Patient Autonomy In Nursing

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This topic was very difficult for me to assess or even formulate a solid opinion on as it is a very deep and complicated case. Throughout nursing school, I have been taught that respect for patient autonomy is an important and indispensable principle in the ethical practice of clinical nursing. Legal tenets recognize the importance of this principle and the inherent right of patients of sound mind and properly informed, to make their own personal medical decisions. In the course of everyday medical practice, however, challenging cases may result in ethical dilemmas for the patient, the medical team, and the hospital. Resolution of these dilemmas requires a thorough understanding of the underlying principles that allow the clinician to make…show more content…
Overall, I believe the hospital team took appropriate measures in regards to the situation. They ultimately did what they thought was best for the fetus, however, I think I would have approached this situation a bit differently. For instance, the patient put up strong resistance against her doctor 's efforts to persuade her to continue with her pregnancy, however, she did make repeated threats to commit suicide, or to discharge herself against medical advice. Legally, in California she could easily have been placed on a 51:50 hold and proceeding further holds to ensure her safety and the safety of the fetus. Involuntary detention in a psychiatric unit, would buy time for treatment for her depression, borderline disorder, suicidal ideations and inherently allow the fetus to develop, if even to a safer gestation for delivery. It would be crucial to optimize the psychiatric care of the patient, by ensuring the continuation of care by a primary clinician and regular psychotherapy. As a result, this could alleviate the psychological distress of the mother, and help motivate her to actually continue with her pregnancy and hopefully increase the chances of a better clinical outcome for…show more content…
Personally, that is the route I would have chosen to help both the patient and the fetus. If the healthcare team does not agree, there is an algorithm for responsible decision making and clinical care that I would suggest. The American journal of Obstetrics and Gynecology provide an algorithm to guide professionally responsible decision making with mentally ill patients. Pregnant women with major mental disorders present obstetricians with a range of clinical challenges, which are magnified when a psychotic or agitated patient presents in labor and there is limited time for decision making. "Therefore, an algorithm was developed of an ethical framework with four components: The concept of a fetus as a patient, the presumption of decision-making capacity, the concept of assent, and beneficence-based clinical judgment. On the basis of this framework, we propose an algorithm to guide professionally responsible decision making that asks 5 questions: (1) Does the patient have the capacity to consent to treatment? (2) Is there time to attempt restoration of capacity? (3) Is there an opportunity for substituted judgment?; (4) Is the patient accepting treatment?; (5) Is there an opportunity for active assent?; and (6) coerced clinical management as the worst alternative. The algorithm is designed to support a deliberative, clinically comprehensive, preventive-ethics approach to guide obstetricians in decision making with this challenging population of patients."

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