A Patient's Right to Self Determination

Introduction

Professional nursing practice entail diagnosing and treating humans in response to actual or probable health problems through provision of services like case finding, health teaching, health counseling, and provision of care to enhance or restore life and wellbeing. Nurses also play an essential role of executing therapeutic regimens as prescribed by licensed doctors in accordance to the established regulations. Nursing is, therefore, concerned with prevention of diseases, lessening suffering, besides promoting and protecting health (Lachman, 2006). Nurses work to influence variables in the social structure that hinder health and well being. To promote safe, competent and ethical practices, nurses have to be committed to developing and implementing practice standards through continuous acquisition, critical use and evaluation of relevant knowledge, attitudes, skills and judgments.

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As such, nursing is a self regulating profession whereby the professionals are responsible and accountable for their practice. Nursing practice is a product of the relationships existing between humans, health, environment and nursing. The practice is offered to a diverse population in the entire lifecycle, as well as groups and communities. Current nursing practices are evidence-based, requiring establishment of viable nursingpatient relationship. In response to the dynamic health challenges, the nurse-patient relationships have evolved from paternalistic, where the nurse made all the decision without the input of the patient to the information model, where the patient decides on the information provided to him or her. Current nurse-patient relationships also involve the modern model which is partnership based. The partnership model empowers the patient to self determination according to his or her perspective. In addition, the partnership model is based on values such as mutual respect, trust, regular consultations, and individual nurse attributes and traits that are appropriate. However, nursing practice in the current world is faced with many ethical dilemmas that pose great challenges and perplexities. The dilemmas are exacerbated further by the developments in medical technology that help in prolonging life, improving the quality of life, in addition to philosophical and legal contestations regarding a patient’s autonomy (Lachman, 2006).

Benefits of the Patient's Right to Self Determination

Ethics is an important aspect of nursing. The nursing profession owes its uniqueness to its historical concern for the wellbeing of patients, wounded people and vulnerable individuals, and social justice. Most patients depend on the expertise of the nurse and assume that the nurse will uphold the patient’s best interests, and therefore cooperate with the treatment plan as developed by the nursing practitioner. The patient’s right to self determination is important as it makes the patient aware of the intended treatment or assessment plans, and can therefore exercise their right to enroll freely into the treatment decisions based on informed consent. Informed consent details the way the nursing practitioner plans to employ given diagnostic or treatment methods to enhance the patient’s wellbeing (Killion & Dempski, 2006).

The right to self determination helps protect a patient’s dignity and integrity in the health care settings. It also is essential in fostering more trust between the nurse and the patient. In the informed consent principle, it is common for medical interventions to be carried out on a patient without the patient having an in-depth understanding of the intervention or the complications which might arise from the intervention. When the patients do not get adequately informed so that they give consent, legal tussles are likely to result whereby the patient can sue the practitioners for malpractices (White, Singer & Siegler, 1993). It, therefore, follows that the perfunctory informed consent methods often fail to achieve the intended function of providing the patient detailed information to enhance his or her capability to make preferred decision. The patient’s right to self determination addresses the shortcomings of the informed consent principle as it emphasizes clearly on the patient’s ethical and legal right to make decisions concerning their live and health (Ulrich, 1999).

By promoting the patient’s right to self determination, nurses and other health care practitioners identify the significance of partnering with the patients or their surrogates in the health care environment, hence designing treatment interventions that reflect the needs of the patient. Patient self determination also encourages individuals to give advance directives concerning health care decisions while they have the capabilities to do so, since it is generally accepted that people have interests in the type of medical interventions provided to them even when they are not in a position to make decisions by themselves. A majority of patients usually have ideas concerning the type of health care they want in case they do not have the capabilities to articulate their desire when the medical interventions are being planned (Killion & Dempski, 2006).

The principle of autonomy of a patient is the primary ethical principle in nursing and health care practice. This ethical principle gives all people the right to self determination, including patients having poor cognitive abilities by virtue of age, for instance children and frail elderly, or diseases which may be mental, psychological, or physical. The patient’s right to self determination also applies to people who may be unconscious or semiconscious, those whose reasoning has been affected by substance use, prisoners, and people who generally lack the capacity for self determination. When a patient does not have the capacity for self determination or when this capacity is diminished, then the immediate family members and guardians who are adults and have the best interest of the patient are conferred with the patient’s right for self determination based on the patient’s prior suggestions and values. The interests may be exercised in light of advance directives if available in form of, “living wills, natural death act statutes, do not resuscitate orders and durable powers of the attorney for health care” (Butts & Rich 2012, p. 173).

The patient has the right to make decisions; hence the patient holds consent for treatment issues like procedures and complications. Additionally, the right for self determination means that the patient can opt not to have treatment. The right to self determination is founded on human dignity, whereby nursing practitioners are supposed to act with integrity and make decisions conforming to the patient’s values, preferences and interests. In nursing practice, upholding a patient’s autonomy involves providing them with free and informed consent for any medical intervention. This requires active involvement of the patients in all health care decisions. Patients retain the legal and moral rights to make decisions regarding their own person, to receive accurate, comprehensive and detailed information in a way that will help them make informed judgments. They are also to be helped in determining the advantages, disadvantages and available alternatives in their treatment, including the option of no treatment; to accent, decline, or stop treatment independently without external influence, coercion or deceit. Nurses are supposed to provide all necessary support in the entire decision making and treatment process. The support could be in form of creating opportunities to make choices affecting patients in consultation with family and significant others. Nursing professionals preserve and support the interests of the patient by evaluating the patient’s understanding of the information availed and the outcome of the decisions made (Butts & Rich, 2012).

