Consider the “Four Topics Approach” (or Four Box method) to ethical decision making on page 61, Table 2.1 in Butts (below). Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.
In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?
Your paper should be 2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.
TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases
Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?
Expert Solution Preview
In my nursing career, I encountered a challenging situation that required careful consideration of the ethical dimensions of a patient case and my role in providing care. The patient, Mr. Smith, was a 65-year-old man who had been admitted with severe pneumonia. His condition was acute and critical, as he presented with respiratory distress and required immediate intervention.
Using the Four Topics Approach to ethical decision-making, I analyzed the situation as follows:
Medical Indications:
1. Mr. Smith’s medical problem was acute and critical pneumonia, which needed urgent treatment.
2. The goals of treatment were to improve his respiratory function, stabilize his condition, and prevent further complications.
3. Medical treatments were indicated given the severity of his condition.
4. The probabilities of treatment success were uncertain, but intervention was necessary to give him the best chance of recovery.
5. Mr. Smith could be benefited by medical care, as it could potentially improve his condition and avoid harm by preventing further deterioration.
Patient Preferences:
1. Mr. Smith was informed of the benefits and risks associated with treatment, and he provided consent.
2. He was mentally capable and legally competent.
3. Mr. Smith expressed his preference for aggressive treatment and maximizing his chances of recovery.
4. There was no need to consider prior preferences as Mr. Smith was capable of expressing his treatment preferences.
5. Mr. Smith was able to make decisions for himself; no surrogate decision-maker was required.
6. He actively cooperated with medical treatment.
Quality of Life:
1. The prospects for Mr. Smith’s return to a normal life were uncertain, even with treatment. He may experience physical, mental, and social deficits.
2. Judging a desirable quality of life for him without his input was challenging. It required considering his values, beliefs, and personal goals.
3. I remained aware of any biases that could influence my evaluation of Mr. Smith’s quality of life.
4. Ethical issues arose concerning the balance between improving his quality of life and avoiding potential harm or burden.
5. The assessment of quality of life raised questions about adjusting treatment plans to ensure they align with his goals and values.
6. The plan was to offer life-sustaining treatment unless it was clearly against Mr. Smith’s own values or expressed wishes.
7. The legal and ethical status of suicide was not pertinent to Mr. Smith’s case.
Contextual Features:
1. There were no professional, interprofessional, or business interests that created conflicts of interest in the clinical treatment of Mr. Smith.
2. The primary parties involved in clinical decisions were clinicians and the patient, Mr. Smith.
3. Patient confidentiality was respected, and no third-party interests affected his care.
4. Financial factors did not create conflicts of interest in clinical decisions.
5. There were no problems of allocation of scarce health resources that affected Mr. Smith’s care.
6. Religious issues did not influence clinical decisions in his case.
7. Legal issues did not impact clinical decisions.
8. Clinical research and education were not relevant to his immediate care.
9. Public health and safety did not significantly affect clinical decisions.
10. No conflicts of interest within institutions or organizations that may affect clinical decisions and patient welfare were present in this case.
In conclusion, applying the Four Topics Approach to this challenging situation had a profound impact on my decision-making process. By systematically addressing the questions within each topic area, I was able to carefully consider the ethical dimensions of the case and the role I played in providing care. This approach helped me ensure that I prioritized the principles of beneficence, nonmaleficence, respect for autonomy, and justice throughout the decision-making process.
The Four Topics process provided a structured framework for analyzing clinical ethics cases, allowing for a comprehensive consideration of the various dimensions involved. It facilitated a more holistic approach to ethical decision-making, considering not only the medical indications but also patient preferences, quality of life, and contextual features.
This process seems valid for application in my practice as a nurse, as it helps ensure that ethical considerations are thoroughly explored and integrated into the decision-making process. It promotes patient-centered care and encourages healthcare professionals to consider the values and preferences of individual patients. By following this process, healthcare providers can make more informed and ethically sound decisions for their patients.
Overall, the Four Topics Approach has proven to be a valuable tool in shaping my decision-making process in challenging ethical situations. It enhances patient care and promotes ethical practice, making it a valid process to apply in my practice and the wider healthcare field.
