Hcs 545 - Ethical Health Care Issue

Ethical Health Care Issue

HCS/545

September 10, 2012

Matt Frederiksen

Ethical Health Care Issue

Patients who have an amputation, experience psychological, social, and physical instabilities. With the loss of a limb, patients may have depression, experience pain, become angry, combative, have feelings of sadness, hopelessness, and helplessness. They will need emotional and physical support. Adding a diabetic component and noncompliance will increase the complexity of the patient's needs. This patient may refuse medications, dressing changes, blood glucose checks, and proper nutrition, that can lead to poor wound healing or developing pressure ulcers. Meeting the patients needs can be an ethical challenge for the health care professional. This paper will examine and evaluate four ethical principles as they apply to noncompliant diabetic patients with an amputation.

Autonomy and the Noncompliant Patient

According to Evans (2007), "The patient should preserve and promote his own health and well-being so far as is reasonably open to him to do so" (para. 13). The patient who is noncompliant is not upholding his duty to his own health. He should understand his risk factors and what is unavoidable (Evans, 2007, para. 13). Diabetic patients who have a recent amputation, may have a sense of sadness, hopelessness, and helplessness. Some patients will also become angry and think they have no control resulting in poor choices regarding their health care. In a nursing home setting, they have the right to make their own choices. Being autonomous in making their own decisions is the only control they may feel is left. The principle of autonomy is applied when the person has the mental capacity to make his own life choices of his own free will and not in the control of others (Morrison, "Chapter 2, Autonomy," 2011).

Nonmaleficence and the Noncompliant Patient

The health care professional has the duty to provide optimal care and avoid harming others. The delima for the professional is making the proper treatment decisions when working with a diabetic patient post amputation who is refusing treatment, such as refusing medications, glucose testing, proper nutrition, or dressing changes. The best course of action is for the patient to comply with taking the prescribed medications, glucose levels checked routinely, receiving the proper nutrition, and having routine dressing changes but the patient has the free will to make decisions. Does the health care professional proceed with the treatment plan or follow the patient's decisions? If the professional does not follow the treatment plan, the result could be harm to the patient. According to Morrsion (2011), "If there is greater benefit, the act is viewed as an ethical one. In fact, you have a duty to provide appropriate care to avoid further harm to the patient" ("Chapter 3, Nonmaleficence and Beneficence").

Beneficence and the Noncompliant Patient

The professional has the obligation "to create benefit and contribute to optimum health for individuals" (Morrison, "Chapter 3, Nonmaleficence and Beneficence," 2011). To fulfill the principle of beneficence, patient education is a must on the proper course of action, including how the diet and compliance with the treatment plan affects his diabetes and wound healing. In addition, educating the patient on how his noncompliance with treatment plan leads to negative outcomes, such as poor wound healing, infection, developing pressure ulcers, or even death. Death and dying are real possibilities with noncompliance in these type of patients. Younger patients may be in denial of dying and very much need further education and possible counseling. Developing a plan of care and involving the patient and family can lead