Nurses held accountable for a child’s death investigation

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Whether nurses should be held accountable for a child’s death if they miss opportunities to identify abuse is complex. First, if they fail to act on clear signs of accountability especially if these signs are documented well, they could be held accountable. Some factors may result in missed opportunities to identify abuse, such as deficiencies in training, overburdened nurses due to a high workload as well as breakdowns in communication within the healthcare team. Nurses are also guided by ethical principles such as beneficence and nonmaleficence, and missing signs of abuse conflict with these. Ultimately, the welfare of a child rests with their caregivers and parents.

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Ethical Dilemmas

Introduction

Ethical dilemmas are common in pediatric healthcare because healthcare providers have to strike a balance between the best interests of children while taking into account their parents’ rights. One of the most common dilemmas faced here is the consent for treatment which, happens when the medical needs of a child conflict with the wishes of the parents. This discussion will focus on the ethical dilemma where parents refuse treatment on behalf of a child and whether healthcare professionals should override this or should respect the decisions of the parents in situations that threaten a child’s life and the best interests of the child differ from the wishes and beliefs of the parents.

Case Description

The scenario is one where a child who is diagnosed with leukemia requires chemotherapy for survival. Due to their religious or personal beliefs, the parents of this child refuse the prescribed treatment despite the medical team’s recommendation as it being the best course of action. The healthcare team hence faces the dilemma of whether to respect or override the parents’ wishes and offer the child treatment.

Ethical Principles at Play

The ethical dilemma above is centered around several main principles of ethics in health care. The first is beneficence. According to this principle, healthcare professionals are supposed to act in the best interest of the child’s health by offering the child treatment. The second is autonomy. This stipulates that once they are capable of understanding their health status, the child should make all the decisions regarding their care as well as the independence of the parents to make decisions regarding the health of their children. The final principle is non-maleficence. This is the principle of healthcare professionals not harming the child hence offering them treatment, which can create a conflict between what they are supposed to do and the wishes of the parents.

ANA Code of Ethics: Provisions 1, 2, and 4

For the resolution of this ethical dilemma, the ANA Code of Ethics provides guidance through three specific provisions. The first provision stipulates that the primary commitment of the nurse should be on the patient and their well-being and hence, should act in the best interests of the child. In this case, since the parents are opposed to the chemotherapy, the nurse may have to advocate for the treatment of the child, even if it is against the wishes of the parents. The second provision charges the nurse with the responsibility to advocate for and promote the safety and well-being of the patient. This may call for the nurse to pursue the treatment of the child despite objection by the parents. Finally, the fourth provision gives the nurse the authority to make decisions in the best interest of the patient and always ensure a high quality of care even in tough ethical situations.

Pro Side of the Debate: Advocating for Treatment Against Parental Consent

The pro position is that the best interest of the child should come above the fact that the parents refused treatment on behalf of the child as healthcare professionals have a responsibility to protect and preserve life and save the life of the child via chemotherapy. The principles of beneficence and non-maleficence justify the healthcare professionals providing chemotherapy for the child despite the objections of the parents. The first provision of the ANA Code of Ethics stresses that the commitment of a nurse first comes to the patient, in this case, the child. Overriding parental consent and treating the child ensures their survival (Tantivitayapong et al., 2019).

In pediatric nursing, the concept of best interests takes precedence because the patients cannot make decisions independently. Healthcare professionals should hence advocate for the well-being of the child. This could involve challenging the parents’ decision about the child’s health if they could harm the child. According to research, treatments such as chemotherapy are important in the survival of a child diagnosed with cancer. This makes it ethical to act against parental wishes. (Tantivitayapong, et al., 2019).

Con Side of the Debate: Respecting the Rights of the Parents

From a con position, the rights of the parents should be respected except in extreme cases. This is because parents have the moral and legal rights to make important decisions on behalf of their children, especially about deep religious and personal decisions. In the case above, the parents refuse treatment due to their religious convictions. Healthcare professionals should hence respect their wishes. The key ethical principle here is autonomy. This principle stresses that their decisions concerning their child should be respected and upheld.

Provision 2 of the ANA Code of Ethics emphasizes the nurse’s responsibility to promote and protect the rights of the family. Respecting the parents’ decisions aligns with this duty. This also contributes to more trust between the parents and the healthcare professionals, and forcing chemotherapy on the child may cause distress to the parents and potentially harm the relationship between the parents and the child. This can even delay the recovery process (Tantivitayapong et al., 2019).

Plan for Resolving the Dilemma

To resolve this dilemma, the healthcare team should employ several approaches. The first is pursuing mediation via family discussions with a mediator. This could be a social worker who can clarify the importance of the treatment to the family while addressing any concerns that the parents might have. Another approach is involving the courts if the two parties cannot reach an amicable agreement concerning the treatment of the child in the case of a life-threatening situation. The final approach involves an ethics committee to ensure all ethical considerations are taken into account before reaching any decisions (American Nurses Association, 2015)

Possible Outcomes

On the Pro Side, the life of the child may be saved if chemotherapy is provided against the wishes of the parents. This could, however, lead to animosity between them and the healthcare team. On the con side, if the healthcare team respects the wishes of the parents, the child may not receive the chemotherapy leading to their death, but the autonomy of the family is preserved.

Conclusion

This ethical dilemma depicts the complexities of pediatric nursing and the importance of balancing conflicting ethical principles. The ANA Code of Ethics provides guidance, but ultimately, the healthcare team must consider the best interest of the child, the rights of the family, and the legal implications of their decisions.

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