Week 10: Ethical Issues in Health Care Delivery Every day nurses make decisions that have critical ethical and legal implications. In addition, nurses must follow doctors’ orders and defer to the wishes of patients and families even when they are not in agreement with those actions. A study conducted by Pavlish et al. (2011) highlights this tension. Researchers surveyed 91 nurses attending a nursing ethics conference and found many of the nurses’ concerns centered on relieving pain in patients while still respecting the wishes of the family (Pavlish et al., 2011). One such dilemma was described as follows: Family of 40-year-old terminally ill patient with cancer refuses all pain medication for fear patient will die. Patient often moans and cries with pain and indicates she wants pain medication. Family has power of attorney and threatens lawsuit if patient is given anything that results in her death. (Pavlish et al., p. 390) Consider your own experiences when faced with ethical challenges. Were you able to advocate for the patient in the way you thought was best? How do you handle situations when your own clinical judgment may differ from other health providers or from the patient’s family members? This week, you will discuss ethical principles related to the aging population, and you will analyze specific provisions of the ANA Code of Ethics in relation to advocacy for population health. Reference: Pavlish, C., Brown-Saltzman, K., Hersh, M., Shirk, M., & Rounkle, A. (2011). Nursing priorities, actions, and regrets for ethical situations in clinical practice. Journal of Nursing Scholarship, 43(4), 385–395. doi:10.1111/j.1547-5069.2011.01422.x Learning Objectives Students will: Students will: Evaluate ethical standards for the allocation of resources for an aging population and end-of-life care Analyze challenges related to the provision of health care for an aging population Analyze attributes of an effective health advocacy campaign Propose a policy solution for a population health issue Assess the role of ethics in developing an advocacy campaign Photo Credit: [Sam Edwards]/[Caiaimage]/Getty Images Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Milstead, J. A. (2013). Health policy and politics: A nurse’s guide (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett Publishers. Chapter 7, “Program Evaluation” (pp. 137–159) In this chapter, the focus is on how nurses can participate in public policy or program evaluation. It includes a summary of the methodologies that can be used in evaluation and how to best communicate the results Craig, H. D. (2010). Caring enough to provide healthcare: An organizational framework for the ethical delivery of healthcare among aging patients. International Journal for Human Caring, 14(4), 27–30. Retrieved from the Walden Library databases. The author of this text investigates the ethical discussions surrounding health care resource allocation among aging patients. The article supplies an organizational decision-making model for health care resource allocation among the aging. Crippen, D., & Barnato, A. E. (2011). The ethical implications of health spending: Death and other expensive conditions. Journal of Law, Medicine & Ethics, 39(2), 121–129. Retrieved from the Walden Library databases. This article analyzes the ethical considerations of health care expenditure in the United States. The authors examine the particular means of funding health care services, as well as the tradeoffs of certain funding decisions. Goethals, S., Gastmans, C., & Dierckx de Casterle, B. (2010). Nurses’ ethical reasoning and behaviour: A literature review. International Journal of Nursing Studies, 47(5), 635–650. Retrieved from the Walden Library databases. This article presents a literature review on nurses’ ethical practice with regard to their processes of ethical reasoning and decision making. The authors explore how nurses reason and act in ethically difficult situations. Pavlish, C., Brown-Saltzman, K., Hersh, M., Shirk, M., & Rounkle, A. (2011). Nursing priorities, actions, and regrets for ethical situations in clinical practice. Journal of Nursing Scholarship, 43(4), 385–395. Retrieved from the Walden Library databases. This article reviews the results of a survey to determine nursing priorities and actions in ethically difficult situations. The authors conclude that not enough evidence-based ethics actions have been developed. Zomorodi, M., & Foley, B. J. (2009). The nature of advocacy vs. paternalism in nursing: Clarifying the ‘thin line.’ Journal of Advanced Nursing, 65(8), 1746–1752. Retrieved from the Walden Library databases. This article explores the concepts of advocacy and paternalism in nursing. The authors utilize four case studies to compare the two concepts. American Nurses Association. (2012). Code of Ethics for Nurses. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses The information on this site provides a framework and guide as to standards of ethical and quality behavior. Hayutin, A. M., Dietz, M., & Mitchell, L. (2010). New realities of an older America. Retrieved from http://longevity3.stanford.edu/wp-content/uploads/2013/01/New-Realities-of-an-Older-America.pdf This report highlights the impending challenges that come with the United States’ shifting demographics. In particular, the authors focus on aging, diversity, housing, health, and personal finance. Required Media Laureate Education (Producer). (2012a). Ethics and advocacy. Baltimore, MD: Author. Note: The approximate length of this media piece is 5 minutes. Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript Discussion: Ethical Issues With an Aging Population According to the CDC, “in the United States, the proportion of the population aged >65 years is projected to increase from 12.4% in 2000 to 19.6% in 2030,” (CDC, 2003, para. 2). Caring for this aging population is going to be one of the greatest challenges facing the health care industry. Not only will the number of individuals requiring care rise, but so will the cost. As poignantly stated by Crippen and Barnato, “unless we change the practice of medicine and reduce future costs, and explicitly address the ethical dilemmas we face, there may come a time when our kids simply cannot afford us” (2011, p. 128). In this Discussion, you will examine the ethical issues that the United States and other nations must address when faced with the health care challenges of an aging population. To prepare: Consider the ethical aspects of health care and health policy for an aging population. Review the Hayutin, Dietz, and Mitchell report presented in the Learning Resources. The authors pose the question, “What are the economic consequences, now and for future generations of taxpayers if we fail to adapt our policies to the changing reality of an older population?” (p. 21). Consider how you would respond to this question. In addition, reflect on the ethical decisions that arise when dispersing limited funds. Contemplate the impact of failing to adjust policy in accordance with the changing reality of an older population. Reflect on the ethical dilemmas that arise when determining expenditures on end-of-life health care. Post an explanation of the ethical standards you believe should be used in determining how resources should be allocated for an aging population and end-of-life care. Then, provide an analysis of the ethical challenges related to the preparation for the provision of such health care.