The right of patient self-determination is founded on the principles of informed consent, and reinforces the patient’s obligation to exercise decision making authority regardless of their decision making capacity (Dossey & Keegan, 2008). In making decisions, nurses should not depend on their individual opinions and values, but rather on the patient’s values. The role of a nurse is limited to participating in supporting the decisions made by the patients or their surrogates to exercise their rights.

Disadvantages of the Patient's Right to Self Determination in Nursing Practice

The disadvantages of the patient’s right to self determination mostly come as ethical dilemmas for nursing practitioners. The patient-nurse relationship is sometimes associated with conflicts between the patient’s right to self determination and the nurse’s role of promoting wellbeing, which is the primary role of nursing practice. Nursing practice is founded on ethical principles which reflect the values and beliefs of the profession, as well as the rules of the society. Conflicts arise whenever the patients or their surrogates make decisions that oppose the beliefs and values of the nursing practice, for instance declining treatment or following a discharge plan as recommended by the practitioners (Ulrich, 1999). Though the patient’s decision conflicts the view held by the health care team, the principle of autonomy demands that the nurses must uphold the patient’s right to self determination. This conflict, therefore, touches on safeguarding the patient’s best interests and denying them their rights. Nurses are responsible for their practice and any choice they make when doing their duties. Often the fear of the consequences may influence the choices made. Sometimes when death is eminent, patients may decline being placed in life support treatments. In very critical situations, the patients may not have the capability to express their ideas concerning the treatment interventions provided to them (Ulrich, 1999). Whereas the code of ethics stipulates the role of nurses as advocates of the patients and client’s interests, deciding the patient’s best interests often becomes an ethical dilemma.

A patient’s or surrogate’s decisions such as withdrawing treatment present ethical challenges to nursing practice. Whereas the caregivers and the patient may often not see the significance of continuing with life support treatments, to the nursing practitioners, there exists a real significance as they may feel like they are engaging in practices that deny the patient the right to life. Even though it is appropriate for the patients to make decisions concerning their condition, it is acknowledged that being capable of making decisions does not always imply that one has the capability to reason on the personal impact (White, Singer & Siegler, 1993). The decisions made could, therefore, not promote the interests of the patients as he or she would have wanted if capable of reasoning. Evidence-based nursing regards an individual as part of a wider network of relationships. A patient’s right to self determination contradicts the evidence based approach as the interests of the significant others are disregarded.

Individual Stand on a Patient's Right to Self Determination

The autonomy of a patient should be given priority over any other concern if the patient is assessed to be competent to exercise their right to self determination. This merges well with the ethical nursing principles of involving the patient in health care planning through active participation in decision making. Nurses, therefore, need to play the role of informing the patient about the options available and letting the patient freely make relevant decisions. Nurses should also act as advocates of the patient and family’s interests. Nursing practitioners ought not to put their individual ethical values into consideration when providing care, but they should promote the patient’s well being by protecting and enhancing patient values and attitudes. Nurses should, therefore, serve as a communication conduit between the patient and family and the health care institution, besides working with other health care practitioners in ensuring that patient’s wishes are implemented. The major role of the nurse is, thus, to create an environment that enhances genuine informed choice and consent through accurate articulation of the patient’s values and wishes in the advance directives (Lachman, 2006).

Relevance of a Patient's right to Self Determination to Nursing Practice

Ethics and human rights merge on the concepts of justice and caring. Therefore, nursing’s basic role of enhancing safeguarding health and eliminating suffering demand a care for humanity and environment. Fundamental to the practice is the promotion and protection of human rights and dignity. A patient's right to self determination is, therefore, core to nursing practice. As people entrusted with human care, nurses have a role of giving health care to all individuals, including the right to choose or decline treatment (Killion & Dempski, 2006).

Recommendation for the Future of the Nursing Profession

With the growing health care challenges, nurses need to develop knowledge and skills to address the challenges through continuing education. This will empower the nurses to be able to deliver the best health care to patients. When nurses are faced with dilemmas concerning the right of a patient to self determination, it is imperative for nurses to consider the process of making ethical decisions, the relative values and the values that take precedence. To improve the decisions made in such conflicting situations, nursing practitioners would need to collect facts and involve all the concerned parties early in the decision making process. Nurses would also ensure they identify the conflicts associated with the ethical issue and consult the major parties on the available alternatives. Where necessary, the health care organization’s ethics organs should be involved as a neutral facilitator on the conflicts (Dossey & Keegan, 2008).

Addressing the increasing dilemmas in nursing requires the exploitation and application of psychological and social skills, as well as medical knowledge. Nurses should endeavor to advance their knowledge and develop patience, sensitivity and trust so that they can guide patients and provide them with comfort to help them cope with their illnesses. Nurses should also empower patients at all levels so that they are able to make informed choices. The most important ways nurses can empower their patients is by providing the relevant information about their illness, therapy options and the means of coping with the illness and treatment. This is essential in decreasing anxiety in patients, resulting to positive health outcomes (Butts & Rich, 2012). Nurses should also champion advocacy in order to promote the well being and interests of the patients. All patients, especially those who have critical diseases are vulnerable and mostly are not in a state to speak for the self. Therefore, nurses must position themselves to perform the responsibility of the advocate after effectively developing understanding of the ethical and legal issues surrounding their care.