conscience regarding a particular patient or situation can cause them to want to consult another physician to care for this patient for whatever reason. Thankfully, there are laws in place to protect a provider from being held legally responsible for refusing to care for a patient’s situation.

Provider conscience is protected under Alabama health, mental health, and environmental control code §22-21B-4 (2018). This written code is detailed into five parts. First, it details that a healthcare provider has the right not to participate in care services that violate his or her conscience. One stipulation to this chapter is that the health care provider has objected in writing prior to being asked to provide such health care services. With this in writing, the healthcare provider shall not be civilly, criminally, or administratively liable for declining care that violates his or her conscience. The only situation that liability is a concern is when the failure to provide care is when the life of a patient is in immediate danger. Furthermore, this law protects providers from being discriminated against in any manner based on declining to participate in services that violate their conscience from any person, other providers, health care institution, public official, or any board which certifies competency. This chapter also protects student providers from being required to perform a health care service because he or she has a particular position on care services. Code §22-21B-4 (2018) also protects patients from life-threatening situations. All healthcare providers are required to provide care in an emergency until other treatment options become available. This chapter also provides support is the affiliating hospital or other healthcare facilities as well as any employee, physician, or member associated with the provider denying care services.

The United States Department of Health and Human Services (2023) also supports the right for healthcare provider conscience. It allows providers the right of providers to deny care services regarding religious or moral beliefs. The department has set up a panel, known as the Federal Health Care Provider Conscience Protection Statutes, where providers can submit a formal complaint if they feel that discrimination regarding their rights has taken place.

What do you feel the right of the provider is to use their conscience to deny the participation in care of a patient? Is this right? Does this contradict the oath we took as providers to care for patients?