Bioethics Nursing Essay

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1. This case is complex and multilayered, as the speakers say. It touches upon several major bioethical issues include respect for patient choice, otherwise known as the principle of patient autonomy. The case also addresses the important issues surrounding physician bias, as well as the lack of competencies in physician communication and physician awareness of diversity issues. Although the diversity issues in this case pertain to same-sex couples, it could just as easily have been a case involving culture or any other diversity variable. Although the speakers did not mention medical paternalism, that is something that comes up in this case. Even had the couple been straight, it is possible the doctor would have disregarded the advanced directive, which would have indicated medical paternalism.

The speakers also did not mention the doctor’s point of view, or that of the hospital, both of which are important to take into consideration when analyzing the ethics of the case. Doctors operate under the broad parameters of the Hippocratic Oath, with its stipulations to do whatever it takes to save lives. This directive does come into direct contact with the more modern principle of patient autonomy, which is why medical paternalism can prove problematic. Even when a doctor thinks he or she “knows best,” they still have an ethical obligation to defer to patients’ wishes.

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That obligation is covered under the rubric of deontological ethics, like the speakers indicate. Bioethics have shifted to elevate the status of patient choice over the desire of a doctor to preserve life at all costs. Sullivan (2003) calls this normative shift “the new subjective medicine,” in which the patient—not the nurse, doctor, or anyone else—decides whether they want to be intubated, whether they want to be on life extension, or whether they prefer to let nature take its course. Of course, this mode of ethical thinking overlaps with discourse related to patient autonomy when it comes to euthanasia and physician-assisted suicide, too. A refreshing resolution to the ethical dilemma posed by cases like these is offered by Quill & Brody (1996): the “enhanced autonomy” model, which “encourages patients and physicians to actively exchange ideas, explicitly negotiate differences, and share power and influence to serve the patient's best interests,” (p. 763). The matter of physician bias is a separate one, and does need to be addressed more thoroughly in hospital policy as well as iin medical school education.….....

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