Case no2 Medical Assistance in Dying1Reasons ethical principle and values and laws

Case no.2 Medical Assistance in Dying.1.Reasons, ethical principle and values and laws that support my position.MY POSITION: In this ethical situation, I will not assist in the procedure because it differs from my own’s values, principle and religious belief. However, in accordance with my professional standard, I will find another nurse to replace me who practice service. If nobody wanted to assist in procedure, then I will do it.Guidance on Nurses’ Roles in Medical Assistance in Dying (CNO, 2018)1. Nurse is assisting an NP or a physician to provide medical assistance in dying inaccordance with the law, they may perform activities such as educating clients, providingsupport to clients and family, or inserting an intravenous line (with an order) that will beused to administer medications that will cause the death of a client (CNO, 2018). In this case, I may able to attend to the procedure by assisting NP or physician in helping MAID.2. CNO, (2018) stated that nurse provide the information to clients about the lawful provision of medical assistance in dying must ensure they do not encourage the client to choose medical assistance in dying. It remains a crime for anyone to encourage, counsel, advise, recommend or in any way seek to influence a person to end their life. It guides that I would not express any moral judgement about patients’ health decision and further, I would not advise clients to make decision and I would actively listen Mrs. S requests for information regarding procedure.3. CNO (2018) stated that college recognizes the nurse’s freedom of conscience. It does not force the nurse to perform the procedure if nurse does not agree with client choice. The law does not compel an individual to provide or assist in providing medical assistance in dying. I may be able to assist but also could refuse as law does not impose, since I do not want to take part in Mrs. S MAID procedure as I do not agree with her decision.4. Nurses who conscientiously object must transfer the care of a client who has made a request for medical assistance in dying to another nurse or health care provider who will address the client’s needs (CNO, 2018). In support to my position, I refuse to take part in procedure as it does not fall within my scope of practice, for moral and religious reason and I will find another nurse to replace me. Until I didn’t find replacement nurse, it is my responsibilities to take care of Mrs. S as per care plan. If other nurse is not willing to participate than I will take part in procedure. b. Ethics practice standard.1. Understanding and respecting client’s value, opinions, voluntary decisions and actively listening to client concern reflect the client wellbeing (CNO, ethics 2019). In this case, Mrs. make a decision for MAID and as a nurse I support and respect her opinion even though I disagree with her choice.2. Client choice means self determination and includes the right to the information necessary to make choice and to consent to or refuse care (CNO, ethics 2019). In this case, I would provide all the necessary information; which helps her to make choice for the best decision. It is solely her decision to either provide consent for procedure or to refuse it.3. When nurse’s value differ from the client and nurse is not able to provide care then nurse need to arrange another caregiver and withdraw from situation. Provide safe, compassionate, competent and ethical nursing care outside of MAID until alternative care provider are replaced (CAN, 2017). In Mrs. S. case, though my value differs from her, I will still provide nursing care to my patient as I am helping her from 6 month and she do not have any family member to support her, if I do not find any other replacement nurse, then I will assist in procedure. 4. Respecting client’s value and not to impose own views onto clients and advocating for palliative care, providing dignified and comfortable care (respect for life). As a nurse I will not use my position to influence, judge or discriminate against persons whose values are different from their own (CNA, 2017). In Mrs. S. case, I will not influence client with my own’s values and further respect her decision. Ethical PrincipleAs a nurse, I will provide fair, equitable nursing treatment to my patient (ethics of justice) though I do not agree with client decision which is against my religious belief. My concern is focusing on doing good (beneficence) for patient by finding my replacement nurse to assist in MAID procedure and in case; if nobody agrees for assisting in procedure then I will do it to prevent from further suffering and harm which implies nonmaleficence. Nursing is all about providing care. I have been with my client for almost 6 months and I have maintained good therapeutic relation with my client; focused on concrete relation and responsibilities and keeping patient first ahead of self -value represent ethics of care. c. Medical Assistance in Dying Statute Law Amendment Act, 2017 Excellent Care for All Act, (2010) : In Medical Assistance in Dying, no action or other proceeding for damages shall be instituted against a physician or nurse practitioner or any other person assisting him or her for any act done or omitted in good faith in the performance or intended performance of medical assistance in dying. This law supports my position, I do not have to face legal or professional problem by assisting in procedure. According to CAN (2015) stated that law (Bill C 14) also establishes safeguards and protections for health-care professionals who provide MAID, in accordance with the law, as well as for persons who assist them. Freedom of Information and Protection of Privacy Act (FIPPA)Ministry of Health and Long-Term Care (2016) stated that FIPPA, act does not apply to identifying information relating to medical assistance in dying. In addition, “identifying information” means information that identifies a person or facility or for which it is reasonably foreseeable in the circumstances that it could be utilized, either alone or with other information, to identify a person or facility. In my case, If I take part in procedure then my identify information is protected.2. Emotional response effects on nursing care.As my value and religious belief conflict with patient decision so, I am not comfortable doing this procedure. My religious strongly support the life as a good gift. But I am bounded by professional standard. However, the standard also stated that the role of Ontario nurses in end-of-life care was to “support clients in making decisions about end-of-life care; support informed discussion about care goals and treatment options; contribute to client well-being by facilitating the implementation of the client’s wishes about end-of-life care and knowing and understanding current legislation” (College of Nurses of Ontario, 2009). This means, I can support Mrs. S. for her decision and advocate for her well being or good death but personally I won’t able to attend the procedure which may affect on our therapeutic relation and she might losts trust on me. 3.Addressing it is appropriate and not appropriateIt is not appropriate to address in this situation. Mr. S. had made voluntary request for medical assistance in dying which is his right to make decision for health care (good death) and he is capable to give consent also. And even he had fixed date of MAID for tomorrow, so I do not have right to interfere in his decision. In this ethical dilemma situation, it is situatable to use ethics of justice, which is based on fair, equitable treatment. However, I have never done MAID so, I would inform the case to nursing manager/supervisor for additional information regarding treatment and help to find the replacement nurse to assist in MAID. If Mr. S. intend to get more, information to manage pain and consult for other treatment options from physician or other health care provider rather than MAID then, I could address the Mr. S. concern. As a nurse, it’s my ethical and legal responsibilities to provide information to promote health of client (ethics of care). 5. My approach on this situation 5 year ago and changes on my approach now.Medical assistance in dying was not legalized five year ago only DNR was legalized. I might help the client with DNR if requested. I was not mature enough to empathies the client situation and perception. There are many changes in my approach as I gain more experience and updated my education so now, I can provide more quality centered care to patient. If patient do not want suffers anymore and prefer good death, then as a nurse I could help not prioritizing my own value. 5. It is uncomfortable to encounter this issues/situation in my practice.It is not comfortable to encounter Mr. S. issues. I will find my replacement nurse to assist the procedure and if nobody is willing to perform then I will do it. In this case, Mr. S. had already fixed the date for MAID, so Thank you for sharing your informative post. It helps me to learn a lot from your post. I would like to add few more information about decongestion.Decongestant have adrenergic and corticosteroid effect which act by causing constriction of engorged and swollen blood vessels (Lilly, Harrington & Snyder, 2011). Patient should inform about availability of newer, non-sedating drug. Patient should inform about other method to relieve decongestion like using Saline which help to relief it by making mucus thin as well as inform about using humidifier in the environment of patient (Moore, 2016). Nurse should inform about using nasal strips to open nostrils which helps to improve breathing with congestion. According to American Heart Association (AHA) stated that individual with hypertension should aware of using decongestant which may increase blood pressure or hinder or interfere effectiveness of antihypertensive (Terrie, C. Y, 2017). It also recommended to avoid medication that are high in sodium (Terrie, C. Y, 2017). Nurse should aware of Kevonne’s past hypertensive history and should aware before giving OTC (decongestion) drug to avoid further complication with hypertension.References:Lilly, L. L., Harrington, S., & Snyder, J.S. (2011) Pharmacology for Canadian health care practice (2nd edition). Toronto: Canada: Elsevier CanadaMoore, D. C. (2016, November 18). Decongestants and Hypertension: Dangerous Together. Retrieved om June 1 from https://www.pharmacytimes.com/publications/issue/2016/november2016/decongestants-and-hypertension-dangerous-togetherTerrie, C. Y. (2017, December 20). Decongestants and Hypertension: Making Wise Choices When Selecting OTC Medications. Retrieved from https://www.pharmacytimes.com/publications/issue/2017/december2017/decongestants-and-hypertension-making-wise-choices-when-selecting-otc-medications Canadian Nurses Association (2017). Retrieved on May 30 from http://www.virtualhospice.ca/Assets/cna-national-nursing-framework-on-maidEng_20170216155827.pdfMinistry of Health and Long-Term Care, (2016, December 9) Retrieved from https://www.oha.com/Legislative%20and%20Legal%20Issues%20Documents1/MAID%20Webinar%20Presentation%20-%20Bill%20Introduction%20-%20EN%20Dec%209%202016%

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